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Transcutaneous Electrical Nerve Stimulation Reduces Resting Pain in Head and Neck Cancer Patients

A Randomized and Placebo-Controlled Double-Blind Pilot Study

Lee, Jennifer E. PhD, MA; Anderson, Carryn M. MD; Perkhounkova, Yelena PhD; Sleeuwenhoek, Brittany M. MS, BS; Louison, Rebecca R. BS

doi: 10.1097/NCC.0000000000000594

Background Individuals receiving radiation for head and neck cancer (HNC) often develop painful oral mucositis that impairs function, possibly leading to feeding tubes, hospitalization, and treatment delays. Although pharmacologic medications provide some relief, many report inadequate analgesia and adverse effects. Transcutaneous electrical nerve stimulation (TENS) is a safe, nonpharmacologic intervention; it decreases pain and analgesics and improves function, yet no studies examined TENS for HNC.

Objective The aim of this study was to examine the efficacy of TENS for pain and function in HNC patients.

Methods This study used a randomized, double-blinded crossover design; participants received 3 TENS treatments during weeks 4 to 6 of radiation: active, placebo, and no TENS over the temporomandibular joint and upper cervical region. Pain (McGill Pain Questionnaire, visual analog scale [VAS] resting and function), function (mouth opening, tongue movement, speaking), fatigue (VAS), and treatment effectiveness (VAS) were assessed before and after TENS at 3 visits.

Results Resting pain (McGill Pain Questionnaire and VAS) decreased significantly more after active TENS than placebo or no TENS; changes in function and pain with function did not differ between conditions. Active TENS decreased fatigue significantly more than no TENS and was rated as more effective than placebo TENS.

Conclusion Transcutaneous electrical nerve stimulation improves pain in HNC patients receiving radiation but not function or pain with function relative to placebo or no TENS.

Implications for Practice Transcutaneous electrical nerve stimulation may be a viable tool for radiation-induced HNC pain to complement pharmacologic approaches. This nonpharmacologic intervention could decrease the debilitating effects of radiation and analgesics, and improve quality of life. Clinical trials should examine the effects and safety of repeated, daily TENS in HNC patients receiving radiation.

Author Affiliations: Department of Psychology, Mount Mercy University (Dr Lee and Ms Louison), Cedar Rapids, Iowa; College of Nursing, The University of Iowa (Drs Lee and Perkhounkova and Ms Sleeuwenhoek), Iowa City; and Radiation Oncology, The University of Iowa Hospitals and Clinics (Dr Anderson), Iowa City.

This work was supported by the University of Iowa Interdisciplinary Pain Research Program (NIH T32 NS045549-07), the American Pain Society Future Leaders in Pain Grant, the Midwest Pain Society Addison/Blonsky Grant, and the Mount Mercy University Pathways to Scholarship program. TENS units were donated by DJO Global, Inc (Vista, California). Kathleen A. Sluka, Barbara A. Rakel, Dana L. Dailey, Carol G. Vance, Tyler S. Johnston, Gerry Funk, and Lucy Karnell provided assistance with the study design. Additional assistance with patient recruitment was provided by Lorraine Brenner, Peggy Folkmann, Jane Hershberger, and Sandy Vollstedt. Data management support was provided by Maria Hein and Sophia Chung.

The authors have no conflicts of interest to disclose.

Correspondence: Jennifer E. Lee, PhD, MA, Department of Psychology, Mount Mercy University, Cedar Rapids, IA 52402 (

Accepted for publication January 26, 2018.

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