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Foundational research could improve future transcutaneous electrical nerve stimulation evaluations

Gladwell, Peter W.; Cramp, Fiona; Palmer, Shea

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Fiona Cramp
Professor in Long Term Conditions

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Shea Palmer
Occasional Associate Lecturer - CHSS - HSW


Background and objectives: There is a lack of good quality evidence regarding the effectiveness of transcutaneous electrical nerve stimulation (TENS) for chronic musculoskeletal pain, including chronic low back pain. High quality randomised controlled trials (RCTs) have been called for to establish effectiveness over and above placebo and some guidance has already been offered regarding the design of such trials. This article expands the discussion regarding the design of future TENS trials. There is qualitative evidence of the complexity of TENS as an intervention which should be considered in future TENS evaluations. This complexity includes multiple benefits reported by patients, depending on their chosen contexts of TENS use. The ideal content and delivery of support for patients to optimise TENS use also lacks consensus. There is no evidence that a TENS education package has been designed to support the complex set of behaviours and choices which experienced users suggest are required to optimise TENS benefits. Finally, clinical and research outcomes have not been contextualised and related to the specific strategies of use. Conclusions: We suggest that research is required to develop consensus about the content and delivery of training in TENS use for patients who live with pain, informed by the experience of patients, clinicians, and researchers. Once a consensus about the content of TENS training has been reached, there is then a need to develop a TENS training course (TTC) based on this content. An effective and acceptable TTC is needed to develop the knowledge and skills required to optimise TENS use, supporting patients to build confidence in using TENS in everyday life situations with the aim of reducing the impact of chronic pain on function and quality of life. Further research is required to extend the evidence base regarding appropriate, contextualised TENS patient-reported outcomes.


Gladwell, P. W., Cramp, F., & Palmer, S. (2022). Foundational research could improve future transcutaneous electrical nerve stimulation evaluations. Medicina, 58(2), Article 149.

Journal Article Type Article
Acceptance Date Jan 14, 2022
Online Publication Date Jan 19, 2022
Publication Date Jan 19, 2022
Deposit Date Jan 25, 2022
Publicly Available Date Jan 25, 2022
Journal Medicina
Electronic ISSN 1648-9144
Publisher MDPI
Peer Reviewed Peer Reviewed
Volume 58
Issue 2
Article Number 149
Keywords transcutaneous electrical nerve stimulation; musculoskeletal pain; low back pain; patient reported outcome measures; qualitative research; complex intervention
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