title: Transcutaneous electrical nerve stimulation reduces pain, fatigue and hyperalgesia while restoring central inhibition in primary fibromyalgia.
abstract: Because transcutaneous electrical nerve stimulation (TENS) works by reducing central excitability and activating central inhibition pathways, we tested the hypothesis that TENS would reduce pain and fatigue and improve function and hyperalgesia in people with fibromyalgia who have enhanced central excitability and reduced inhibition. The current study used a double-blinded randomized, placebo-controlled cross-over design to test the effects of a single treatment of TENS with people with fibromyalgia. Three treatments were assessed in random order: active TENS, placebo TENS and no TENS. The following measures were assessed before and after each TENS treatment: pain and fatigue at rest and in movement; pressure pain thresholds, 6-m walk test, range of motion; 5-time sit-to-stand test, and single-leg stance. Conditioned pain modulation was completed at the end of testing. There was a significant decrease in pain and fatigue with movement for active TENS compared to placebo and no TENS. Pressure pain thresholds increased at the site of TENS (spine) and outside the site of TENS (leg) when compared to placebo TENS or no TENS. During active TENS, conditioned pain modulation was significantly stronger compared to placebo TENS and no TENS. No changes in functional tasks were observed with TENS. Thus, the current study suggests TENS has short-term efficacy in relieving symptoms of fibromyalgia while the stimulator is active. Future clinical trials should examine the effects of repeated daily delivery of TENS, similar to the way in which TENS is used clinically on pain, fatigue, function, and quality of life in individuals with fibromyalgia.
authors.affiliation: Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA, USA College of Nursing, University of Iowa, Iowa City, IA, USA University of the City of Sao Paulo, Physical Therapy Department, Sao Paulo, Brazil Department of Rheumatology, University of Iowa, Iowa City, IA, USA Department of Biostatistics, University of Kentucky, College of Public Health, Lexington, KY, USA.
authors.forename: Dana L
authors.initials: DL
authors.lastname: Dailey
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Rakel
authors.forename: Carol G T
authors.initials: CGT
authors.lastname: Vance
authors.forename: Richard E
authors.initials: RE
authors.lastname: Liebano
authors.forename: Anand S
authors.initials: AS
authors.lastname: Amrit
authors.forename: Heather M
authors.initials: HM
authors.lastname: Bush
authors.forename: Kyoung S
authors.initials: KS
authors.lastname: Lee
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Lee
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Sluka
mesh_terms: D000328:Adult; D000368:Aged; D002490:Central Nervous System / Q000503:physiopathology; D018592:Cross-Over Studies; D005221:Fatigue / Q000209:etiology / Q000628:therapy*; D005260:Female; D005356:Fibromyalgia / Q000150:complications* / Q000628:therapy*; D006801:Humans; D006930:Hyperalgesia / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology; D010146:Pain / Q000209:etiology*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D017288:Pain Threshold / Q000502:physiology; D016059:Range of Motion, Articular / Q000502:physiology; D012146:Rest / Q000502:physiology; D018401:Sample Size; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology
keywords: Analgesia; Chronic widespread pain; Electrical stimulation; Fatigue; Fibromyalgia; Hyperalgesia; Pain; Transcutaneous electrical nerve stimulation (TENS)
references.citation: J Pain. 2012 Feb;13(2):195-206
references.pmid: 22245361
references.citation: Neuroscience. 2009 Nov 10;163(4):1233-41
references.pmid: 19576962
references.citation: Arch Phys Med Rehabil. 2008 Apr;89(4):754-60
references.pmid: 18374009
references.citation: Pain. 2012 Oct;153(10):1997-2008
references.pmid: 22770841
references.citation: J Clin Rheumatol. 1996 Feb;2(1):18-22
references.pmid: 19078022
references.citation: Med Sci Sports Exerc. 2011 Jun;43(6):1106-13
references.pmid: 21085031
references.citation: Pain Med. 2001 Sep;2(3):208-15
references.pmid: 15102253
references.citation: Pain. 1994 Sep;58(3):309-315
references.pmid: 7838579
references.citation: Curr Pain Headache Rep. 2005 Oct;9(5):316-21
references.pmid: 16157059
references.citation: Phys Ther. 2012 Jul;92(7):898-910
references.pmid: 22466027
references.citation: Heart Surg Forum. 2008;11(5):E300-3
