Transcutaneous electrical nerve stimulation for the management of painful conditions: focus on neuropathic pain

The management of neuropathic pain is challenging, with medication being the first-line treatment. Transcutaneous electrical nerve stimulation (TENS) is an inexpensive, noninvasive, self-administered technique that is used as an adjunct to medication. Clinical experience suggests that TENS is beneficial providing it is administered at a sufficiently strong intensity, close to the site of pain. At present, there are too few randomized controlled trials on TENS for neuropathic pain to judge effectiveness. The findings of systematic reviews of TENS for other pain syndromes are inconclusive because trials have a low fidelity associated with inadequate TENS technique and infrequent treatments of insufficient duration. The use of electrode arrays to spatially target stimulation more precisely may improve the efficacy of TENS in the future.

[1]  P. Falcoz,et al.  Is transcutaneous electrical nerve stimulation effective in relieving postoperative pain after thoracotomy? , 2010, Interactive cardiovascular and thoracic surgery.

[2]  D. Somers,et al.  High-frequency transcutaneous electrical nerve stimulation alters thermal but not mechanical allodynia following chronic constriction injury of the rat sciatic nerve. , 1998, Archives of physical medicine and rehabilitation.

[3]  K. Ericson,et al.  Pain Relief in Labor by Transcutaneous Electrical Nerve Stimulation , 1982, Acta obstetricia et gynecologica Scandinavica.

[4]  H. Flor,et al.  Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): Somatosensory abnormalities in 1236 patients with different neuropathic pain syndromes , 2010, PAIN.

[5]  A. English,et al.  Electrical stimulation promotes peripheral axon regeneration by enhanced neuronal neurotrophin signaling , 2007, Developmental neurobiology.

[6]  J. Neilson,et al.  Transcutaneous electrical nerve stimulation (TENS) for pain relief in labour. , 2009, The Cochrane database of systematic reviews.

[7]  Xiaoshu Zhu,et al.  Transcutaneous electrical nerve stimulation for primary dysmenorrhoea , 2002 .

[8]  C. Goldsmith,et al.  Electrotherapy for neck pain. , 2009, The Cochrane database of systematic reviews.

[9]  Panos Barlas,et al.  Sensory stimulation (TENS): effects of parameter manipulation on mechanical pain thresholds in healthy human subjects , 2002, PAIN.

[10]  P. Tugwell,et al.  Transcutaneous electrical nerve stimulation (TENS) for the treatment of rheumatoid arthritis in the hand. , 2003, The Cochrane database of systematic reviews.

[11]  C. Mannheimer,et al.  Risk of Interference from Transcutaneous Electrical Nerve Stimulation on the Sensing Function of Implantable Defibrillators , 2008, Pacing and clinical electrophysiology : PACE.

[12]  R. Frantz,et al.  Effect of electrical stimulation on chronic wound healing: a meta‐analysis , 1999, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[13]  Anne-Marie Bagnall,et al.  Transcutaneous electrical nerve stimulation (TENS) for phantom pain and stump pain following amputation in adults. , 2010, The Cochrane database of systematic reviews.

[14]  J. Jahng,et al.  Thirty minutes of low intensity electrical stimulation promotes nerve regeneration after sciatic nerve crush injury in a rat model. , 2010, Acta neurologica Belgica.

[15]  M. Cotter,et al.  Nerve function in experimental diabetes in rats: effects of electrical stimulation. , 1993, American Journal of Physiology.

[16]  K. Sluka,et al.  Hypoalgesic effect of the transcutaneous electrical nerve stimulation following inguinal herniorrhaphy: a randomized, controlled trial. , 2008, The journal of pain : official journal of the American Pain Society.

[17]  J G Chen,et al.  Low-Frequency Stimulation of Afferent Aδ-Fibers Induces Long-Term Depression at Primary Afferent Synapses with Substantia Gelatinosa Neurons in the Rat , 1997, The Journal of Neuroscience.

[18]  L. Brown,et al.  The application of transcutaneous electrical nerve stimulation to acupuncture points (Acu-TENS) for pain relief: a discussion of efficacy and potential mechanisms , 2009 .

[19]  M. Herceg,et al.  Electrotherapy for the treatment of painful diabetic peripheral neuropathy: a review. , 2010, Journal of rehabilitation medicine.

