TENS Improves Pain For Women With Fibromyalgia

Women with fibromyalgia can see a significant improvement in pain, fatigue, and disease impact during physical activity when treated with transcutaneous electrical nerve stimulation (TENS), according to a new study presented at the 2018 ACR/ARHP Annual Meeting.

Pharmacologic trials have reported that less than half of patients treated for fibromyalgia have experienced clinically meaningful benefits without clinically important adverse effects.

“Non-pharmacologic interventions such as exercise and cognitive behavioral strategies have problems related to adherence and access to providers.” Dr Leslie Crofford, director of the division of rheumatology and immunology at Vanderbilt University, told Rheumatology Consultant. “Since PT practices are typically easily accessible and they commonly use TENS, this study provides a concrete strategy for applying a treatment that should be easily accessible.”

For their study, Crofford and colleagues randomly assigned women aged 18 to 70 years with fibromyalgia pain 4 or greater using the American College of Rheumatology 1990 fibromyalgia criteria to active TENS (n=103), a TENS placebo (n=99), or no TENS treatment (n=99). 

The active TENS delivered an electric pulse at an intensity set by the patient, whereas the placebo TENS delivered a 45-second dose of electric pulses that went down to off even with the unit still turned on. 

The participants were instructed to apply active TENS, TENS placebo, or non-active TENS to their upper and lower back, and to use it during at least 2 hours of activity per day.

“Since TENS works to inhibit central mechanisms of pain transmission and inhibition, FM was the ideal population,” Crofford said. “We also wanted to conduct a clinical trial of the very highest quality using a non-pharmacologic intervention but using rigorous strategies learned from pharmaceutical trials.”

After 1 month, the participants who had used active TENS reported a significant mean reduction in activity-induced pain (1.82), activity-induced fatigue (1.53), resting pain, brief pain inventory interference, and multidimensional assessment of fatigue compared with those who used a placebo or non-active TENS. 

The active TENS group showed improved fibromyalgia impact questionnaire mean (8.48) when compared with those who did not use TENS, but not when compared with participants in the placebo group.

Overall, 70% of participants in the active TENS group reported improvement in their conditions, whereas 31% in the TENS placebo group and 9% in the non-active TENS group reported improvement. 

“TENS works in this population and can be added to conventional treatment…we also showed that we can do rigorous, well-controlled studies of non-pharmacologic treatments in this population so that we can be confident in our conclusions,” Crofford said.

—Colleen Murphy

Reference:

Crofford L, Daily D, Vance C, et al. Transcutaneous electrical nerve stimulation (TENS) reduces pain and fatigue and improves disease impact in women with fibromyalgia: a randomized controlled trial. Paper presented at: 2018 ACR/ARHP Annual Meeting; October 19-24, 2018; Chicago, IL. https://acrabstracts.org/abstract/transcutaneous-electrical-nerve-stimulation-tens-reduces-pain-and-fatigue-and-improves-disease-impact-in-women-with-fibromyalgia-a-randomized-controlled-trial/. Accessed October 30, 2018.