[Analgesic effects of transcutaneous electrical nerve stimulation (TENS) in patients with fibromyalgia: A systematic review]

Álvaro Megía García, Diego Serrano-Muñoz, Elisabeth Bravo-Esteban, Sara Ando Lafuente, Juan Avendaño-Coy, Julio Gómez-Soriano, Álvaro Megía García, Diego Serrano-Muñoz, Elisabeth Bravo-Esteban, Sara Ando Lafuente, Juan Avendaño-Coy, Julio Gómez-Soriano

Abstract

Objective: To determine whether transcutaneous electrical nerve stimulation (TENS) has an analgesic effect greater than placebo or other treatments in patients with fibromyalgia. Furthermore, it was intended to analyze the optimal application parameters to achieve a greater reduction of pain.

Design: A systematic review.

Data source: Randomized clinical trials on the effect of TENS on fibromyalgia in the databases Pubmed, Cochrane and PEDro until November 2016.

Selection of studies: 8 studies out of a total of 62 were selected. Controlled clinical trials in which TENS was applied in patients with fibromyalgia were included.

Data extraction: Pain was analyzed as the main variable, although other variables such as fatigue, quality of life and impact, range of motion and depression were also included.

Results: 6 out of 8 studies obtained a significant decrease of pain. In 2 studies, TENS was applied as complementary treatment to therapeutic exercise with results evidencing a decrease in pain. The rest of the variables studied presented a great variability and conclusive results could not be established.

Conclusions: Treatment with TENS is effective for reducing pain in people with fibromyalgia. In addition, the inclusion of TENS in therapeutic exercise programs seems to have a greater effect than practicing therapeutic exercise in isolation. However, no efficacy has been demonstrated in other variables different to pain. Further studies are needed to investigate the optimization of the parameters of the TENS and a greater consensus among the variables used.

Keywords: Central sensitization; Chronic pain; Dolor crónico; Estimulación eléctrica nerviosa transcutánea; Fibromialgia; Fibromyalgia; Sensibilización central; Transcutaneous electric nerve stimulation.

Copyright © 2018 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.

Figures

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Figura 1
Diagrama de flujo según la declaración PRISMA.