[20]  Mark I. Johnson,et al.  Short-term efficacy of physical interventions in osteoarthritic knee pain. A systematic review and meta-analysis of randomised placebo-controlled trials , 2007, BMC musculoskeletal disorders.

[21]  P. Wall,et al.  Textbook of pain , 1989 .

[22]  K. Yılmaz,et al.  The effect of transcutaneous electrical nerve stimulation on postmastectomy skin flap necrosis , 2009, Breast Cancer Research and Treatment.

[23]  L. Bouter,et al.  Non-invasive physical treatments for chronic/recurrent headache. , 2004, The Cochrane database of systematic reviews.

[24]  X. Navarro,et al.  Immediate electrical stimulation enhances regeneration and reinnervation and modulates spinal plastic changes after sciatic nerve injury and repair , 2008, Experimental Neurology.

[25]  K. Sluka,et al.  Development of opioid tolerance with repeated transcutaneous electrical nerve stimulation administration , 2003, Pain.

[26]  S. Willich,et al.  Pragmatic randomized trial evaluating the clinical and economic effectiveness of acupuncture for chronic low back pain. , 2006, American journal of epidemiology.

[27]  T. Watson Transcutaneous Electrical Nerve Stimulation ( TENS ) , 2007 .

[28]  E. Carrol,et al.  Focal intense brief transcutaneous electric nerve stimulation for treatment of radicular and postthoracotomy pain. , 2001, Archives of physical medicine and rehabilitation.

[29]  S. Novak,et al.  How clinically relevant is a meta-analysis of electrical nerve stimulation when based on heterogeneous disease states? , 2007, Pain.

[30]  Mark I. Johnson,et al.  Transcutaneous electrical nerve stimulation for acute pain. , 2015, The Cochrane database of systematic reviews.

[31]  K. Westlund,et al.  Increased release of serotonin in the spinal cord during low, but not high, frequency transcutaneous electric nerve stimulation in rats with joint inflammation. , 2006, Archives of physical medicine and rehabilitation.

[32]  Mark I. Johnson,et al.  Pain: Continued uncertainty of TENS' effectiveness for pain relief , 2010, Nature Reviews Rheumatology.

[33]  M. Morari,et al.  The Influence of Electrode Size on Selectivity and Comfort in Transcutaneous Electrical Stimulation of the Forearm , 2010, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[34]  Mark I. Johnson,et al.  An investigation into the hypoalgesic effects of high- and low-frequency transcutaneous electrical nerve stimulation (TENS) on experimentally-induced blunt pressure pain in healthy human participants. , 2010, The journal of pain : official journal of the American Pain Society.

[35]  J. Willer,et al.  Transcutaneous electrical nerve stimulation: effect on peripheral nerve conduction, mechanical pain threshold, and tactile threshold in humans. , 1998, Archives of physical medicine and rehabilitation.

[36]  Claudia Pedroza,et al.  Comparison of Stochastic vs. Conventional Transcutaneous Electrical Stimulation for Pain Modulation in Patients with Electromyographically Documented Radiculopathy , 2004, American journal of physical medicine & rehabilitation.

[37]  K. Sluka,et al.  Transcutaneous electrical nerve stimulation activates peripherally located alpha-2A adrenergic receptors , 2005, Pain.

[38]  L. F. Frey Law,et al.  A new transient sham TENS device allows for investigator blinding while delivering a true placebo treatment. , 2010, The journal of pain : official journal of the American Pain Society.

[39]  T. Lundeberg,et al.  Transcutaneous electrical nerve stimulation and acupuncture , 2006 .

[40]  D. V. Reynolds,et al.  Surgery in the Rat during Electrical Analgesia Induced by Focal Brain Stimulation , 1969, Science.

[41]  Mark I. Johnson Transcutaneous Electrical Nerve Stimulation (TENS) and TENS-like devices: do they provide pain relief? , 2001 .

[42]  P. Halligan,et al.  Contralateral stimulation, using TENS, of phantom limb pain: two confirmatory cases. , 2010, Pain medicine.

[43]  R A Deyo,et al.  A controlled trial of transcutaneous electrical nerve stimulation (TENS) and exercise for chronic low back pain. , 1990, The New England journal of medicine.

