Dworkin RH, Turk DC, McDermott MP, Peirce-Sandner S, Burke LB, Cowan P, et al. With regard incomplete outcome data, we separately considered risk of bias assessment for 'attrition' and 'participation exclusion' domains. Similarly, we found variation of TENS application times; from 15 minutes up to hourly sessions applied four times daily. Outcome measure a VAS composite of pain and sensory symptoms. Again, this may create some discrepancy between study findings and the experience of people with neuropathic pain who use or plan to use TENS. They recommend 10 mm on a 0 mm to 100 mm VAS as the threshold for minimal importance for mean betweengroup change though they stress this should be interpreted with caution as it remains possible that estimates that fall closely below this point may still reflect a treatment that benefits an appreciable number of people. Please enable it to take advantage of the complete set of features! Baseline pain intensity post drug titration phase was compared to final pain intensity scores at four weeks. PEMF therapy can help to restore correct polarization to neurons, helping them to function properly. We judged two of the five studies in the pooled analysis investigating pain intensity with TENS versus sham TENS at low risk of bias (Buchmuller 2012; Celik 2013). 2016 Apr;13(2):295-310. doi: 10.1007/s13311-015-0415-1. Where available data were not analysed or participant data were included in group they were not originally assigned to). Before Of the 15 included studies, three reported adverse events which were minor and limited to 'skin irritation' at or around the site of electrode placement (very low quality evidence). Treatments were delivered five times per week over two weeks followed by one week washout between treatments. Two studies employed confirmatory nerve conduction studies (Casale 2013; Koca 2014), two used the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale (Celik 2013; Vitalii 2014), and one study used the Douleur Neuropathique 4 (DN4) questionnaire (zkul 2015). Oral nonopioid analgesic tablet consumption/day reduced by (mean SD) 50 19% in the PENS group and 29 17% in the TENS group posttreatment compared to pretreatment for each phase: for PENS this equated to a reduction of approximately 1 tablet/day on average (approximately 2.5 tablets/day to 1.5 tablets/day). One study (very low quality evidence, downgraded for limitations of study, inconsistency and imprecision) investigated TENS plus pharmacological therapy versus exercise plus pharmacological therapy versus plus pharmacological therapy alone for pain in participants with PDN. Pregabalin and transcutaneous electrical nerve stimulation for postherpetic neuralgia treatment, Effects of transcutaneous electrical nerve stimulation on pain in patients with spinal cord injury: a randomized controlled trial. Given that the effectiveness of TENS is widely thought to be related to the intensity of the stimulus, a true sham that establishes robust blinding of participants is not achievable (Sluka 2013). You may have considered many kinds of treatments for your chronic pain, including medication, physical therapy, and perhaps surgery. A pilot investigation of the hypoalgesic effects of transcutaneous electrical nerve stimulation upon low back pain in people with multiple sclerosis, Electrical nerve stimulation with sinusoidal modulated current therapy for pain deriving from double crash syndrome: efficacy evaluation trial. No participant dropout after TENS group randomisation. What is a nerve conduction velocity test? This is an especially helpful benefit for stroke survivors who must essentially relearn basic motor functions. postoperative or traumatic neuropathic pain; Pain intensity as measured using a visual analogue scale (VAS), numerical rating scale (NRS), verbal rating scale or Likert scale. labour pain, rheumatoid arthritis, phantom limb pain and chronic low back pain) (Brosseau 2003; Khadilkar 2008; Dowswell 2009; Johnson 2010; Johnson 2015). At least three studies on TENS and spinal cord injury pain have shown improvements in this kind of pain, which is hard to treat. We analysed primary outcomes and presented this on a continuous scale as mean difference (MD) with 95% confidence intervals (CI). None of the included studies in this review providing useable data employed a methodology whereby effect on pain intensity was assessed and reported on during TENS application which may impact on effect estimates. Neuropathic pain is defined as "pain caused by a lesion or disease of the somatosensory system" and represents a significant source of chronic pain and loss of function at both an individual and societal level (Jensen 2011). Sluka, K. Journal of the American Physical Therapy