Transcutaneous electrical nerve stimulation (TENS) for phantom pain and stump pain following amputation in adults: an extended analysis of excluded studies from a Cochrane systematic review

Abstract

Background:

Amputee pain may present in a body part that has been amputated (phantom pain) and/or at the site of amputation (stump pain). Mainstay treatments are pharmacological although the need for non-pharmacological management strategies has been recognized. Transcutaneous electrical nerve stimulation (TENS) is recommended as a treatment option.

Objective:

The aim of this systematic review was to inform TENS technique and dosages by undertaking an extended descriptive analysis of findings from case reports, non-randomized studies, and uncontrolled studies excluded from our previous Cochrane Review.

Methods:

A search of MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, PsycINFO, AMED, CINAHL, PEDro, and SPORTDiscus was performed for randomized controlled trials (RCTs) using any surface electrical nerve stimulation for amputee pain. Two review authors screened potential studies for inclusion.

Results:

Of the 72 articles identified by the searches, 14 were considered relevant. A descriptive analysis of the 14 studies suggested that TENS was safe and acceptable to the patients. An evaluation of the treatment protocols used to administer TENS found that there was much variation in the location of TENS electrodes, electrical characteristics, and dosing regimens used.

Conclusion:

Low quality evidence suggests TENS is safe and acceptable to patients for the treatment of phantom limb pain and stump pain. An adequately powered randomized control trial is needed to establish efficacy. Careful consideration should be given to randomization, allocation concealment, blinding, adequacy of TENS, and the timing and appropriateness of the outcome measures.

Keywords:

• Amputation
• Phantom limb pain
• Stump pain
• Systematic review
• Transcutaneous electric nerve stimulation

Acknowledgements

We would like to acknowledge the support of the Cochrane Pain, Palliative and Support Care group. The results of the original Cochrane review were previously published as part of the Cochrane Review Library (Mulvey MR, Bagnall AM, Johnson MI, Marchant PR. Transcutaneous electrical nerve stimulation (TENS) for phantom pain and stump pain following amputation in adults. Cochrane Database Syst Rev. 2010;(5):CD007264)