[44]  M. Tramèr,et al.  Transcutaneous electrical nerve stimulation (TENS) for chronic pain. , 2000, The Cochrane database of systematic reviews.

[45]  G. Cheing,et al.  Transcutaneous Electrical Nerve Stimulation for Neuropathic Pain , 2005, Journal of hand surgery.

[46]  M. Viitanen,et al.  Stimulation with low frequency (1.7 Hz) transcutaneous electric nerve stimulation (low-tens) increases motor function of the post-stroke paretic arm. , 1998, Scandinavian journal of rehabilitation medicine.

[47]  Mark I. Johnson,et al.  Transcutaneous electrical nerve stimulation (TENS) and acupuncture for acute pain , 2008 .

[48]  M. Granat,et al.  Prevention of shoulder subluxation after stroke with electrical stimulation. , 1999, Stroke.

[49]  F. McGlone,et al.  Comparative effectiveness of different stimulation modes in relieving pain. Part I. A pilot study , 1991, Pain.

[50]  Mark I. Johnson,et al.  Transcutaneous Electrical Nerve Stimulation , 2009, Anesthesiology In-Training Exam Review.

[51]  M. Tramèr,et al.  Randomization is important in studies with pain outcomes: systematic review of transcutaneous electrical nerve stimulation in acute postoperative pain. , 1996, British journal of anaesthesia.

[52]  Adriana Clemente Mendonça,et al.  Directly applied low intensity direct electric current enhances peripheral nerve regeneration in rats , 2003, Journal of Neuroscience Methods.

[53]  T. Aziz,et al.  EFNS guidelines on neurostimulation therapy for neuropathic pain , 2007, European journal of neurology.

[54]  Ramses Forsyth,et al.  Influence of burst TENS stimulation on collagen formation after Achilles tendon suture in man. A histological evaluation with Movat's pentachrome stain. , 2005, Acta orthopaedica Belgica.

[55]  M. Akai,et al.  Effect of electrical stimulation on musculoskeletal systems; A meta‐analysis of controlled clinical trials , 2002, Bioelectromagnetics.

[56]  Influences of transcutaneous electrical stimulation of cutaneous and mixed nerves on subcortical and cortical somatosensory evoked potentials. , 1989, Electroencephalography and clinical neurophysiology.

[57]  F. McGlone,et al.  Comparative effectiveness of different stimulation modes in relieving pain. Part II. A double-blind controlled long-term clinical trial , 1991, Pain.

[58]  Bernard Laurent,et al.  Prevalence of chronic pain with neuropathic characteristics in the general population , 2008, PAIN.

[59]  J. Djurhuus,et al.  Transcutaneous electrical nerve stimulation for refractory daytime urinary urge incontinence. , 2009, The Journal of urology.

[60]  A. Baptista,et al.  High‐ and low‐frequency transcutaneous electrical nerve stimulation delay sciatic nerve regeneration after crush lesion in the mouse , 2008, Journal of the peripheral nervous system : JPNS.

[61]  B. Southwell,et al.  Improvement of quality of life in children with slow transit constipation after treatment with transcutaneous electrical stimulation. , 2009, Journal of pediatric surgery.

[62]  B. Sjölund,et al.  HAZARD FROM TRANSCUTANEOUS NERVE STIMULATION IN PATIENTS WITH PACEMAKERS , 1978, The Lancet.

[63]  K. Paik,et al.  Electrophysiological evidence for the antinociceptive effect of transcutaneous electrical stimulation on mechanically evoked responsiveness of dorsal horn neurons in neuropathic rats , 1995, Neuroscience Letters.

[64]  Tessa Gordon,et al.  Chapter 24: Electrical stimulation for improving nerve regeneration: where do we stand? , 2009, International review of neurobiology.

[65]  Thomas J. Smith,et al.  Pilot trial of a patient-specific cutaneous electrostimulation device (MC5-A Calmare®) for chemotherapy-induced peripheral neuropathy. , 2010, Journal of Pain and Symptom Management.

[66]  R. Dubinsky,et al.  Assessment: Efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence-based review) , 2010, Neurology.

[67]  W. Reenstra Inhibition of cAMP- and Ca-dependent Cl- secretion by phorbol esters: inhibition of basolateral K+ channels. , 1993, The American journal of physiology.