references.pmid: 18948245
references.citation: Rheum Dis Clin North Am. 1990 Aug;16(3):681-98
references.pmid: 2217965
references.citation: Pain. 2000 Oct;88(1):69-78
references.pmid: 11098101
references.citation: Arthritis Rheum. 2005 Jan;52(1):296-303
references.pmid: 15641057
references.citation: Arch Phys Med Rehabil. 2002 Jan;83(1):44-7
references.pmid: 11782832
references.citation: Eur J Pain. 2003;7(2):181-8
references.pmid: 12600800
references.citation: J Crit Care. 2005 Jun;20(2):187-91; discussion 191-3
references.pmid: 16139163
references.citation: J Pharmacol Exp Ther. 1999 May;289(2):840-6
references.pmid: 10215661
references.citation: Clin J Pain. 1997 Sep;13(3):189-96
references.pmid: 9303250
references.citation: Cochrane Database Syst Rev. 2009 Oct 07;(4):CD007321
references.pmid: 19821403
references.citation: Pain. 2002 Sep;99(1-2):49-59
references.pmid: 12237183
references.citation: J Geriatr Phys Ther. 2007;30(1):8-15
references.pmid: 19839175
references.citation: Exp Brain Res. 2001 Mar;137(1):94-102
references.pmid: 11310176
references.citation: Pain. 2003 Mar;102(1-2):87-95
references.pmid: 12620600
references.citation: J Pain. 2007 May;8(5):422-9
references.pmid: 17293165
references.citation: J Pain. 2003 Oct;4(8):455-64
references.pmid: 14622666
references.citation: Pain. 2010 Jan;148(1):114-119
references.pmid: 19959293
references.citation: Pain. 1997 Mar;70(1):41-51
references.pmid: 9106808
references.citation: Physiother Theory Pract. 2008 May-Jun;24(3):151-66
references.pmid: 18569853
references.citation: J Neurosurg. 1985 Feb;62(2):276-87
references.pmid: 3871474
references.citation: J Rehabil Med. 2009 Jun;41(7):557-62
references.pmid: 19543667
references.citation: Phys Ther. 2002 Feb;82(2):128-37
references.pmid: 11856064
references.citation: Neurosci Lett. 1996 Sep 27;216(2):125-8
references.pmid: 8904799
references.citation: Expert Opin Pharmacother. 2007 Aug;8(11):1629-42
references.pmid: 17685881
references.citation: Womens Health Issues. 2008 Sep-Oct;18(5):406-12
references.pmid: 18723374
references.citation: J Pain. 2001 Dec;2(6):334-44
references.pmid: 14622813
references.citation: Pain. 2010 Feb;148(2):188-197
references.pmid: 19632780
references.citation: J Pharmacol Exp Ther. 2001 Jul;298(1):257-63
references.pmid: 11408550
references.citation: Cochrane Database Syst Rev. 2009 Apr 15;(2):CD006142
references.pmid: 19370629
references.citation: Eur J Pain. 2002;6(2):149-59
references.pmid: 11900475
references.citation: Brain Res. 2007 Mar 9;1136(1):43-50
references.pmid: 17234163
references.citation: Pain. 2007 Jul;130(1-2):157-65
references.pmid: 17383095
references.citation: Curr Rheumatol Rep. 2008 Dec;10(6):492-9
references.pmid: 19007541
references.citation: J Neurochem. 2005 Dec;95(6):1794-801
references.pmid: 16236028
references.citation: J Clin Rheumatol. 2004 Dec;10(6):295-9
references.pmid: 17043536
references.citation: J Rehabil Med. 2004 Sep;36(5):220-5
references.pmid: 15626162
references.citation: Pain. 1993 Jul;54(1):99-106
references.pmid: 8378107
references.citation: J Pain. 2008 Sep;9(9):792-805
references.pmid: 18524684
references.citation: J Pain. 2010 Mar;11(3):230-8
references.pmid: 19945354
references.citation: Med Sci Sports Exerc. 2011 May;43(5):905-12
references.pmid: 20881881
references.citation: Arthritis Res Ther. 2010;12(3):R79
references.pmid: 20459730
references.citation: Arch Phys Med Rehabil. 1999 Mar;80(3):305-12
references.pmid: 10084439
references.citation: Curr Pain Headache Rep. 2002 Aug;6(4):259-66
references.pmid: 12095460
references.citation: Pain. 2012 Jun;153(6):1148-1158
references.pmid: 22494920
references.citation: J Neurosci Methods. 2006 Jan 15;150(1):74-9
references.pmid: 16051372
references.citation: Spine (Phila Pa 1976). 2001 Jan 1;26(1):53-60
references.pmid: 11148646
references.citation: Clin Exp Rheumatol. 2005 Sep-Oct;23(5 Suppl 39):S154-62
references.pmid: 16273800
references.citation: Pain. 2011 Feb;152(2):335-342
references.pmid: 21144659
references.citation: J Pharmacol Exp Ther. 1998 Oct;287(1):232-7
references.pmid: 9765342
references.citation: Rheumatol Int. 2013 Mar;33(3):649-55
references.pmid: 22527135
references.citation: Med Sci Sports Exerc. 2012 Jun;44(6):1186-93
references.pmid: 22157881
references.citation: Spine (Phila Pa 1976). 1999 Jun 1;24(11):1082-9
references.pmid: 10361657
references.citation: Cochrane Database Syst Rev. 2000;(4):CD002823
references.pmid: 11034768
references.citation: J Pain. 2011 Aug;12(8):929-35
references.pmid: 21481649