Association, May 2013. Pulses aimed at the nervous system block the transmission of pain signals from reaching the spinal cord and brain. The amount of pain relief it provides, and for how long, varies from person to person. The 15 studies included 728 participants at intake. Within this, it is estimated that 20% of people with chronic pain will have neuropathic pain characteristics, translating to an approximate prevalence of 6% to 7% in the general population (Bouhassira 2008). open list). Pain intensity at baseline was not presented or compared between groups. Theres not a lot of good research on TENS, and some of the results are conflicting. Each group further subdivided by concurrent dose of pregabalin. Where adequate data existed, we used a randomeffects model to metaanalyse outcome data from suitably homogeneous studies using Review Manager 5 (RevMan 2014). Its generally considered safe, with fewer side effects than some other types of pain relief. The study reported significantly different withingroup changes in pain intensity (VAS 010) while betweengroup testing was not. TENS followed by VI. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. Sample sizes ranged from n = 21 (Vitalii 2014), up to n = 122 (Buchmuller 2012). Due to the very low quality evidence, this Cochrane systematic review was unable to confidently state whether TENS is effective for pain relief compared to sham TENS in people with neuropathic pain. Studies show that TENS can help relieve pain from diabetic nerve damage, most commonly in the hands and feet. Within this group, the length of intervention varied in duration from four days (Tilak 2016) to two weeks (zkul 2015), three weeks (Casale 2013; Ghoname 1999; Prabhakar 2011), and eight weeks (Serry 2015). The review will be reassessed for updating in two years. Celik 2013 carried out a similar sized study in 33 participants with spinal cord injury randomised to TENS or sham TENS. Unable to accurately state gender composition of each group. One study investigated TENS versus sham TENS in participants with chronic radicular low back pain (Buchmuller 2012). A repeat baseline SF36 was not reported prior to each subsequent treatment phase with all posttreatment PCS/MCS scores being compared to the single original baseline assessment. Given that we rated the key domains of selection and blinding bias domains as high risk for Celik 2013, we investigated the effect of study quality on the pooled estimate by removing this study from the pooled analysis (see Figure 5). Random sequence generation (selection bias), Blinding of participants and personnel (performance bias). This represents a risk of bias to all sham controlled trials of TENS. You can get TENS treatments from a machine you use at home or from a device at your doctor's or physical therapist's office. Always follow the manufacturer's specific instructions. Pain and electrophysiological parameters are improved by combined 830-1064 high intensity LASER in symptomatic carpal tunnel syndrome versus transcutaneous electrical nerve stimulation, European Journal of Physical and Rehabilitation Medicine, The effect of low-frequency TENS in the treatment of neuropathic pain in patients with spinal cord injury, Studies on the concomitant use of carbamazepine and clomipramine for the relief of post herpetic neuralgia. Therefore, this review has now been stabilised following discussion with the authors and editors. For a detailed description of all studies see Characteristics of included studies and Characteristics of excluded studies table. ), #5 TOPIC: (("transcutaneous electric stimulation" or "transcutaneous electrical stimulation")), #4 TOPIC: (("electric nerve therap*" or "electrical nerve therap*" or electroanalgesi*)), #3 TOPIC: (("transcutaneous electric nerve stimulation" or "transcutaneous electrical nerve stimulation" or "transcutaneous nerve stimulation")), #2 TOPIC: (("electric nerve stimulation" or "electrical nerve stimulation" or "electrostimulation therap*" or "electrostimulation therap*"). We searched multiple databases for both published and unpublished studies. Oosterhof J, Samwel H, Boo TM, Wilder-Smith OHG, Oostendorp RAB, Crul BJP. Therefore, it is possible that a small mean betweengroup effect size might reflect that a proportion of participants responded very well to the intervention tested. We included all standard modes of TENS, regardless of the device manufacturer, in which the TENS condition delivered a clearly perceptible sensation. There was no information given with respect to the pain intensity VAS measure (mean pain, peak pain, etc.) In three of the 15 studies, some people using TENS experienced skin irritation under the electrode pads. What happens when nerves get damaged? NMES can help when the client is either unable or unwilling to volitionally elicit strong muscle contractions. Outcome measure not pain intensity. The studies investigating TENS versus usual care employed a wide range of comparative treatments which precluded pooling of data. Prabhakar 2011 investigated TENS versus cervical mobilisation versus exercise in participants with cervical radiculopathy. We included randomised controlled trials (RCTs) or quasirandomised trials (including crossover designs) of TENS applied as treatment for central or peripheral neuropathic pain of any aetiology in adults. 