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Efficacy of Transcutaneous Electrical Nerve Stimulation (TENS) for Chronic Low-back Pain in a Multiple Sclerosis Population: A Randomized, Placebo-controlled Clinical Trial

Warke, Kim PhD*; Al-Smadi, Jamal PhD; Baxter, David PhD; Walsh, Deirdre M. PhD*; Lowe-Strong, Andrea S. PhD*

doi: 10.1097/01.ajp.0000210935.73686.79
Original Articles

Objective This study was designed to investigate the hypoalgesic effects of self-applied transcutaneous electrical nerve stimulation (TENS) on chronic low-back pain (LBP) in a multiple sclerosis (MS) population.

Methods Ninety participants with probable or definite MS (aged 21 to 78 y) presenting with chronic LBP were recruited and randomized into 3 groups (n=30 per group): (1) low-frequency TENS group (4 Hz, 200 μs); (2) high-frequency TENS group (110 Hz, 200 μs); and (3) placebo TENS. Participants self-applied TENS for 45 minutes, a minimum of twice daily, for 6 weeks. Outcome measures were recorded at weeks 1, 6, 10, and 32. Primary outcome measures included: Visual Analog Scale for average LBP and the McGill Pain Questionnaire. Secondary outcome measures included: Visual Analog Scale for worst and weekly LBP, back and leg spasm; Roland Morris Disability Questionnaire; Barthel Index; Rivermead Mobility Index; Multiple Sclerosis Quality of Life-54 Instrument, and a daily logbook. Data were analyzed blind using parametric and nonparametric tests, as appropriate.

Results Results indicated a statistically significant interactive effect between groups for average LBP (P=0.008); 1-way analysis of covariance did not show any significant effects at any time point once a Bonferonni correction was applied (P>0.05). However, clinically important differences were observed in some of the outcome measures in both active treatment groups during the treatment and follow-up periods.

Discussion Although not statistically significant, the observed effects may have implications for the clinical prescription and the use of TENS within this population.

*Health and Rehabilitation Sciences Research Institute, University of Ulster, Jordanstown, Northern Ireland

Faculty of Rehabilitation Sciences, University of Jordan, Jordan

Centre for Physiotherapy Research, School of Physiotherapy, University of Otago, New Zealand

Reprints: Deirdre M. Walsh, PhD, Health and Rehabilitation Sciences Research Institute, Faculty of Life and Health Sciences, University of Ulster, Jordanstown Campus, Shore Road, Newtownabbey, Co. Antrim BT37 0QB, N. Ireland (e-mail:

Received for publication March 19, 2005; accepted June 14, 2006

© 2006 Lippincott Williams & Wilkins, Inc.