title: Problems, Solutions, and Strategies Reported by Users of Transcutaneous Electrical Nerve Stimulation for Chronic Musculoskeletal Pain: Qualitative Exploration Using Patient Interviews.
abstract: Transcutaneous electrical nerve stimulation (TENS) could offer a non-drug form of pain relief, but there is no consensus regarding its effectiveness for chronic musculoskeletal pain or chronic low back pain. A recent review of previous trial methods identified significant problems with low treatment fidelity. There is little information available to inform the development of a pragmatic implementation design for a TENS evaluation.
  
  
  
  The aim of this study was to explore the experiences of patients who were receiving secondary care in a pain clinic and who had expertise in using TENS to manage chronic musculoskeletal pain. These key informants were selected because they had the potential to generate knowledge that could inform research design and clinical practice.
  
  
  
  A qualitative method using individual semistructured interviews with open questions was selected for its capacity to generate rich data.
  
  
  
  Semistructured interviews were conducted with 9 patients (6 women, 3 men). Thematic analysis was used as the primary data analysis method, and this analysis was enhanced by a case-level analysis of the context and processes of TENS use of each individual.
  
  
  
  Data analysis indicated that patients learned to address a range of problems in order to optimize TENS use. Patients may need to personalize the positioning of electrodes and the TENS settings and to readjust them over time. Patients learned to use TENS in a strategic manner, and the outcomes of each strategy varied.
  
  
  
  The findings indicated that a pragmatic TENS evaluation may need to incorporate a learning phase to allow patients to optimize this complex pattern of TENS usage, and evaluation may need to be sensitive to the outcomes of strategic use. These findings also have implications for clinical practice.
authors.affiliation: P.W. Gladwell, PhD, MCSP, BScHons, Pain Management Service, North Bristol NHS Trust, Southmead Hospital, Southmead Road, Bristol BS10 5NB, United Kingdom. Peter.Gladwell@nbt.nhs.uk.
authors.forename: Peter William
authors.initials: PW
authors.lastname: Gladwell
authors.affiliation: K. Badlan, MPhil, CertEdFE, MCSP, Faculty of Health and Life Sciences, University of the West of England, Bristol, United Kingdom.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Badlan
authors.affiliation: F. Cramp, PhD, FCSP, BScHons, Faculty of Health and Life Sciences, University of the West of England.
authors.forename: Fiona
authors.initials: F
authors.lastname: Cramp
authors.affiliation: S. Palmer, PhD, MCSP, FHEA, BScHons, Allied Health Professions, University of the West of England.
authors.forename: Shea
authors.initials: S
authors.lastname: Palmer
mesh_terms: D000328:Adult; D059350:Chronic Pain; D004566:Electrodes; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009068:Movement; D059352:Musculoskeletal Pain / Q000628:therapy*; D011340:Problem Solving; D036301:Qualitative Research; D013546:Sweating; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods