Problems, solutions, and strategies reported by users of transcutaneous electrical nerve stimulation for chronic musculoskeletal pain: Qualitative exploration using patient interviews

Cramp, Fiona; Gladwell, Peter William; Badlan, Kathryn; Palmer, Shea

Abstract

© 2016 American Physical Therapy Association. Background: 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. Objectives: 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. Design: A qualitative method using individual semistructured interviews with open questions was selected for its capacity to generate rich data. Methods: 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. Results: 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. Conclusions: 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.

• Journal Article Type: Article
• Acceptance Date: Dec 6, 2015
• Publication Date: Jul 1, 2016
• Deposit Date: Jan 5, 2016
• Publicly Available Date: Dec 17, 2016
• Journal: Physical Therapy
• Print ISSN: 0031-9023
• Electronic ISSN: 1538-6724
• Publisher: Oxford University Press (OUP)
• Peer Reviewed: Peer Reviewed
• Volume: 96
• Issue: 7
• Pages: 1039-1048
• DOI: https://doi.org/10.2522/ptj.20150272
• Keywords: musculoskeletal pain, TENS, interviews
• Public URL: https://uwe-repository.worktribe.com/output/904647
• Publisher URL: http://dx.doi.org/10.2522/ptj.20150272
• Additional Information: Additional Information : Copyright 2016 American Physical Therapy Association
• Contract Date: Jul 18, 2016