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Critical Reviews™ in Physical and Rehabilitation Medicine

Publicado 4 números por año

ISSN Imprimir: 0896-2960

ISSN En Línea: 2162-6553

SJR: 0.141 SNIP: 0.129 CiteScore™:: 0.6 H-Index: 18

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The Clinical Effectiweness of TENS in Pain Management

Volumen 12, Edición 2, 2000, pp. 131-149
DOI: 10.1615/CritRevPhysRehabilMed.v12.i2.40
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SINOPSIS

Transcutaneous electrical nerve stimulation (TENS) is used extensively throughout the world to manage painful conditions, including postoperative pain, labor pain, and chronic pain. However, the results of systematic reviews of randomized controlled trials (RCTs) on TENS have questioned the clinical effectiveness of TENS for these conditions. This article critically evaluates TENS effectiveness in light of these systematic reviews and demonstrates that methodological problems associated with RCTs included in systematic reviews may account in part for the negative findings. TENS effectiveness has been determined by some authors using comparisons with active treatments, such as conventional medication, although this is inappropriate because both TENS and the active treatment may be more effective than a placebo control. A sham TENS control group is necessary to determine absolute clinical effectiveness, although in practice this may be difficult to achieve. The authenticity of claims of double-blind procedures in TENS trials is questioned and the role of triple-blinding in trials of TENS discussed. The wide variety of TENS treatment protocols used in RCTs highlights the difficulty of synthesizing the results of TENS trials. Inappropriate TENS treatment interventions in studies with high methodological quality scores emphasize the danger of taking RCT results at face value. This article concludes that it would be hasty to withdraw support for the use of TENS in the management of acute and chronic pain at present as methodological problems associated with some of the RCTs included in systematic reviews may account for the negative findings.

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