Richard M. Dubinsky Discusses New Guideline on the Efficacy of TENS for Treatment of Pain

December 30, 2009


The Technology and Therapeutics Assessment Subcommittee of the Practice Committee of the AAN has released its evidence-based review of the efficacy of TENS (transcutaneous electric stimulation) for treatment of pain. Daniel B. Hier, MD, MBA, interviewed the lead guideline author, Richard M. Dubinsky, MD, MPH, for about the recently published assessment of TENS. Briefly summarize your conclusions regarding the efficacy of TENS for pain in neurological conditions.

Dubinsky: TENS was found to be of no benefit for people with chronic low back pain. However, people with diabetic neuropathy received some benefit from therapy with TENS. What was the motivation of the Technology and Therapeutics Assessment (TTA) Subcommittee for assessing TENS?

Dubinsky: We sought to address the lack of any evidence-based guidelines on the utility of TENS for neurologic conditions. What procedure did your subcommittee utilize to assess TENS?

Dubinsky: Systematic literature review, using the AAN Quality Standards and Technology and Therapeutics Assessment methodology to find papers and to rank them based on their inherent levels of potential bias. From the articles, conclusions about efficacy were made, followed by recommendations. How did you define a meaningful improvement in pain for this technology assessment?

Dubinsky: We adopted the definition for meaningful improvement used in each individual study. The amount of improvement considered clinically significant in these studies was less than the typical values used in studies of cancer-associated pain (verbal analog scale, or VAS). How was TENS-sham used as blinded control for TENS in some of the studies?

Dubinsky: Inactive units with blinking lights similar to the active TENS devices were used in some studies, and in others different TENS modalities were compared without a placebo arm. No Class I studies showed a benefit for TENS in lower back pain. What is the difference between a Class I and a Class II study?

Dubinsky: A Class I study is a well controlled, randomized clinical trial, which is double blinded. Cohort assignment is completely randomized and cannot be influenced by the study personnel. The populations are well defined, and there is a low drop-out rate. What further studies are needed to better assess the utility of TENS for pain in neurological disorders?

Dubinsky: First, the optimum TENS paradigm needs to be determined. Then TENS needs to be compared to sham TENS in well defined populations, which are naïve to TENS, for long-term treatment of painful disorders.

Author Disclosures

Dr. Dubinsky holds financial interests in Abbott and Allergan.

Within the past 24 months, Dr. Hier received compensation for medical legal consulting. In the same period he gave expert testimony in medical malpractice cases.