2018 Jun;114:e800-e808. Neuropathic pain, which is due to nerve disease or damage, represents a significant burden on people and society. Given discrepancy in treatment types and application. We found one study comparing TENS versus mirror therapy (Tilak 2016). We were unable to confidently state whether TENS is effective (compare to sham TENS) for pain relief in people with neuropathic pain. Neuropathic pain may be classified as peripheral or central in origin depending on the site of lesion or disease. This option was not required. American Academy of Orthopaedic Surgeons: Alternative Methods to Help Manage Pain After Orthopaedic Surgery., Medscape: "Transcutaneous Electrical Nerve Stimulation.". More research is needed, though. S4 ("transcutaneous electric nerve stimulation" or "transcutaneous electrical nerve stimulation" or "transcutaneous nerve stimulation"). One study reported minor skin irritation in 11 participants in the active group versus three participants in the sham group. Skin irritation was "reported in a few" TENS participants. This study reported significant differences pretreatment to posttreatment in exercise and TENS groups; however, they reported no betweengroup comparison or presented any pain intensity data. Serry 2015 investigated TENS versus exercise in 60 participants with diabetic peripheral neuropathy randomised to TENS, exercise or regular pharmacological therapy groups (20 per group). One study investigated TENS versus visual illusion in participants with neuropathic pain following spinal cord injury (zkul 2015). If you can't tolerate the side effects, the device can be shut off. Overall, we judged 11 studies at high risk of bias, and four at unclear risk. Means of the four measures obtained at day one and day 12 were calculated and used in the final analysis. The comparison was: pregabalin 300 mg plus TENS versus pregabalin 300 mg plus sham TENS, pregabalin 600 mg plus TENS versus pregabalin 600 mg plus sham TENS. mean, minimal, maximal pain) were not described. The pooled effect sizes for pain intensity were presented as MDs. Consideration may be given to further studies assessing optimal care versus optimal care plus active TENS as an acknowledgment that sham TENS methodologies may be inherently flawed. Sharing your medical history and a list of medications and supplements you take is always a smart and safe approach, too. In addition to the important dual frequency feature, the iReliev TENS +EMS has 14 programs to target acute and chronic pain, calm stiffness, muscle recovery, and much more. ("transcutaneous electric nerve stimulation" or "transcutaneous electrical nerve stimulation" or "transcutaneous nerve stimulation").tw. #1 MESH DESCRIPTOR Transcutaneous Electric Nerve Stimulation EXPLODE ALL TREES, #2 ("TENS" or "TNS" or "ENS" or "TES"):TI,AB,KY, #3 (("transcutaneous electric nerve stimulation" or "transcutaneous electrical nerve stimulation" or "transcutaneous nerve stimulation")):TI,AB,KY, #4 (("electric nerve stimulation" or "electrical nerve stimulation" or "electrostimulation therap*" or "electrostimulation therap*")):TI,AB,KY, #5 (("electric nerve therap*" or "electrical nerve therap*" or electroanalgesi*)):TI,AB,KY, #6 ( ("transcutaneous electric stimulation" or "transcutaneous electrical stimulation")):TI,AB,KY, #8 MESH DESCRIPTOR PAIN EXPLODE ALL TREES, #9 MESH DESCRIPTOR Peripheral Nervous System Diseases EXPLODE ALL TREES, #10 MESH DESCRIPTOR SOMATOSENSORY DISORDERS EXPLODE ALL TREES, #11 (((pain* or discomfor*) adj10 (central or complex or rheumat* or muscl* or nerv* or neuralgia* or neuropath*))):TI,AB,KY, #12 (((neur* or nerv*) adj6 (compress* or damag*))):TI,AB,KY, 1 exp Transcutaneous Electric Nerve Stimulation/2 ("TENS" or "TNS" or "ENS").ti.3 ("TENS" or "TNS" or "ENS").ab.4 ("transcutaneous electric$ nerve stimulation" or "transcutaneous nerve stimulation").mp.5 ("electric$ nerve stimulation" or "electrostimulation therap$" or "electrostimulation therap$").mp.6 ("electric$ nerve therap$" or electroanalgesi$).mp.7 transcutaneous electric$ stimulation.mp.8 TES.ti,ab.9 or/1810 exp PAIN/11 exp PERIPHERAL NERVOUS SYSTEM DISORDERS/12 exp SOMATOSENSORY