Effects of transcutaneous electrical nerve stimulation on pain, pain sensitivity, and function in people with knee osteoarthritis: a randomized controlled trial

Abstract

Background: Transcutaneous electrical nerve stimulation (TENS) is commonly used for the management of pain; however, its effects on several pain and function measures are unclear.

Objective: The purpose of this study was to determine the effects of high-frequency TENS (HF-TENS) and low-frequency TENS (LF-TENS) on several outcome measures (pain at rest, movement-evoked pain, and pain sensitivity) in people with knee osteoarthritis.

Design: The study was a double-blind, randomized clinical trial.

Setting: The setting was a tertiary care center.

Participants: Seventy-five participants with knee osteoarthritis (29 men and 46 women; 31-94 years of age) were assessed.

Intervention: Participants were randomly assigned to receive HF-TENS (100 Hz) (n=25), LF-TENS (4 Hz) (n=25), or placebo TENS (n=25) (pulse duration=100 microseconds; intensity=10% below motor threshold).

Measurements: The following measures were assessed before and after a single TENS treatment: cutaneous mechanical pain threshold, pressure pain threshold (PPT), heat pain threshold, heat temporal summation, Timed "Up & Go" Test (TUG), and pain intensity at rest and during the TUG. A linear mixed-model analysis of variance was used to compare differences before and after TENS and among groups (HF-TENS, LF-TENS, and placebo TENS).

Results: Compared with placebo TENS, HF-TENS and LF-TENS increased PPT at the knee; HF-TENS also increased PPT over the tibialis anterior muscle. There was no effect on the cutaneous mechanical pain threshold, heat pain threshold, or heat temporal summation. Pain at rest and during the TUG was significantly reduced by HF-TENS, LF-TENS, and placebo TENS.

Limitations: This study tested only a single TENS treatment.

Conclusions: Both HF-TENS and LF-TENS increased PPT in people with knee osteoarthritis; placebo TENS had no significant effect on PPT. Cutaneous pain measures were unaffected by TENS. Subjective pain ratings at rest and during movement were similarly reduced by active TENS and placebo TENS, suggesting a strong placebo component of the effect of TENS.

Trial registration: ClinicalTrials.gov NCT01354054.

Figures

Figure 1.

CONSORT diagram. Most people were excluded from the initial screening because of earlier transcutaneous electrical nerve stimulation (TENS) use or minimal pain. However, all participants allocated to a group completed the study. CNS=central nervous system, CVA=cerebrovascular accident, OA=osteoarthritis

Figure 2.

Time line for the 3-hour testing session. CMPT=cutaneous mechanical pain threshold, HF=high frequency, HPT=heat pain threshold, HTS=heat temporal summation, LF=low frequency, PPT=pressure pain threshold, TENS=transcutaneous electrical nerve stimulation, TUG=Timed “Up & Go” Test, VAS=visual analog scale

Figure 3.

Differences between pressure pain threshold (PPT) before transcutaneous electrical nerve stimulation (TENS) and PPT after TENS for both the knee and the tibialis anterior muscle both ipsilaterally and contralaterally. Data are expressed as the mean and standard error of the mean. *=significantly different from baseline, +=significantly different from placebo. HF=high-frequency TENS, LF=low-frequency TENS, P=placebo TENS

Figure 4.

Difference scores for pain at rest in ipsilateral and contralateral knees during transcutaneous electrical nerve stimulation (TENS). Significant decreases were observed ipsilaterally for all 3 groups (placebo TENS [P], low-frequency TENS [LF], and high-frequency TENS [HF]). Data are expressed as the mean and standard error of the mean. *=significantly different from baseline

Figure 5.

Difference scores for movement-evoked pain during the Timed “Up & Go” Test (TUG) in ipsilateral and contralateral knees during transcutaneous electrical nerve stimulation (TENS). Significant decreases were observed ipsilaterally for all 3 groups (placebo TENS [P], low-frequency TENS [LF], and high-frequency TENS [HF]). Data are expressed as the mean and standard error of the mean. *=significantly different from baseline