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Long-Term Transcutaneous Electrical Nerve Stimulation (TENS) Use: Impact on Medication Utilization and Physical Therapy Costs

Chabal, Charles M.D.*; Fishbain, David A. M.D., F.A.P.A.; Weaver, Marcia M.A., Ph.D.; Heine, Lisa Wipperman M.Sc.§

The Clinical Journal of Pain: March 1998 - Volume 14 - Issue 1 - p 66-73
Review Article

Objective: A study was conducted to assess a variety of treatment outcomes in long-term users of transcutaneous electrical nerve stimulation (TENS) who suffer from chronic pain. Key components of the study examined the effects of long-term TENS therapy on pain-related medications and physical/occupational therapy (PT/OT) use.

Design: From a population of 2,003 chronic pain patients (CPPs) who acquired a TENS device (Epix XL®, Empi, Inc., St. Paul, MN, U.S.A.) for pain management, a randomly selected sample of 376 patients who used TENS were interviewed by telephone by an independent research firm. The survey assessed a variety of outcome variables including changes in medication use, number of pain-related medications, and use of PT/OT prior to TENS and after a minimum 6 months of TENS treatment. The data were subjected to a paired t test analysis. A cost simulation model was then applied to the medication and PT/OT data.

Results: The mean duration of pain, for which TENS was prescribed, was 40 ± 60 months. As compared with the period prior to TENS use, this long-term TENS user group reported a statistically significant reduction in the following types of pain medications: opiate analgesics, tranquilizers, muscle relaxants, nonsteroidal anti-inflammatory drugs (NSAIDs), and steroids. PT/OT use was also significantly reduced. Cost simulations of pain medications and PT/OT are presented.

Conclusions: Long-term use of TENS is associated with a significant reduction in the utilization of pain medication and PT/OT. In this study population, cost simulations of medication and PT/OT indicate that with long-term TENS use, costs can be reduced up to 55% for medications and up to 69% for PT/OT. The potential for TENS associated improvement, combined with reduced medication-related complications and costs, are important points that clinicians should consider when constructing a treatment plan for chronic pain patients. Finally, cost simulation techniques provide a useful tool for assessing outcomes in pain treatment and research.

*Seattle VA Medical Center and Anesthesiology Department, University of Washington School of Medicine, Seattle, Washington, U.S.A.; †Department of Psychiatry, University of Miami School of Medicine, Miami Beach, Florida, U.S.A.; ‡Department of Health Services, University of Washington, Seattle, Washington, U.S.A.; and §Department of Clinical Research, Empi, Inc., St. Paul, Minnesota, U.S.A.

Manuscript submitted December 30, 1996; revision received June 25, 1997; accepted for publication August 26, 1997.

Address correspondence and reprint requests to Dr. Charles Chabal, Seattle VA Medical Center and Anesthesiology Department, University of Washington School of Medicine, 1660 South Columbian Way, Seattle, WA 98108, U.S.A.

© Lippincott-Raven Publishers