title: Combined neuromuscular electrical stimulation and transcutaneous electrical nerve stimulation for treatment of chronic back pain: a double-blind, repeated measures comparison.
abstract: OBJECTIVE
  A preliminary examination of NMES and combined NMES/TENS for the management of chronic back pain.
  
  
  METHODS
  Double-blind, placebo-controlled, randomized repeated measures.
  
  
  METHODS
  Consecutive sample of 24 chronic back pain patients (16 women and 8 men) attending an outpatient pain clinic (mean age 51.67 years, mean pain duration 3.83 years). All treatments were administered at home.
  
  
  METHODS
  Subjects self-administered NMES, combined NMES/TENS, TENS, and placebo treatments. Each treatment had a duration of 5 consecutive hours per day over 2 consecutive days, with a 2-day hiatus between treatments to minimize carryover effects.
  
  
  METHODS
  Pain reduction was assessed through pretreatment to posttreatment differences on the Present Pain Intensity (PPI) scale, and a visual analogue scale of Pain Intensity (VAS-I). Posttreatment pain relief was assessed using a visual analogue scale of Pain Relief (VAS-R).
  
  
  RESULTS
  Combined treatment, NMES, and TENS each produced significant pretreatment to posttreatment reductions in pain intensity as measured by both the PPI and VAS-I (p < .05). Combined treatment was superior to placebo on pain reduction (p = .001, p = .016) as well as pain relief (p < .001). Combined treatment was also superior to both TENS and NMES for pain reduction and pain relief (p < .01). NMES and TENS were superior only to placebo for pain relief (p < .001).
  
  
  CONCLUSIONS
  Combined NMES/TENS treatment consistently produced greater pain reduction and pain relief than placebo, TENS, or NMES. NMES alone, although less effective, did produce as much pain relief as TENS. Although preliminary, this pattern of results suggests that combined NMES/TENS may be a valuable adjunct in the management of chronic back pain. Further research investigating the effectiveness of both NMES and combined NMES/TENS seems warranted.
authors.affiliation: Center for Neurologic Study, San Diego, CA 92121, USA.
authors.forename: S R
authors.initials: SR
authors.lastname: Moore
authors.forename: J
authors.initials: J
authors.lastname: Shurman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D004561:Transcutaneous Electric Nerve Stimulation