[68]  H. Davies,et al.  Diminishing returns or appropriate treatment strategy? – an analysis of short-term outcomes after pain clinic treatment , 1997, Pain.

[69]  D. Fishbain,et al.  Long-term transcutaneous electrical nerve stimulation (TENS) use: impact on medication utilization and physical therapy costs. , 1998, The Clinical journal of pain.

[70]  D. Walsh,et al.  An investigation of the development of analgesic tolerance to TENS in humans , 2011, PAIN®.

[71]  High-frequency transcutaneous electrical nerve stimulation (TENS) differentially modulates sensorimotor cortices: An MEG study , 2010, Clinical Neurophysiology.

[72]  Mark I. Johnson,et al.  Hypoalgesia in response to transcutaneous electrical nerve stimulation (TENS) depends on stimulation intensity. , 2011, The journal of pain : official journal of the American Pain Society.

[73]  K. Sluka,et al.  Transcutaneous electrical nerve stimulation (TENS) reduces chronic hyperalgesia induced by muscle inflammation , 2006, Pain.

[74]  C. Price,et al.  Electrical stimulation for preventing and treating post-stroke shoulder pain. , 2000, The Cochrane database of systematic reviews.

[75]  Influence of choice of electrical stimulation site on peripheral neurophysiological and hypoalgesic effects. , 2009, Journal of rehabilitation medicine.

[76]  T. Nurmikko,et al.  EFNS guidelines on pharmacological treatment of neuropathic pain , 2006, European journal of neurology.

[77]  T. Watson,et al.  Bioelectricity and microcurrent therapy for tissue healing – a narrative review , 2009 .

[78]  J. Reeves,et al.  The effects of transcutaneous electrical nerve stimulation on experimental pain and sympathetic nervous system response. , 2004, Pain medicine.

[79]  P. White,et al.  Percutaneous electrical nerve stimulation: an alternative to TENS in the management of sciatica , 1999, PAIN.

[80]  C. Peretz,et al.  Segmental noxious versus innocuous electrical stimulation for chronic pain relief and the effect of fading sensation during treatment , 2005, Pain.

[81]  C D Naylor,et al.  Meta-analysis of controlled clinical trials. , 1989, The Journal of rheumatology.

[82]  Tessa Gordon,et al.  Brief electrical stimulation accelerates axon regeneration in the peripheral nervous system and promotes sensory axon regeneration in the central nervous system. , 2009, Motor control.

[83]  Mark I. Johnson,et al.  Feasibility study of Transcutaneous Electrical Nerve Stimulation (TENS) for cancer bone pain. , 2010, The journal of pain : official journal of the American Pain Society.

[84]  R D Herbert,et al.  Analgesic effects of treatments for non-specific low back pain: a meta-analysis of placebo-controlled randomized trials. , 2009, Rheumatology.

[85]  G. Wells,et al.  Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. , 2008, The Cochrane database of systematic reviews.

[86]  R. Foreman,et al.  Decreased activity of spontaneous and noxiously evoked dorsal horn cells during transcutaneous electrical nerve stimulation (TENS) , 1994, Pain.

[87]  D. Gökçay,et al.  Quantification of the effects of transcutaneous electrical nerve stimulation with functional magnetic resonance imaging: a double-blind randomized placebo-controlled study. , 2010, Archives of physical medicine and rehabilitation.

[88]  S. Sprague,et al.  Electrical Stimulation for Fracture Healing: Current Evidence , 2010, Journal of orthopaedic trauma.

[89]  T. Jensen,et al.  The evidence for pharmacological treatment of neuropathic pain , 2010, PAIN.

[90]  Mark I. Johnson,et al.  Transcutaneous electrical nerve stimulation (TENS) can reduce postoperative analgesic consumption. A meta‐analysis with assessment of optimal treatment parameters for postoperative pain , 2003, European journal of pain.

[91]  E. Lonergan,et al.  Transcutaneous electrical nerve stimulation (TENS) for dementia. , 2003, The Cochrane database of systematic reviews.

[92]  R. Treede,et al.  Recommendations for the Pharmacological Management of Neuropathic Pain: An Overview and Literature Update SUPPLEMENT ARTICLE , 2010 .

[93]  Mark I. Johnson,et al.  Transcutaneous electric nerve stimulation (TENS) for cancer pain in adults. , 2008, The Cochrane database of systematic reviews.

