Current Rheumatology Reports

, 10:492 | Cite as

Effectiveness of transcutaneous electrical nerve stimulation for treatment of hyperalgesia and pain

  • Josimari M. DeSantanaEmail author
  • Deirdre M. Walsh
  • Carol Vance
  • Barbara A. Rakel
  • Kathleen A. Sluka


Transcutaneous electrical nerve stimulation (TENS) is a nonpharmacologic treatment for pain relief. TENS has been used to treat a variety of painful conditions. This review updates the basic and clinical science regarding the use of TENS that has been published in the past 3 years (ie, 2005–2008). Basic science studies using animal models of inflammation show changes in the peripheral nervous system, as well as in the spinal cord and descending inhibitory pathways, in response to TENS. Translational studies show mechanisms to prevent analgesic tolerance to repeated application of TENS. This review also highlights data from recent randomized, placebo-controlled trials and current systematic reviews. Clinical trials suggest that adequate dosing, particularly intensity, is critical to obtaining pain relief with TENS. Thus, evidence continues to emerge from both basic science and clinical trials supporting the use of TENS for the treatment of a variety of painful conditions while identifying strategies to increase TENS effectiveness.


Chronic Constriction Injury Transcutaneous Electrical Nerve Stimulation Pressure Pain Threshold Chronic Musculoskeletal Pain Spinal Cord Dorsal Horn 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References and Recommended Reading

  1. 1.
    Sluka KA: The Neurobiology of pain and foundations for electrical stimulation. In Clinical Electrophysiology. Edited by Robinson AJ, Snyder-Mackler L. Philadelphia: Lippincott Williams & Wilkins; 2008:107–149.Google Scholar
  2. 2.
    Sluka KA, Deacon M, Stibal A, et al.: Spinal blockade of opioid receptors prevents the analgesia produced by TENS in arthritic rats. J Pharmacol Exp Ther 1999, 289:840–846.PubMedGoogle Scholar
  3. 3.
    Kalra A, Urban MO, Sluka KA: 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.PubMedGoogle Scholar
  4. 4.
    Sluka KA, Chandran P: Enhanced reduction in hyperalgesia by combined administration of clonidine and TENS. Pain 2002, 100:183–190.PubMedCrossRefGoogle Scholar
  5. 5.
    Loeser JD, Treede RD: The Kyoto protocol of IASP Basic Pain Terminology. Pain 2008 (in press).Google Scholar
  6. 6.
    Sluka KA, Lisi TL, Westlund KN: Increased release of serotonin in the spinal cord during low, but not high, frequency transcutaneous electric nerve stimulation in rats with joint inflammation. Arch Phys Med Rehabil 2006, 87:1137–1140.PubMedCrossRefGoogle Scholar
  7. 7.
    King EW, Audette K, Athman GA, et al.: Transcutaneous electrical nerve stimulation activates peripherally located alpha-2A adrenergic receptors. Pain 2005, 115:364–373.PubMedGoogle Scholar
  8. 8.
    Radhakrishnan R, Sluka KA: Deep tissue afferents, but not cutaneous afferents, mediate transcutaneous electrical nerve stimulation-Induced antihyperalgesia. J Pain 2005, 6:673–680.PubMedCrossRefGoogle Scholar
  9. 9.
    Vance CG, Radhakrishnan R, Skyba DA, et al.: Transcutaneous electrical nerve stimulation at both high and low frequencies reduces primary hyperalgesia in rats with joint inflammation in a time-dependent manner. Phys Ther 2007, 87:44–51.PubMedCrossRefGoogle Scholar
  10. 10.
    Sabino GS, Santos CM, Francischi JN, et al.: Release of endogenous opioids following transcutaneous electric nerve stimulation in an experimental model of acute inflammatory pain. J Pain 2008, 9:157–163.PubMedCrossRefGoogle Scholar
  11. 11.
    Ainsworth L, Budelier K, Clinesmith M, et al.: Transcutaneous electrical nerve stimulation (TENS) reduces chronic hyperalgesia induced by muscle inflammation. Pain 2006, 120:182–187.PubMedCrossRefGoogle Scholar
  12. 12.
    Somers DL, Clemente FR: Transcutaneous electrical nerve stimulation for the management of neuropathic pain: the effects of frequency and electrode position on prevention of allodynia in a rat model of complex regional pain syndrome type II. Phys Ther 2006, 86:698–709.PubMedGoogle Scholar
  13. 13.
    Hingne PM, Sluka KA: Differences in waveform characteristics have no effect on the anti-hyperalgesia produced by transcutaneous electrical nerve stimulation (TENS) in rats with joint inflammation. J Pain 2007, 8:251–255.PubMedCrossRefGoogle Scholar
  14. 14.
    Maeda Y, Lisi TL, Vance CG, et al.: 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.PubMedCrossRefGoogle Scholar
  15. 15.
    Sluka KA, Vance CG, Lisi TL: High-frequency, but not low-frequency, transcutaneous electrical nerve stimulation reduces aspartate and glutamate release in the spinal cord dorsal horn. J Neurochem 2005, 95:1794–1801.PubMedCrossRefGoogle Scholar
  16. 16.
    DeSantana JM, Sluka KA: Antinociceptive effect of transcutaneous electric nerve stimulation (TENS) is mediated by ventrolateral periaqueductal grey (vlPAG). Presented at the XII World Congress in Pain. Glasgow, Scotland; August 17–22, 2008.Google Scholar
  17. 17.
    Chandran P, Sluka KA: Development of opioid tolerance with repeated transcutaneous electrical nerve stimulation administration. Pain 2003, 102:195–201.PubMedCrossRefGoogle Scholar
  18. 18.
    Hingne PM, Sluka KA: Blockade of NMDA receptors prevents analgesic tolerance to repeated transcutaneous electrical nerve stimulation (TENS) in rats. J Pain 2008, 9:217–225.PubMedCrossRefGoogle Scholar
  19. 19.
    DeSantana JM, Sluka KA: Blockade of cholecystokinin receptors prevents the development of analgesic tolerance to transcutaneous electric nerve stimulation (TENS). Presented at the XII World Congress in Pain. Glasgow, Scotland; August 17–22, 2008.Google Scholar
  20. 20.
    DeSantana JM, Santana-Filho VJ, Sluka KA: Modulation between high- and low-frequency transcutaneous electric nerve stimulation delays the development of analgesic tolerance in arthritic rats. Arch Phys Med Rehabil 2008, 89:754–760.PubMedCrossRefGoogle Scholar
  21. 21.
    Brown L, Tabasam G, Bjordal JM, et al.: An investigation into the effect of electrode placement of transcutaneous electrical nerve stimulation (TENS) on experimentally induced ischemic pain in healthy human participants. Clin J Pain 2007, 23:735–743.PubMedCrossRefGoogle Scholar
  22. 22.
