Graduate Program in Physiological Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
Department of Physical Therapy, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
J Pain. 2023 Aug;24(8):1337-1382. doi: 10.1016/j.jpain.2023.03.014. Epub 2023 Apr 7.
This report provides a systematic review of the literature to analyze the effects of transcutaneous electrical nerve stimulation (TENS) on analgesia on sensitization measures, in studies with chronic musculoskeletal pain and in studies with acute experimental pain. The protocol was registered at PROSPERO (CRD42020213473). The authors searched Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Latin American and Caribbean Health Sciences Literature via Biblioteca Virtual de Saúde, Physiotherapy Evidence Database, PubMed, ScienceDirect, Web of Science, Google Scholar, and hand-searched reference lists were also conducted. Among 22,252 manuscripts found, 58 studies were included in the systematic review and 35 in the meta-analysis. Thirty-four studies assessed pain intensity; 24 studies investigated hyperalgesia; temporal summation was only evaluated in 2 studies; and conditioned pain modulation was not observed in the included studies. Meta-analyses favored TENS, despite its limitations and heterogeneity. Primary hyperalgesia in studies with musculoskeletal pain presented a high level of evidence, while other outcomes presented moderate evidence in the studies that were included. It is not possible to infer results about both temporal summation and conditioned pain modulation. Moderate evidence suggests that TENS promotes analgesia by reducing both central and peripheral sensitization, as shown by the reduction in primary and secondary hyperalgesia, pain intensity at rest, and during movement in experimental acute pain and chronic musculoskeletal pain. Overall, both types of studies analyzed in this review presented meta-analyses favorable to the use of TENS (compared to placebo TENS), showing reductions in both primary and secondary hyperalgesia, as well as decreases in pain intensity at rest and in motion. PERSPECTIVE: This article presents data from the literature on the effect of TENS through sensitization assessments in individuals with chronic musculoskeletal pain, or acute experimental pain. These data contribute to knowledge about pain neuroscience research, using TENS technology.
本报告对文献进行了系统回顾，以分析经皮神经电刺激（TENS）对慢性肌肉骨骼疼痛研究和急性实验性疼痛研究中痛觉过敏测量指标的镇痛作用。该方案已在 PROSPERO（CRD42020213473）中注册。作者检索了 Cochrane 对照试验中心注册库、护理学和联合健康文献累积索引、EMBASE、拉丁美洲和加勒比卫生科学文献通过虚拟健康图书馆、物理治疗证据数据库、PubMed、ScienceDirect、Web of Science、Google Scholar，并进行了手工检索参考文献列表。在 22252 篇文献中，有 58 项研究被纳入系统评价，35 项研究被纳入荟萃分析。34 项研究评估了疼痛强度；24 项研究调查了痛觉过敏；只有 2 项研究评估了时间总和；纳入的研究中没有观察到条件性疼痛调制。尽管 TENS 存在局限性和异质性，但荟萃分析仍支持 TENS。肌肉骨骼疼痛研究中的原发性痛觉过敏具有高水平的证据，而其他研究结果在纳入的研究中具有中等水平的证据。关于时间总和和条件性疼痛调制的结果无法推断。中等证据表明，TENS 通过减轻中枢和外周敏化来促进镇痛，这表现在原发性和继发性痛觉过敏、静息和运动时的疼痛强度的降低，在急性实验性疼痛和慢性肌肉骨骼疼痛中。总体而言，本综述分析的两种类型的研究都对 TENS 的使用进行了荟萃分析（与 TENS 安慰剂相比），显示原发性和继发性痛觉过敏均有所降低，静息和运动时的疼痛强度也有所降低。观点：本文介绍了文献中关于 TENS 通过在慢性肌肉骨骼疼痛或急性实验性疼痛患者中进行敏化评估的镇痛作用的数据。这些数据有助于了解使用 TENS 技术的疼痛神经科学研究。
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