Remote Analgesic Effects Of Conventional Transcutaneous Electrical Nerve Stimulation: A Scientific And Clinical Review With A Focus On Chronic Pain

Figures & data

Table 1 Animal Pain–Model Studies Demonstrating Remote Analgesic Effects Of Conventional TENS

Reference	Animal	Pain Model	Remote Analgesic Effects
Ainsworth et al^Citation27	Rat	Muscle inflammation	Contralateral
Somers et al^Citation98	Rat	Nerve constriction	Contralateral
Somers et al^Citation99	Rat	Nerve constriction	Contralateral
Somers et al^Citation100	Rat	Nerve constriction	Contralateral
Sabino et al^Citation103	Rat	Extremity inflammation	Contralateral
Cho et al^Citation104	Rat	Nerve ligation	Contralateral
Garrison and Foreman^Citation105	Cat	None	Contralateral
Neto et al^Citation21	Rat	Joint inflammation	Contralateral, segmental

Table 2 Experimental Human-Pain Studies Demonstrating Remote Analgesic Effects Of Conventional TENS

Reference	Experimental Pain Model	Remote Analgesic Effects
da Silva et al^Citation108	Mechanical pain	Extrasegmental
Brown et al^Citation20	Ischemic pain	Extrasegmental
Chan and Tsang^Citation110	Nociceptive flexion reflex	Segmental, extrasegmental
Kawamura et al^Citation113	Thermal pain	Contralateral, segmental
Takiguchi and Shomoto^Citation114	Nociceptive flexion reflex	Contralateral
Peng et al^Citation115	Thermal pain	Contralateral
Zoppi et al^Citation28	Painful electrical stimulation	Contralateral, segmental, extrasegmental
Buonocore et al^Citation117	Thermal pain	Contralateral
Lehmann and Strian^Citation118	Thermal pain	Contralateral
Eriksson et al^Citation119	Thermal pain	Contralateral
Dean et al^Citation120	Mechanical pain, thermal pain	Contralateral
Hoshiyama and Kakigi^Citation121	Painful electrical stimulation	Contralateral

Table 3 Randomized Controlled Trials Demonstrating Remote Analgesic Effects Of TENS

Reference	Design	Condition	Stimulation Site	Control Group(s)	Remote Analgesic Effects
Jamison et al^Citation143 NCT02944513	Parallel (n=68)	Chronic low-back pain	Leg	Usual care	Segmental
Dailey et al^Citation22 NCT00932360	Crossover (n=43)	Fibromyalgia	Back/neck	Sham TENS, no TENS	Segmental, extrasegmental
Crofford et al^Citation34 NCT01888640	Parallel (n=301)	Fibromyalgia	Back/neck	Sham TENS, no TENS	Segmental, extrasegmental
Yarnitsky et al^Citation24 NCT02453399	Crossover (n=71)	Migraine	Arm	Sham TENS	Extrasegmental
Yarnitsky et al^Citation35 NCT03361423	Parallel (n=252)	Migraine	Arm	Sham TENS	Extrasegmental

Ainsworth L, Budelier K, Clinesmith M, et al. Transcutaneous electrical nerve stimulation (TENS) reduces chronic hyperalgesia induced by muscle inflammation. Pain. 2006;120(1–2):182–187. doi:10.1016/j.pain.2005.10.03016360266

 PubMed Web of Science ®Google Scholar

Somers DL, Clemente FR. The relationship between dorsal horn neurotransmitter content and allodynia in neuropathic rats treated with high-frequency transcutaneous electric nerve stimulation. Arch Phys Med Rehabil. 2003;84(11):1575–1583. doi:10.1053/S0003-9993(03)00290-914639554

 PubMed Web of Science ®Google Scholar

Somers DL, Clemente FR. Transcutaneous electrical nerve stimulation for the management of neuropathic pain: the effects of frequency and electrode position on prevention of allodynia in a rat model of complex regional pain syndrome type II. Phys Ther. 2006;86(5):698–709.16649893

 PubMed Web of Science ®Google Scholar

Somers DL, Clemente FR. Contralateral high or a combination of high- and low-frequency transcutaneous electrical nerve stimulation reduces mechanical allodynia and alters dorsal horn neurotransmitter content in neuropathic rats. J Pain. 2009;10(2):221–229. doi:10.1016/j.jpain.2008.08.00819010735

 PubMed Web of Science ®Google Scholar

Sabino GS, Santos CM, Francischi JN, de Resende MA. Release of endogenous opioids following transcutaneous electric nerve stimulation in an experimental model of acute inflammatory pain. J Pain. 2008;9(2):157–163. doi:10.1016/j.jpain.2007.09.00317988952

 PubMed Web of Science ®Google Scholar

Cho HY, Suh HR, Han HC. A single trial of transcutaneous electrical nerve stimulation reduces chronic neuropathic pain following median nerve injury in rats. Tohoku J Exp Med. 2014;232(3):207–214. doi:10.1620/tjem.232.20724646955

 PubMed Web of Science ®Google Scholar

Garrison DW, Foreman RD. Effects of Transcutaneous Electrical Nerve Stimulation (TENS) electrode placement on spontaneous and noxiously evoked dorsal horn cell activity in the cat. Neuromodulation. 2002;5(4):231–237. doi:10.1046/j.1525-1403.2002.02036.x22150851

 PubMed Web of Science ®Google Scholar

Neto MLP, Maciel LYS, Cruz KML, Filho VJS, Bonjardim LR, DeSantana JM. Does electrode placement influence tens-induced antihyperalgesia in experimental inflammatory pain model? Braz J Phys Ther. 2017;21(2):92–99. doi:10.1016/j.bjpt.2017.03.00328460716

 PubMed Web of Science ®Google Scholar

da Silva EP, Silva VR, Bernardes AS, Matuzawa F, Liebano RE. Segmental and extrasegmental hypoalgesic effects of low-frequency pulsed current and modulated kilohertz-frequency currents in healthy subjects: randomized clinical trial. Physiother Theory Pract. 2019;1–10.