    Aarskog R, Johnson MI, Demmink JH, et al.: Is mechanical pain threshold after transcutaneous electrical nerve stimulation (TENS) increased locally and unilaterally? A randomized placebo-controlled trial in healthy subjects. Physiother Res Int 2007, 12:251–263.PubMedCrossRefGoogle Scholar
  23. 23.
    Claydon LS, Chesterton LS, Barlas P, Sim J: Effects of simultaneous dual-site TENS stimulation on experimental pain. Eur J Pain 2008, 12:696–704.PubMedCrossRefGoogle Scholar
  24. 24.
    Buonocore M, Camuzzini N: Increase of the heat pain threshold during and after high-frequency transcutaneous peripheral nerve stimulation in a group of normal subjects. Europa Medicophysica 2007, 43:155–160.PubMedGoogle Scholar
  25. 25.
    Tong KC, Lo SK, Cheing GL: Alternating frequencies of transcutaneous electric nerve stimulation: does it produce greater analgesic effects on mechanical and thermal pain thresholds? Arch Phys Med Rehabil 2007, 88:1344–1349.PubMedCrossRefGoogle Scholar
  26. 26.
    Oosterhof J, Samwel HJ, de Boo TM, et al.: Predicting outcome of TENS in chronic pain: A prospective, randomized, placebo controlled trial. Pain 2008, 136:11–20.PubMedCrossRefGoogle Scholar
  27. 27.
    Warke K, Al-Smadi J, Baxter D, et al.: Efficacy of transcutaneous electrical nerve stimulation (TENS) for chronic low-back pain in a multiple sclerosis population: a randomized, placebo-controlled clinical trial. Clin J Pain 2006, 22:812–819.PubMedCrossRefGoogle Scholar
  28. 28.
    Mora B, Giorni E, Dobrovits M, et al.: Transcutaneous electrical nerve stimulation: an effective treatment for pain caused by renal colic in emergency care. J Urol 2006, 175:1737–1741.PubMedCrossRefGoogle Scholar
  29. 29.
    Lang T, Barker R, Steinlechner B, et al.: TENS relieves acute posttraumatic hip pain during emergency transport. J Trauma 2007, 62:184–188.PubMedCrossRefGoogle Scholar
  30. 30.
    Defrin R, Ariel E, Peretz C: Segmental noxious versus innocuous electrical stimulation for chronic pain relief and the effect of fading sensation during treatment. Pain 2005, 115:152–160.PubMedCrossRefGoogle Scholar
  31. 31.
    DeSantana JM, Santana-Filho VJ, Guerra DR, et al.: Hypoalgesic effect of the transcutaneous electrical nerve stimulation following inguinal herniorrhaphy: a randomized, controlled trial. J Pain 2008, 9:623–629.PubMedCrossRefGoogle Scholar
  32. 32.
    DeSantana JM, Sluka KA, Lauretti GR: High and low frequency TENS reduce postoperative pain intensity after laparoscopic sterilization for tubal ligation: a randomized controlled trial. Clin J Pain 2008 (in press).Google Scholar
  33. 33.
    Cipriano G, Carvalho AC, Bernardelli GF, et al.: Short-term transcutaneous electrical nerve stimulation after cardiac surgery: effect on pain, pulmonary function, and electrical muscle activity. Interact CardioVasc Thorac Surg 2008, 7:539–543.PubMedCrossRefGoogle Scholar
  34. 34.
    Solak O, Turna A, Pekcolaklar A, et al.: Transcutaneous electric nerve stimulation for the treatment of postthoracotomy pain: a randomized prospective study. Thorac Cardiov Surg 2007, 55:182–185.CrossRefGoogle Scholar
  35. 35.
    Erdogan M, Erdogan AE, Erbil N, et al.: Prospective, randomized, placebo-controlled study of the effect of TENS on postthoractomy pain and pulmonary function. World J Surg 2005, 29:1563–1570.PubMedCrossRefGoogle Scholar
  36. 36.
    Cheing GL, Hui-Chan CW: Transcutaneous electrical nerve stimulation: nonparallel antinociceptive effects on chronic clinical pain and acute experimental pain. Arch Phys Med Rehabil 1999, 80:305–312.PubMedCrossRefGoogle Scholar
  37. 37.
    Deyo RA, Walsh NE, Martin DC, et al.: A controlled trial of transcutaneous electrical stimulation (TENS) and exercise for chronic low back pain. N Engl J Med 1990, 322:1627–1634.PubMedGoogle Scholar
  38. 38.
    Khadilkar A, Milne S, Brosseau L, et al.: Transcutaneous electrical nerve stimulation (TENS) for chronic low-back pain. Cochrane Database System Rev 2005, Issue 3.Google Scholar
  39. 39.
    Johnson M, Martinson M: Efficacy of electrical nerve stimulation for chronic musculoskeletal pain: a meta-analysis of randomized controlled trials. Pain 2007, 130:157–165.PubMedCrossRefGoogle Scholar
  40. 40.
    Chen C, Tabasam G, Johnson MI: Does the pulse frequency of transcutaneous electrical nerve stimulation (TENS) influence hypoalgesia? A systematic review of studies using experimental pain and healthy human participants. Physiotherapy 2008, 94:11–20.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Josimari M. DeSantana
    • 1
    Email author
  • Deirdre M. Walsh
  • Carol Vance
  • Barbara A. Rakel
  • Kathleen A. Sluka
  1. 1.Department of Physical TherapyFederal University of SergipeSergipeBrasil

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