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In transcutaneous electrical nerve stimulation (TENS) and percutaneous electrical nerve stimulation (PENS), low level electrical impulses are used to modify the pain. Properly applied, there are no side effects to treatment and TENS or PENS may be used in addition to other treatment modalities for chronic low back pain.
TENS uses electrical pulses through skin patch electrodes and PENS provides the electrical impulses through a small needle to acupuncture points. Research indicates that the frequency of electrical stimulation seems to be an important determinant of the effectiveness of PENS to reduce pain. Mixed low and high frequency stimulation was shown to be more effective than either low or high frequencies alone in the treatment of low back pain. (Ghonames 1999).
The evidence on the effectiveness of TENS for chronic low back pain is conflicting, with some trials finding it reduces pain and improves range of motion and other studies finding it no better than placebo for any outcome measures. In a recent systematic review of six clinical trials, however, evidence was found that TENS and ALTENS (acupuncture-like transcutaneous electrical nerve stimulation) reduce pain and improve range of motion in chronic back pain patients, at least in the short term (Gadsby, 2000). Success rates vary due to a variety of factors including electrode placement, how long the problem has been chronic, and previous treatments. Newer research suggests that PENS is more effective for the management of chronic low back pain caused by degenerative disk disease. In a study comparing PENS, TENS and exercise therapy, PENS produced a significant improvement over the other interventions in pain relief, improved level of activity, and use of nonopioid analgesics on a short term basis. (Ghoname 1999)
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