[94]  T. Nurmikko,et al.  EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision , 2010, European journal of neurology.

[95]  D. Kumar,et al.  Diabetic Peripheral Neuropathy: Amelioration of Pain With Transcutaneous Electrostimulation , 1997, Diabetes Care.

[96]  P. Wall,et al.  Pain mechanisms: a new theory. , 1965, Science.

[97]  D. Walsh,et al.  Effectiveness of transcutaneous electrical nerve stimulation for treatment of hyperalgesia and pain , 2008, Current rheumatology reports.

[98]  F. Hanai,et al.  Effect of Electrical Stimulation of Peripheral Nerves on Neuropathic Pain , 2000, Spine.

[99]  Martha L. Hall,et al.  Ottawa Panel Evidence-Based Clinical Practice Guidelines for Electrotherapy and Thermotherapy Interventions in the Management of Rheumatoid Arthritis in Adults. , 2004, Physical therapy.

[100]  M. Bhandari,et al.  Electrical stimulation for long-bone fracture-healing: a meta-analysis of randomized controlled trials. , 2008, The Journal of bone and joint surgery. American volume.

[101]  D. K. Riker ASSESSMENT: EFFICACY OF TRANSCUTANEOUS ELECTRIC NERVE STIMULATION IN THE TREATMENT OF PAIN IN NEUROLOGIC DISORDERS (AN EVIDENCE-BASED REVIEW); UTILITY OF TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION IN NEUROLOGIC PAIN DISORDERS , 2010, Neurology.

[102]  P. White,et al.  Percutaneous electrical nerve stimulation: a novel analgesic therapy for diabetic neuropathic pain. , 2000, Diabetes care.

[103]  J. W. Thompson,et al.  Long Term Use of Transcutaneous Electrical Nerve Stimulation at Newcastle Pain Relief Clinic , 1992, Journal of the Royal Society of Medicine.

[104]  Mark I. Johnson,et al.  An in-depth study of long-term users of transcutaneous electrical nerve stimulation (TENS). Implications for clinical use of TENS , 1991, Pain.

[105]  S. Geuna,et al.  Electrical stimulation impairs early functional recovery and accentuates skeletal muscle atrophy after sciatic nerve crush injury in rats , 2010, Muscle & nerve.

[106]  K. Sluka,et al.  Deep tissue afferents, but not cutaneous afferents, mediate transcutaneous electrical nerve stimulation-Induced antihyperalgesia. , 2005, The journal of pain : official journal of the American Pain Society.

[107]  D. Kumar,et al.  Diabetic Peripheral Neuropathy: Effectiveness of electrotherapy and amitriptyline for symptomatic relief , 1998, Diabetes Care.

[108]  G. Steineck,et al.  Can individuals identify if needling was performed with an acupuncture needle or a non-penetrating sham needle? , 2008, Complementary therapies in medicine.

[109]  M. Schmelz,et al.  Electrically induced quantitative sudomotor axon reflex test in human volunteers , 2011, Autonomic Neuroscience.

[110]  K. Sluka,et al.  Transcutaneous electrical nerve stimulation at both high and low frequencies activates ventrolateral periaqueductal grey to decrease mechanical hyperalgesia in arthritic rats , 2009, Neuroscience.

[111]  L. Elveback,et al.  Transcutaneous electrical stimulation: a double-blind trial of its efficacy for pain G. Thorsteinsson, H.H. Stonnington, G.K. Stillwell and L.R. Elveback, Arch. phys. Med. 58 (1977) 8–13 , 1979, PAIN.

[112]  L. Chesterton,et al.  Does transcutaneous electrical nerve stimulation (TENS) produce 'dose-responses'? A review of systematic reviews on chronic pain , 2008 .

[113]  Mark I. Johnson,et al.  Transcutaneous electric nerve stimulation (TENS) for cancer pain in adults (Review) , 2008 .

[114]  D. Younger Diabetic peripheral neuropathy. , 1998, Drugs of today.

[115]  D. Somers,et al.  Contralateral high or a combination of high- and low-frequency transcutaneous electrical nerve stimulation reduces mechanical allodynia and alters dorsal horn neurotransmitter content in neuropathic rats. , 2009, The journal of pain : official journal of the American Pain Society.

