Is TENS/IFC Effective in Treating Chronic Lower Back Pain
Written by: Emily Moehlman, Karah Loftin, Lauren Douglas, Ashleigh McDaniel, Stephanie Moore, Rashad Al-Sabban
Low back pain (LBP) is extremely common among Americans and is in the top five most common medical complaints for which people seek medical treatment [1]. Almost everyone will experience a form of low back pain at some point in their lives, but for some it can be a constant irritant [1]. Treatment for chronic low back pain is often a prescription pain reliever, but for some individuals is not enough [1]. Transcutaneous electrical nerve stimulation (TENS) and interferential current (IFC) are two common modalities utilized by many physical therapists to provide pain relief for patients with LBP. The goal of using TENS/IFC is to stimulate nerve tissue and thus promotes a therapeutic effect for pain relief. This post provides a brief review of the literature on the effectiveness of TENS and IFC for treating LBP.
Research on TENS and IFC treatments show varied results for effectiveness of these electrical currents as beneficial pain relievers of low back pain. Melzak, Vetere, and Finch’s article found that TENS was more effective for treating low back pain when compared to gentle massage [2]. The researchers found that pain was reduced and straight leg raising was significantly improved[2]. In a study done by Kofotolis, patients received rhythmic stabilization exercises, rhythmic stabilization and TENS, or TENS treatment. The patients who received rhythmic stabilization exercises had reduced pain and increased range of motion compared to patients who received only TENS [3]. There was no significant difference between the rhythmic stabilization and TENS group which supports that TENS had no additional effect of pain relief when added to rhythmic stabilization exercises [3]. A study done by Topuz et al found that when compared to TENS, percutaneous neuromodulation therapy treatment reduced pain significantly during activity and increased health perception of the patients [4]. In a study by Deyo et al, patients had a reduction of pain with an exercise program that involved daily stretches more than the group who received TENS [5]. The results of these comparisons show that other treatment options such as PNT are more optimal for treating low back pain than TENS, and TENS on its own being the poorest at treating pain. Evidence from the literature shows that even though TENS does show some effectiveness at treating low back pain, it may not be the optimal choice as long as alternate treatments such as exercise, rhythmic stabilization, and PNT are available. Although both IFC and TENS to seem to provide some short-term pain relief, research does not show a significant difference in the effectiveness of the two treatments[6,7,8].
In conclusion, TENS and IFC seem to provide some short-term pain relief for patients with LBP. However, this short-term pain relief may be due to more of a placebo effect than actually treating the problem causing the lower back pain. If this short-term effect is sufficient at treat pain and in aiding a patient to tolerate a long-term treatment for their chronic LBP, then its analgesic effect is beneficial and can be used in the clinic. TENS/IFC may be considered for use in therapy after or in combination with other treatments that have been shown to treat chronic LBP more effectively, such as rhythmic stabilization, PNT, and exercise.
References
Walker, Emily P. CMS Nixes TENS for Back Pain. Wasting Correspondent, MedPage Today. 2012. http://www.medpagetoday.com/Neurology/PainManagement/33210.
Melzak R, Vetere P, and Finch L. Transcutaneous electrical nerve stimulation for low back pain: A comparison of TENS and massage for pain and range of motion. Journal of the American Physical Therapy Association. 1983;63:489-493. http://ptjournal.apta.org/content/63/4/489.full.pdf
Kofotolis N, Vlachopoulos S, Kellis E. Sequentially allocated clinical trial of rhythmic stabilization exercises and TENS in women with chronic low back pain. Clinical Rehabilitation. 2008;22:99-111. http://web.a.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=4&sid=4920a4bd-2fc0-44ef-8127-fba8b1352c02%40sessionmgr4003&hid=4201
Topuz O, Özfidan E, Ozgen M, Ardic F. Efficacy of transcutaneous electrical nerve stimulation and percutaneous neuromodulation therapy in chronic low back pain. Journal Of Back & Musculoskeletal Rehabilitation [serial online]. July 2004;17(3-4):127-133. Available from: CINAHL with Full Text, Ipswich, MA. Accessed August 27, 2015.
Deyo RA, Walsh NE, Martin DC, Schoenfeld LS, Ramamurthy S. A controlled trial of transcutaneous electrical nerve stimulation (TENS) and exercise for chronic low back pain. The New England Journal of Medicine. 1990;322(23):1627-1634
Jarzem PF, Harvey EJ, Arcaro N, Kaczorowski J. Transcutaneous electrical nerve stimulation [TENS] for short-term treatment of low back pain– Randomized double blind crossover study of sham versus conventional TENS. Journal of Musculoskeletal Pain. 2005;13(2):11-17. http://content.ebscohost.com/ContentServer.asp?T=P&P=AN&K=27646125&S=R&D=a9h&EbscoContent=dGJyMNLe80SeqLU4v%2BvlOLCmr02ep7RSsai4TLKWxWXS&ContentCustomer=dGJyMPGutk2zqK5PuePfgeyx44Dt6fIA
Facci LM, Nowotny JP, Tormem F, Trevisani VF. Effects of transcutaneous electrical nerve stimulation (TENS) and interferential currents (IFC) in patients with nonspecific chronic low back pain: Randomized clinical trial. Soa Paulo Medical Journal. 2011;129(4):206-16. http://www.ncbi.nlm.nih.gov/pubmed/21971895
Jarzem PF, Harvey EJ, Arcaro N, Kaczorowski J. Transcutaneous electrical nerve stimulation [TENS] for chronic low back pain. Journal of Musculoskeletal Pain. 2005;13(2):3-9. http://content.ebscohost.com/ContentServer.asp?T=P&P=AN&K=27646124&S=R&D=a9h&EbscoContent=dGJyMNLe80SeqLU4v%2BvlOLCmr02ep7RSsaa4TbaWxWXS&ContentCustomer=dGJyMPGutk2zqK5PuePfgeyx44Dt6fIA