References

    1. Mease P. Fibromyalgia syndrome: review of clinical presentation, pathogenesis outcome measure, and treatment. J Rheumatol. 2005;75:6–21. Suppl.
    1. Plazier M., Ost J., Stassijns G., de Ridder D., Vanneste S. Pain characteristics in fibromyalgia: understanding the multiple dimensions of pain. Clin Rheumatol. 2015;34:775–783. PubMed PMID:25048743.
    1. Carmona L., Ballina J., Gabriel R., Laffon A., EPISER Study Group The burden of musculoskeletal diseases in the general population of Spain: results from a national survey. Ann RheumDis. 2001;60:1040–1045.
    1. English B. Neural and psychosocial mechanisms of pain sensitivity in fibromyalgia. Pain ManagNurs. 2014;15:530–538.
    1. Sluka K.A., Clauw D.J. Neurobiology of fibromyalgia and chronic widespread pain. Neuroscience. 2016;338:114–129.
    1. Bosma R.L., Mojarad E.A., Leung L., Pukall C., Staud R., Stroman P.W. FMRI of spinal and supra-spinal correlates of temporal pain summation in fibromyalgia patients. Hum Brain Mapp. 2016;37:1349–1360.
    1. Cagnie B., Coppieters I., Denecker S., Six J., Danneels L., Meeus M. Central sensitization in fibromyalgia?. A systematic review on structural and functional brain MRI. Semin Arthritis Rheum. 2014;44:68–75.
    1. Craggs J.G., Staud R., Robinson M.E., Perlstein W.M., Price D.D. Effective connectivity among brain regions associated with slow temporal summation of C-fiber-evoked pain in fibromyalgia patients and healthy controls. J Pain. 2012;13:390–400.
    1. Staud R., Weyl E.E., Riley J.L., 3rd, Fillingim R.B. Slow temporal summation of pain for assessment of central pain sensitivity and clinical pain of fibromyalgia patients. PLoSOne. 2014;9:e89086.
    1. Lim M., Roosink M., Kim J.S., Kim D.J., Kim H.W., Lee E.B. Disinhibition of the primary somatosensory cortex in patients with fibromyalgia. Pain. 2015;156:666–674.
    1. Staud R., Robinson M.E., Vierck C.J., Jr., Price D.D. Diffuse noxious inhibitory controls (DNIC) attenuate temporal summation of second pain in normal males but not in normal females or fibromyalgia patients. Pain. 2003;101:167–174.
    1. DeSantana J.M., da Silva L.F., de Resende M.A., Sluka K.A. Transcutaneous electrical nerve stimulation at both high and low frequencies activates ventrolateral periaqueductal grey to decrease mechanical hyperalgesia in arthritic rats.Neuroscience. 2009;163:1233–1241.
    1. Kalra A., Urban M.O., Sluka K.A. Blockade of opioid receptors in rostral ventral medulla prevents antihyperalgesia produced by transcutaneous electrical nerve stimulation (TENS) J Pharmacol Exp Ther. 2001;298:257–263.
    1. Maeda Y., Lisi T.L., Vance C.G., Sluka K.A. Release of GABA and activation of GABA(A) in the spinal cord mediates the effects of TENS in rats. Brain Res. 2007;1136:43–50.
    1. Gopalkrishnan P., Sluka K.A. Effect of varying frequency, intensity, and pulse duration of transcutaneous electrical nerve stimulation on primary hyperalgesia in inflamed rats. Arch Phys Med Rehabil. 2000;81:984–990.
    1. Urrutia G., Bonfill X. Declaracion PRISMA: una propuesta para mejorar la publicacion de revisiones sistemáticas y metaánalisis. Med Clin (Barc). 2010;135:507–511.
    1. Maher C.G., Sherrington C., Herbert R.D., Moseley A.M., Elkins M. Reliability of the PEDro scale for rating quality of randomized controlled trials. PhysTher. 2003;83:713–721.
    1. Dailey D.L., Rakel B.A., Vance C.G., Liebano R.E., Amrit A.S., Bush H.M. Transcutaneous electrical nerve stimulation reduces pain, fatigue and hyperalgesia while restoring central inhibition in primary fibromyalgia. Pain. 2013;154:2554–2562.
    1. Lauretti G.R., Chubaci E.F., Mattos A.L. Efficacy of the use of two simultaneously TENS devices for fibromyalgia pain. Rheumatol Int. 2013;33:2117–2122.
    1. Carbonario F., Matsutani L.A., Yuan S.L., Marques A.P. Effectiveness of high-frequency transcutaneous electrical nerve stimulation at tender points as adjuvant therapy for patients with fibromyalgia. Eur J Phys Rehabil Med. 2013;49:197–204.
    1. Mutlu B., Paker N., Bugdayci D., Tekdos D., Kesiktas N. Efficacy of supervised exercise combined with transcutaneous electrical nerve stimulation in women with fibromyalgia: a prospective controlled study. Rheumatol Int. 2013;33:649–655.
    1. Löfgren M., Norrbrink C. Pain relief in women with fibromyalgia: a cross-over study of superficial warmth stimulation and transcutaneous electrical nerve stimulation. J Rehabil Med. 2009;41:557–562.
    1. DiBenedetto P., Iona L.F., Zidarich V. Clinical evaluation of S-adnosyl-Lmethionine versus transcutaneous electrical nerve stimulation in primary fibromyalgia. CurrTherapeut Res. 1993;53:222.
    1. Da Silva T.F.G., Suda E., Marçulo C., da Silva Paes F., Pinheiro G. Comparação dos efeitos da estimulaçãoelétrica nervosa transcutânea e da hidroterapia nador, flexibilidade e qualidade de vida de pacientes com fibromialgia. Fisioterapia e Pesquisa. 2008;15:118–124.
    1. Sunshine W., Field T.M., Quintino O., Fierro K., Kuhn C., Burman I. Fibromyalgia benefits from massage therapy and transcutaneous electrical stimulation. J Clin Rheumatol. 1996;2:18–22.
    1. Radhakrishnan R., Sluka K.A. Deep tissue afferents, but not cutaneous afferents, mediate transcutaneous electrical nerve Stimulation–Induced antihyperalgesia. The Journal of Pain. 2005;6:673–680.
    1. Sluka K.A., Walsh D. Transcutaneous electrical nerve stimulation: Basic science mechanisms and clinical effectiveness. J Pain. 2003;4:109–121.
    1. White P.F., Craig W.F., Vakharia A.S., Ghoname E., Ahmed H.E., Hamza M.A. Percutaneous neuromodulation therapy: Does the location of electrical stimulation effect the acute analgesic W response? AnesthAnalg. 2000;91:949–954.

Source: PubMed

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