Efficacy of transcutaneous electrical nerve stimulation in the treatment of chronic pelvic pain

Nidhi Sharma, Kaja Rekha, Jayashree K Srinivasan, Nidhi Sharma, Kaja Rekha, Jayashree K Srinivasan

Abstract

Background: Chronic pelvic pain is prevalent in 2% of women population globally. The etiology is multifactorial. Even in the absence of pelvic pathology, there is a subgroup of women who do not respond to analgesic and anti-inflammatory therapy. Chronic pelvic pain can be inhibited by direct inhibition of impulses in the preganglionic afferent neuron by closing the hypothetical gate in the dorsal horn of the spinal cord. Transcutaneous electrical nerve stimulation (TENS) is based on the gate control theory of abolishing the painful stimuli by providing simultaneous inputs in larger myelinated nerve fibers.

Aims and objectives: This study was designed to assess the effectiveness and safety of TENS in idiopathic chronic pelvic pain.

Methods: It is a prospective, experimental study to evaluate the effectiveness of TENS versus placebo in reducing pain severity in chronic pelvic pain (G1 = 30, G2 = 32, G3 = 30, and G0 = 30). Patients with chronic pelvic pain due to benign lesions of genital tract, gastrointestinal, and renal disorders were excluded from the study after performing an ultrasound study of abdomen and pelvis. Ten treatment sessions (5 sessions/week) of 30 min were conducted.

Observations and results: There was a significant improvement in pain scores in TENS group as compared with control group, and two patients were completely pain free following TENS therapy.

Conclusion: In women patients with idiopathic chronic pelvic pain, TENS can be a useful intervention. TENS units are safe, economical, and easily commercially available.

Keywords: Chronic pelvic pain; idiopathic; transcutaneous electrical nerve stimulation.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Transcutaneous electrical nerve stimulation wave characters. The amplitude is same as intensity. It is set at 0–80 mA. Duration is set at 50–400 μs. Three different frequencies were used
Figure 2
Figure 2
Improvement in pain scores in placebo (G0 = 30), low frequency (G1 = 30), medium frequency (G2 = 32), and high frequency (G3 = 30)

References

    1. Fenton BW, Palmieri P, Diantonio G, Vongruenigen V. Application of patient-reported outcomes measurement information system to chronic pelvic pain. J Minim Invasive Gynecol. 2011;18:189–93.
    1. Grace VM, MacBride-Stewart S. 'Women get this': Gendered meanings of chronic pelvic pain. Health (London) 2007;11:47–67.
    1. Ch. 32. VG Padubidri, SN Daftary. Elsevier: India; 2004. Hawkins and Bourne Shaw's Textbook of Gynaecology; pp. 429–32.
    1. Johnson M. Transcutaneous electrical nerve stimulation: Mechanisms, clinical applications and evidence. Br J Pain. 2007;1:7–11.
    1. Gildenberg PL. History of electrical neuromodulation for chronic pain. Pain Med. 2006;7:7–13.
    1. Melzack R, Wall PD. Pain mechanisms: A new theory. Science. 1965;150:971–9.
    1. Asbjornsen G, Hernaes B, Molvaer G. The effect of transcutaneous electrical nerve stimulation on pressure sores in geriatric patients. Journal of Clinical and Experimental Gerontology. 1990;12:209–10.
    1. Kaada B. Promoted healing of chronic ulceration by transcutaneous nerve stimulation (TNS) Vasa. 1983;12:262–9.
    1. Kaada B, Emru M. Promoted healing of leprous ulcers by transcutaneous nerve stimulation. Acupunct Electrother Res. 1988;13:165–76.
    1. Turner JA, Deyo RA, Loeser JD, Von Korff M, Fordyce WE. The importance of placebo effects in pain treatment and research. JAMA. 1994;271:1609–14.
    1. Dworkin RH, Turk DC, Wyrwich KW, Beaton D, Cleeland CS, Farrar JT, et al. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. J Pain. 2008;9:105–21.
    1. Woolf CJ. Segmental afferent fiber-induced analgesia: Transcutaneous electrical nerve stimulation (TENS) and vibration. In: Melzack R, Wall PD, editors. Textbook of Pain. 2nd ed. Edinburgh: Churchill-Livingstone; 1994. pp. 884–96.
    1. Vance CG, Dailey DL, Rakel BA, Sluka KA. Using TENS for pain control: The state of the evidence. Pain Manag. 2014;4:197–209.
    1. Nnoaham KE, Kumbang J. Transcutaneous electrical nerve stimulation (TENS) for chronic pain. Cochrane Database Syst Rev. 2008;16(3):CD003222.
    1. Catley MJ, Gibson W, Wand BM, Meads C, O'Connell NE. Transcutaneous electrical nerve stimulation (TENS) for chronic pain – An overview of Cochrane reviews (Protocol) Cochrane Database Syst Rev. 2015;9(11):CD011890.
    1. Sikiru L, Shmaila H, Muhammed SA. Transcutaneous electrical nerve stimulation (TENS) in the symptomatic management of chronic prostatitis/chronic pelvic pain syndrome: A placebo-control randomized trial. Int Braz J Urol. 2008;34:708–13.
    1. Johnson M, Martinson M. Efficacy of electrical nerve stimulation for chronic musculoskeletal pain: A meta-analysis of randomized controlled trials. Pain. 2007;130:157–65.
    1. DeSantana JM, Walsh DM, Vance C, Rakel BA, Sluka KA. Effectiveness of transcutaneous electrical nerve stimulation for treatment of hyperalgesia and pain. Curr Rheumatol Rep. 2008;10:492–9.
    1. Banerjee G, Johnson MI. Transcutaneous electrical nerve stimulation (TENS): A potential intervention for pain management in India. Indian J Pain. 2013;27:132–41.

Source: PubMed

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