DISORDERS/13 ((pain* or discomfor*) adj10 (central or complex or rheumat* or muscl* or nerv* or neuralgia* or neuropath*)).tw.14 ((neur* or nerv*) adj6 (compress* or damag*)).tw.15 10 or 11 or 12 or 13 or 1416 9 and 1517 randomized controlled trial.pt.18 controlled clinical trial.pt.19 randomized.ab.20 placebo.ab.21 drug therapy.fs.22 randomly.ab.23 trial.ab.24 groups.ab.25 17 or 18 or 19 or 20 or 21 or 22 or 23 or 2426 exp animals/ not humans.sh.27 25 not 2628 16 and 27, 1. exp Transcutaneous Electric Nerve Stimulation/. . Due to the small number of eligible studies, the high levels of risk of bias across the studies and small sample sizes, we rated the quality of the evidence as very low for the pooled analysis and very low individual GRADE rating of outcomes from single studies. Casale 2013 compared laser with TENS for pain intensity (on a 0 to 10 VAS) and paraesthesia in 20 participants with carpal tunnel syndrome. Unclear risk for blinding of participants (TENS vs sham, attempted to manage participant expectations of sensation but no detail on whether TENS device appeared 'live' or not). Ghoname 1999 in a onearm randomised crossover study compared percutaneous electrical nerve stimulation (PENS) versus TENS versus sham PENS in participants with lumbar radicular pain. A nerve conduction velocity (NCV) test also called a nerve conduction study (NCS) measures how fast an electrical impulse moves through your nerve. Eippert F, Bingel U, Schoell E, Yacubian J, Klinger R, Lorenz J, et al. S6 ("electric nerve therap*" or "electrical nerve therap*" or electroanalgesi*). We described the remainder of the studies in narrative form. You can choose to buy your own TENS machine withoutgetting medical advice, but it's generally better to have a proper assessment first, so you can find out whether a TENS machineis appropriate for you and be taught how to use it properly. ((effectiveness or evaluat$) adj3 (stud$ or research$)).tw. Terms of Service | Privacy Policy | Ad Policy, Electronic stimulation therapy is at the forefront of nerve damage treatment, 8 Easy Home Remedies for Peripheral Neuropathy Relief, 3 Best Essential Oils for Soothing Nerve Pain, Take Care of Your Feet with Cushy Shoes for Neuropathy, This is How to Choose a Vibration Therapy Device, One of Our Favorite Floor Vibration Devices, These 7 Foods Improve Nerve Health, Heres Why, Best Value Red Light Therapy Panel Goes to Mito, Easy Creamy Cauliflower & Potato Soup Soothes Your Souland Your Nerves, Renphro Air Compression: A Great Value for the Money, Neurochondria by Thorne: A Supplement for Nerve Pain Review, Joy Organics: The Clean Family-Owned CBD Brand, 5 Best E-Stimulation Devices for Pain and Nerve Regeneration, Whole Body Vibration Plates for Natural Nerve Damage Home Treatment. 60 participants with chronic DPN were randomised to 3 treatment groups: TENS group n = 20, exercise group n = 20, pharmacological group n = 20. There were also significant differences in final outcome measurement between groups and issues with participant/personnel blinding. The costs and consequences of adequately managed chronic non-cancer pain and chronic neuropathic pain. There were no language restrictions. Impact of low frequency transcutaneous electrical nerve stimulation on symptomatic diabetic neuropathy using the new Salutaris device. Turn on the TENS machine when the pads are attached in the correct places. The current literature indicates the imminent clinical applicability of acute brief low-frequency electrical stimulation after surgical repair to effectively promote axonal regeneration as the stimulation has yielded promising evidence to maximize functional recovery in diverse types of peripheral nerve injuries. Small study effects in meta-analyses of osteoarthritis trials: meta-epidemiological study, Treatment of neuropathic pain: an overview of recent guidelines. Pain intensity scoring in response to stimulus evoked pain. Neuropathic subgroup: TENS group: n = 71; sham TENS group: n = 68. Value of TENS for relief of chronic low back pain with or without radicular pain. Accessibility Electrode placement and the device itself were identical to active TENS. The burden of neuropathic pain: results from a cross-sectional survey, Systematic Reviews in Pain Research: Methodology Refined. Kaplan, B. Baseline demographics and site of amputation were well described and no significant differences in age, duration of phantom limb pain or pain intensity was found. No data on primary outcome of study. 