 Web of Science ®Google Scholar

Brown L, Tabasam G, Bjordal JM, Johnson MI. An investigation into the effect of electrode placement of transcutaneous electrical nerve stimulation (TENS) on experimentally induced ischemic pain in healthy human participants. Clin J Pain. 2007;23(9):735–743. doi:10.1097/AJP.0b013e31814b86a918075398

 PubMed Web of Science ®Google Scholar

Chan CW, Tsang H. Inhibition of the human flexion reflex by low intensity, high frequency transcutaneous electrical nerve stimulation (TENS) has a gradual onset and offset. Pain. 1987;28(2):239–253. doi:10.1016/0304-3959(87)90119-93493465

 PubMed Web of Science ®Google Scholar

Kawamura H, Nishigami T, Yamamoto A, et al. Comparison of the pain-relieving effects of transcutaneous electrical nerve stimulation applied at the same dermatome levels as the site of pain in the wrist joint. J Phys Ther Sci. 2017;29(11):1996–1999. doi:10.1589/jpts.29.199629200643

 PubMedGoogle Scholar

Takiguchi N, Shomoto K. Contralateral segmental transcutaneous electrical nerve stimulation inhibits nociceptive flexion reflex in healthy participants. Eur J Pain. 2019;23(6):1098–1107. doi:10.1002/ejp.2019.23.issue-630707478

 PubMed Web of Science ®Google Scholar

Peng WW, Tang ZY, Zhang FR, et al. Neurobiological mechanisms of TENS-induced analgesia. Neuroimage. 2019;195:396–408. doi:10.1016/j.neuroimage.2019.03.07730946953

 PubMed Web of Science ®Google Scholar

Zoppi M, Francini F, Maresca M, Procacci P. Changes of cutaneous sensory thresholds induced by non-painful transcutaneous electrical nerve stimulation in normal subjects and in subjects with chronic pain. J Neurol Neurosurg Psychiatry. 1981;44(8):708–717. doi:10.1136/jnnp.44.8.7086975355

 PubMed Web of Science ®Google Scholar

Buonocore M, Camuzzini N, Dall’Angelo A, Mandrini S, Dalla Toffola E. Contralateral antalgic effect of high-frequency transcutaneous peripheral nerve stimulation. Pm R. 2015;7(1):48–52. doi:10.1016/j.pmrj.2014.06.01224998403

 PubMedGoogle Scholar

Lehmann WP, Strian F. Comparative effects of ipsilateral and contralateral TENS on subjective sensitization to tonic heat. Clin J Pain. 1985;1(4):211–216. doi:10.1097/00002508-198501040-00005

 Google Scholar

Eriksson MB, Rosen I, Sjolund B. Thermal sensitivity in healthy subjects is decreased by a central mechanism after TNS. Pain. 1985;22(3):235–242. doi:10.1016/0304-3959(85)90023-53875826

 PubMed Web of Science ®Google Scholar

Dean J, Bowsher D, Johnson MI. The effects of unilateral transcutaneous electrical nerve stimulation of the median nerve on bilateral somatosensory thresholds. Clin Physiol Funct Imaging. 2006;26(5):314–318. doi:10.1111/cpf.2006.26.issue-516939510

 PubMed Web of Science ®Google Scholar

Hoshiyama M, Kakigi R. After-effect of transcutaneous electrical nerve stimulation (TENS) on pain-related evoked potentials and magnetic fields in normal subjects. Clin Neurophysiol. 2000;111(4):717–724. doi:10.1016/S1388-2457(99)00299-010727923

 PubMed Web of Science ®Google Scholar

Jamison RN, Wan L, Edwards RR, Mei A, Ross EL. Outcome of a high-frequency transcutaneous electrical nerve stimulator (hfTENS) device for low back pain: a randomized controlled trial. Pain Pract. 2019;19(5):466–475. doi:10.1111/papr.2019.19.issue-530636101

 PubMed Web of Science ®Google Scholar

Dailey DL, Rakel BA, Vance CG, et al. Transcutaneous electrical nerve stimulation reduces pain, fatigue and hyperalgesia while restoring central inhibition in primary fibromyalgia. Pain. 2013;154(11):2554–2562. doi:10.1016/j.pain.2013.07.04323900134

 PubMed Web of Science ®Google Scholar

Crofford L, Daily D, Vance C, et al. Transcutaneous Electrical Nerve Stimulation (TENS) reduces pain and fatigue and improves disease impact in women with fibromyalgia: a randomized controlled trial [abstract]. Arthritis Rheumatol. 2018;70(suppl 10).

 Google Scholar

Yarnitsky D, Volokh L, Ironi A, et al. Nonpainful remote electrical stimulation alleviates episodic migraine pain. Neurology. 2017;88(13):1250–1255. doi:10.1212/WNL.000000000000376028251920

 PubMed Web of Science ®Google Scholar

Yarnitsky D, Dodick DW, Grosberg BM, et al. Remote Electrical Neuromodulation (REN) relieves acute migraine: a randomized, double-blind, placebo-controlled, multicenter trial. Headache. 2019. doi:10.1111/head.v59.8

 Web of Science ®Google Scholar