Wearable transcutaneous electrical nerve stimulation (TENS) reduces pain interference with activity in individuals with chronic low back pain (CLBP)

Objectives CLBP is associated with decreased function and reduced activity levels. Wearable TENS devices are placed in a predetermined anatomical location that maximizes dosage and utilization. Patients using a wearable TENS device located on the upper calf reported pain relief in CLBP. Here we determined whether wearable TENS reduces pain interference with activity in individuals with CLBP and identified predictors of wearable TENS effectiveness in reduction of pain interference with activity in CLBP.

Methods This retrospective, observational study (no case/cohort control) evaluated users of a TENS device to manage CLBP over a 10-week period. The device and companion smartphone application collected data on utilization, demographics, pain characteristics, and pain interference with activity. All data were stored in and retrieved from a cloud database. Inclusion criteria required recording the following in a cloud database: (a) age, sex, height, and weight; (b) self-reported low back pain; (c) self-reported herniated disc, spinal stenosis, or prior back injury; (d) pain duration >3 months and pain frequency at least several times a week; (e) baseline pain interference with activity (≥ 4 on an 11-point numerical rating scale); and (f) 10 weeks of TENS utilization and follow-up perceived pain levels. Individuals that logged <10 weeks of TENS data were defined as lost to follow-up. Reasons for study withdrawal included halting TENS use, failure to synchronize the device with the smartphone application, and closing the database account. Statistical analysis used multivariable regression modeling of the change in pain interference with activity with TENS use.

Results and Conclusion Pain outcomes were determined in 1441 individuals (Table).

Tab. 1 Pain catastrophizing score available for subset of participants (n = 306). SD, standard deviation.

Self-reported Demographic Data and Baseline PainAttributes (N = 1441)
Variable	Value
Mean age, years (SD)	57.7 (12.5)
Female, %	54.6
Mean BMI, kg/m2 (SD)	31.1 (7.0)
Pain duration ≥ 4 years, %	80.7
Number of anatomic pain sites (0-11), mean (SD)	5.4 (2.4)
Number of painful health conditions (0-16), mean (SD)	5.0 (2.3)
Pain catastrophizing (0-16), mean (SD)	11.5 (3.5)
Worst pain during activity, %	20.0
Pain affected by weather, %	68.4
Pain intensity (0-10), mean (SD)	6.7 (1.8)
Pain interference with sleep (0-10), mean (SD)	5.8 (2.8)
Pain interference with activity (0-10), mean (SD)	7.4 (1.8)
Pain interference with mood (0-10), mean (SD)	6.9 (2.4)

The overall population exhibited a clinically meaningful reduction (≥ 1 point) in pain interference with activity (Figure), and improvement in pain interference with activity showed a strong utilization (dose) association.

Abb 1 Change in Pain Interference With Activity

Positive predictors of wearable TENS effectiveness were greater utilization, older age, higher baseline pain interference with activity and pain during activity, and pain sensitivity to cold weather. Negative predictors of wearable TENS effectiveness were higher baseline pain intensity and pain interference with mood.

In this study population of individuals with CLBP, patients using a wearable TENS device reported reduced pain interference with activity.

Stichwörter -

Publication History

Article published online:
15 October 2020