12 people dropped out during/followup approximately evenly across groups. Amitriptyline for neuropathic pain and fibromyalgia in adults, Challenges in design and interpretation of chronic pain trials. A transcutaneous electrical nerve stimulation (TENS) unit is a battery-operated device that may help treat period pain, arthritis, fibromyalgia and other types of pain. Personnel high risk as the same care provider applied both active and sham treatments. Gerson 1977 compared pharmacological treatment (carbamazepine plus clomipramine) versus TENS in 29 participants with postherpetic neuralgia. Well review the research on whether CBD oil is effective. One study investigated exercise plus pharmacotherapy versus TENS plus pharmacotherapy versus pharmacotherapy alone for pain in participants with diabetic peripheral neuropathy (Serry 2015). New Device Worn on the Wrist May Help People with Hand Tremors, Transcutaneous Electrical Nerve Stimulation Unit, Stages of Osteoarthritis (OA) of the Knee. As a subgroup within this sample, 139 participants were classified as having a neuropathic component to their condition. Dowswell C, Bedwellc, Lavender T, Neilson JP. The same review authors then independently extracted data, assessed for risk of bias using the Cochrane standard tool and rated the quality of evidence using GRADE. Electrical stimulation of the vagus nerve is a common treatment for epilepsy. The majority of studies did not provide sufficient detail to allow judgement with respect to allocation concealment and we assigned them unclear risk of bias (Barbarisi 2010; Bi 2015; Casale 2013; Gerson 1977; Nabi 2015; Prabhakar 2011; Rutgers 1988; Serry 2015; Vitalii 2014). Electrical Stimulation to Enhance Axon Regeneration After Peripheral Nerve Injuries in Animal Models and Humans. TENS group: n = 17; sham TENS group: n = 16. The study reported this as a statistically significant difference although there was no information on the tests employed. Bi 2015 randomised 52 participants with spinal cord injury into TENS versus sham TENS groups. Gossrau G, Wahner M, Kuschke M, Konrad B, Reichmann H, Wiedemann B, et al. Ghoname 1999 investigated PENS versus TENS in participants with sciatica. TENS application and its stimulation of peripheral neural structures is a source of considerable large diameter afferent activity and this is therefore a plausible means of TENS induced analgesia. Not defined neuropathic pain condition in study. Healthy aging in relation to chronic pain and quality of life in Europe, Deciphering the role of endogenous opioids in high-frequency TENS using low and high doses of naloxone, Reduced analgesic effect of acupuncture-like TENS but not conventional TENS in opioid-treated patients, The role of sodium channels in chronic pain. Central neuropathic pain results from injury or disease affecting the central nervous system (spinal cord, brainstem or brain) and includes central poststroke pain, postspinal cord injury pain and pain related to multiple sclerosis. Where insufficient data were presented to enter into an otherwise viable metaanalysis, we contacted the study authors. ), #1 TOPIC: (("TENS" or "TNS" or "ENS" or "TES")), TENS or TNS or ENS or transcutaneous or TES or nerve stimulation or electrostimulat$ [Words] and pain$ or discomfor$ or compress$ or damag$ [Words] and random$ or trial$ or crossover$ or blind$ or placebo$ [Words]. TENS application is commonly described as being in either high or low frequency modes. Sabino GS, Santos CM, Francischi JN, Resende MA. Neuropathic pain is pain due to injury or disease to nerves and can be difficult to treat effectively. Lastly, in four of the five studies in the pooled analysis the clinical personnel were not blinded to treatment (Barbarisi 2010; Bi 2015; Celik 2013; Vitalii 2014). Mysliwiec A, Saulicz E, Kuszewski M, Wolny T, Saulicz M, Knapik A. We judged six out of the 15 included studies to have adequately described random sequence generation and we classified them as low risk for selection bias (Barbarisi 2010; Bi 2015; Buchmuller 2012; Casale 2013; zkul 2015; Tilak 2016). One study investigated cervical spinal joint mobilisation versus TENS versus isometric exercises for pain in participants with cervical radiculopathy (Prabhakar 2011). Pain intensity was assessed (on a 0 to 10 VAS) as a mean of the previous week's pain at baseline and three weeks after completion of treatment. We identified 10 studies that compared TENS to usual care; however, there was great diversity in the treatment provided in the usual care arm of these studies precluding any quantitative data synthesis. Inconsistencies in data presentation. Some studies did not report variance data for group means (VAS) and one study did not report group sample size. For the individual studies discussed in narrative form, the methodological limitations, quality of reporting and heterogeneous nature of interventions compared did not allow for reliable overall estimates of the effect of TENS. DOI: Electrical nerve