title: Percutaneous electrical nerve stimulation: an alternative to TENS in the management of sciatica.
abstract: Sciatica is a common pain problem and current pharmacologic therapies have proven inadequate for many patients. The objective of this sham-controlled investigation was to compare a novel non-pharmacologic technique, percutaneous electrical nerve stimulation (PENS), to transcutaneous electrical nerve stimulation (TENS) in the management of the radicular pain associated with sciatica. Sixty-four consenting patients with sciatica due to lumbar disc herniation were treated with PENS, TENS and sham-PENS according to a randomized, single-blinded, cross-over study. All patients had been maintained on a stable oral non-opioid analgesic regimen for at least 6 weeks prior to entering the study. Each treatment modality was administered for a period of 30 min three times per week for 3 weeks, with 1 week 'off' between each modality. Both PENS and TENS treatments were administered using a stimulation frequency of 4 Hz. The pre-treatment assessment included the health status survey short form (SF-36), as well as visual analog scales (VAS) for radicular pain, physical activity and quality of sleep. The pain VAS was also repeated after each treatment session. At the end of each 3-week treatment block, the SF-36 was repeated. After receiving all three treatment modalities, a global assessment questionnaire was completed. Both PENS (42%) and TENS (23%) were significantly more effective than the sham (8%) treatments in decreasing VAS pain scores. The daily oral analgesic requirements were also significantly reduced compared to the pre-treatment values with PENS (P<0.01) and TENS (P<0.05). However, PENS was significantly more effective than TENS (and sham-PENS) in improving physical activity and quality of sleep. The SF-36 evaluation confirmed the superiority of PENS (versus TENS and sham-PENS) with respect to post-treatment functionality. In the overall assessment, 73% of the patients reported that PENS was the most desirable modality (versus 21% for TENS and 6% for sham-PENS). Finally, 71% of the patients stated that they would be willing to pay extra to receive PENS therapy compared to 22% and 3% for TENS and sham-PENS, respectively. In this sham-controlled study, we concluded that PENS was more effective than TENS when administered at a stimulation frequency of 4 Hz in providing short-term pain relief and improved functionality in patients with sciatica.
authors.affiliation: McDermott Center for Pain Management, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, Dallas, USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Ghoname
authors.forename: P F
authors.initials: PF
authors.lastname: White
authors.forename: H E
authors.initials: HE
authors.lastname: Ahmed
authors.forename: M A
authors.initials: MA
authors.lastname: Hamza
authors.forename: W F
authors.initials: WF
authors.lastname: Craig
authors.forename: C E
authors.initials: CE
authors.lastname: Noe
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D018592:Cross-Over Studies; D004599:Electric Stimulation Therapy; D005260:Female; D006801:Humans; D008297:Male; D010147:Pain Measurement; D012585:Sciatica / Q000503:physiopathology / Q000628:therapy*; D016037:Single-Blind Method; D013997:Time Factors; D004561:Transcutaneous Electric Nerve Stimulation