|The following article is part of conference coverage from the 2018 American College of Rheumatology and Association of Rheumatology Health Professionals (ACR/ARHP) Annual Meeting in Chicago, Illinois. Rheumatology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in rheumatology. Check back for the latest news from ACR/ARHP 2018 .|
CHICAGO – Transcutaneous electrical nerve stimulation (TENS) administered during physical activity may effectively alleviate fibromyalgia-associated pain, fatigue, and disease impact in women, according to a study presented at the 2018 ACR/ARHP Annual Meeting, held October 19-24, in Chicago, Illinois.
TENS is thought to confer analgesic properties through activation of endogenous opioid pathways when delivered at low frequency (ie, <10 Hz), and through indirect inhibition of small-diameter afferent fibers in the spinal cord via stimulation of large-diameter afferent fibers (referred to as the gate control theory of pain), when delivered at high frequency (ie, >50 Hz).
In this study, women aged 18 to 70 years with fibromyalgia defined by ACR 1990 criteria with pain intensity ≥4 on a 0 to 10 scale were randomly assigned to receive TENS during physical activity (active TENS; delivered on upper and lower back with mixed intensity at 200 µs pulses; n=103), placebo TENS (delivery of a 45 s-long electrical current; n=99), or no TENS (use of an inactive TENS unit; n=99).
Women were asked to use the TENS unit during physical activity for a minimum of 2 hours daily over a 1-month period. Study participants were instructed to rate their pain intensity (using the brief pain inventory), level of fatigue (with the multidimensional assessment of fatigue), disease impact (using a revised fibromyalgia impact questionnaire), and global rating of change at rest and during physical activity at baseline, during their first day using TENS, and after 1 month on an at-home TENS regimen.
Physical activity-associated pain, the study’s primary outcome, was found to be reduced after using active TENS for 1 month (mean reduction, 1.82; 95% CI, 2.39-1.25) compared with placebo TENS (mean reduction, 0.85; 95% CI, 1.43-0.27; P =.01) and no TENS (mean reduction, 0; P =.01). Activity-associated fatigue was also improved in women receiving active TENS for 1 month (mean reduction, 1.53; 95% CI, 2.23-0.83) compared with those receiving placebo TENS (mean reduction, 0.08; 95% CI, 0.79-0.63; P =.01) or no TENS (mean reduction, +0.35; P =.01).
At rest pain, pain interference and fatigue were also improved in study participants who had received active TENS for 1 month vs those who had received placebo or no TENS (P <.05 for all). Disease impact was ameliorated in women who received active vs no TENS (mean reduction, 8.48; 95% CI, 12.94-4.04 vs mean reduction, 1.39, respectively; P <.001), but not compared with placebo TENS (mean reduction, 3.42; 95% CI, 6.54-0.30; P =.07). A greater percentage of participants receiving active TENS vs placebo TENS or no TENS reported an improved global rating of change (70%, 31%, and 9%, respectively; P <.001).
“As a safe, inexpensive, home based-treatment, TENS may be included as part of the management strategy for women with [fibromyalgia],” concluded the study authors.
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Crofford L, Daily D, Vance C, Chimenti R, Merriwether E, Zimmerman MB, et al. Transcutaneous electrical nerve stimulation (TENS) reduces pain and fatigue and improves disease impact in women with fibromyalgia: A randomized controlled trial. Presented at: ACR/ARHP 2018 Annual Meeting; October 19-24, 2018; Chicago, IL. Abstract L19.
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