Transcutaneous Electrical Nerve Stimulation

The Transcutaneous Electrical Nerve Stimulation recommendation has been downgraded two levels because of inconsistent evidence and a lack of internal consistency with recommendations of equal supporting evidence.

A meta-analysis was performed using pain data from two high quality studies (Palmer 2014, Inal 2016) and one moderate quality study (Atamaz 2012) in which Transcutaneous Electrical Nerve Stimulation (TENS) was compared to sham TENS in subjects with knee osteoarthritis. Blinding effectiveness was considered fair in all three studies. The results of the meta-analysis can be seen in Figure 15 in the appendix. The overall findings were in favor of receiving TENS for reducing pain in subjects with knee osteoarthritis. A similar meta-analysis was performed using the same studies for measures of function. The results of this meta-analysis can be seen in Figure 16 in the appendix. The overall findings did not favor the use of TENS to improve measures of function in subjects with knee osteoarthritis.

Benefits/Harms of Implementation

TENS units are small, portable, non-invasive devices that could provide pain relief and may allow some patients to reduce pain medication use. Some patients may experience skin irritations or allergic reactions to the adhesive pads used to deliver the stimulation. Use of TENS is not recommended in people with pacemakers and women who are pregnant should not apply TENS in the abdominal or pelvic regions.

Acceptability

The interventions appear to be acceptable to most patients however some patients may not like the sensation of electrical or electro-magnetic energy being applied to their bodies.

Future Research

Continued research with larger randomized trials that examine long-term effectiveness of the interventions is warranted. Studies that identify factors discriminating between responders and non-responders to the interventions would also be important.