stimulation for arthritis pain. Sham group (pregabalin 300 mg, n = 8; pregabalin 600 mg, n = 6). In terms of the two active treatments (TENS and IFT), there was an MD of 1.88 (95% CI 2.68 to 1.07, P < 0.0001) in favour of IFT. Activation of the opioidergic descending pain control system underlies placebo analgesia. It involves using a small battery operated unit to apply low level electrical currents through electrodes attached to the skin. October 14th, 2020 3 minute read Nerves can be seen as the wiring system of the body, carrying messages from the brain to the rest of the body. Epub 2023 Mar 30. Bouhassira D, Lanteri-Minet M, Attal N, Laurent B, Touboul C. Prevalence of chronic pain with neuropathic characteristics in the general population. Pain intensity mean of morning and evening. Monitoring Editor: Cochrane Pain, Palliative and Supportive Care Group. Make sure the units settings are correct before using it on your own. More and more research is showing that electronic stimulation is a viable therapy for damaged nerves, helping to actively encourage their repair and regeneration. The GRADE system uses the following criteria for assigning grade of evidence: We included a 'Summary of findings' table to present the main findings for the comparison 'TENS versus sham TENS' in a transparent and simple tabular format. Low frequency and high frequency TENS effects have been shown to be mediated via and opioid receptor classes, respectively and as such low frequency TENS effects may be limited in people using opioids for pain relief as they primarily act via opioid receptor pathways (Leonard 2010; Leonard 2011; Sluka 2013). In the total sample, there were 32 women and 28 men. This study employed concomitant treatment with gabapentin 900 mg. Chen, L. Anesthesia and Analgesia, November 1998. 2005 - 2023 WebMD LLC, an Internet Brands company. Total sample = 13 women, 10 men. s: microseconds; ACU: electroacupuncture; DN4: Douleur Neuropathique 4; DPN: diabetic peripheral neuropathy; IFT: interferential therapy; LANSS: Leeds Assessment of Neuropathic Symptoms and Signs; n: sample size; NRS: numerical rating scale; NSAID: nonsteroidal antiinflammatory drug; PENS: percutaneous electrical nerve stimulation; PRF: pulsed radiofrequency; RCT: randomised controlled trial; RDQ: RolandMorris Disability Questionnaire; SD: standard deviation; SF36: 36item Short Form; TENS: transcutaneous electrical nerve stimulation; VAS: visual analogue scale; VI: visual illusion. (2015). For TENS compared to sham TENS, five studies were suitable for pooled analysis. No dropouts reported over entire study. McDermott AM, Toelle TR, Rowbotham DJ, Schaefer CP, Dukes EM. One study investigated TENS versus acupuncture in participants with PHN (Rutgers 1988). However, serious limitations in methodology and potential bias means this result should be viewed with very limited confidence. What they all have in common, however, is that the success of treatment will be best when the underlying cause can be eliminated. Score reflected pain intensity during previous 24 hours. Whether youre recovering from an injury or stroke or dealing with the pain of fibromyalgia or another condition, you may benefit from a physical therapy procedure called electrical stimulation, or e-stim. Finsen V, Persen L, Lovlien M, Veslegaard EK, Simensen M, Gavann AK, et al. E-stim is still considered an alternative therapy. This study had very significant methodological issues including high risk of bias across multiple domains, lack of published useable data and no statistical analysis; therefore, we were unable to draw conclusions regarding relative effectiveness of the investigated interventions. Most importantly, aim to get your body in good working order by supporting it with whole anti-inflammatory nutritious foods. The parameters of the VAS pain intensity measure (e.g. Different types of peripheral nerve damage have different causes. Jensen TS, Baron R, Haanpaa M, Kalso E, Loeser JD, Rice AS, et al. The mechanisms of action of TENS is complex and depends on the localisation of the TENS stimulation. Participants who reported a 50% reduction in pain then progressed to PRF sympathectomy. While this exceeded our prespecified minimally important difference for pain outcomes, we assessed the quality of evidence as very low meaning we have very little confidence in this effect estimate and the true effect is likely to be substantially different from that reported in this review. government site. However, given the limited number of studies, we pooled data from studies in different neuropathic pain conditions but have considered whether diagnostic group appears to be a source of important heterogeneity.
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