[116]  Mark I. Johnson,et al.  An Investigation Into the Effect of Electrode Placement of Transcutaneous Electrical Nerve Stimulation (TENS) on Experimentally Induced Ischemic Pain in Healthy Human Participants , 2007, The Clinical journal of pain.

[117]  R. M. Glaser,et al.  The effects of functional electrical stimulation on shoulder subluxation, arm function recovery, and shoulder pain in hemiplegic stroke patients. , 1994, Archives of physical medicine and rehabilitation.

[118]  D. Somers,et al.  Transcutaneous electrical nerve stimulation for the management of neuropathic pain: the effects of frequency and electrode position on prevention of allodynia in a rat model of complex regional pain syndrome type II. , 2006, Physical therapy.

[119]  Mark I. Johnson Acupuncture-like transcutaneous electrical nerve stimulation (AL-TENS) in the management of pain , 1998 .

[120]  S. Martin,et al.  Effective treatment of symptomatic diabetic polyneuropathy by high-frequency external muscle stimulation , 2005, Diabetologia.

[121]  N. Foster,et al.  Defining an Adequate Dose of Acupuncture Using a Neurophysiological Approach – a Narrative Review of the Literature , 2008, Acupuncture in medicine : journal of the British Medical Acupuncture Society.

[122]  Shawn M Robbins,et al.  The therapeutic effect of functional and transcutaneous electric stimulation on improving gait speed in stroke patients: a meta-analysis. , 2006, Archives of physical medicine and rehabilitation.

[123]  Mark I. Johnson,et al.  Is mechanical pain threshold after transcutaneous electrical nerve stimulation (TENS) increased locally and unilaterally? A randomized placebo-controlled trial in healthy subjects. , 2007, Physiotherapy research international : the journal for researchers and clinicians in physical therapy.

[124]  S. Merkel,et al.  Use of transcutaneous electrical nerve stimulation in a young child with pain from open perineal lesions. , 1999, Journal of pain and symptom management.

[125]  J. Ochoa,et al.  NEUROPATHIC PAIN: REDEFINITION AND A GRADING SYSTEM FOR CLINICAL AND RESEARCH PURPOSES , 2009, Neurology.

[126]  Melissa Martinson,et al.  Efficacy of electrical nerve stimulation for chronic musculoskeletal pain: A meta-analysis of randomized controlled trials , 2007, PAIN.

[127]  R. Oostendorp,et al.  Predicting outcome of TENS in chronic pain: A prospective, randomized, placebo controlled trial , 2008, PAIN.

[128]  S. Willich,et al.  Acupuncture in Patients With Headache , 2008, Cephalalgia : an international journal of headache.

[129]  David Moher,et al.  Revised STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA): Extending the CONSORT Statement , 2010, PLoS medicine.

[130]  Shealy Cn,et al.  Electrical inhibition of pain by stimulation of the dorsal columns: preliminary clinical report. , 1967 .

[131]  C. Aurilio,et al.  Pregabalin and Transcutaneous Electrical Nerve Stimulation for Postherpetic Neuralgia Treatment , 2010, The Clinical journal of pain.

[132]  Tessa Gordon,et al.  Electrical stimulation promotes sensory neuron regeneration and growth-associated gene expression , 2007, Experimental Neurology.

[133]  Silvestro Micera,et al.  Array electrode design for transcutaneous electrical stimulation: a simulation study. , 2009, Medical engineering & physics.

[134]  M. A. de Resende,et al.  Release of endogenous opioids following transcutaneous electric nerve stimulation in an experimental model of acute inflammatory pain. , 2008, The journal of pain : official journal of the American Pain Society.

[135]  J. C. Mulier,et al.  The effects of electric currents on ATP generation, protein synthesis, and membrane transport of rat skin. , 1982, Clinical orthopaedics and related research.

[136]  F. R. Clemente,et al.  The relationship between dorsal horn neurotransmitter content and allodynia in neuropathic rats treated with high-frequency transcutaneous electric nerve stimulation. , 2003, Archives of physical medicine and rehabilitation.

[137]  M. Williams,et al.  A national study of the availability and use of electrophysical agents by Australian physiotherapists , 2009, Physiotherapy theory and practice.

[138]  Jay Smith,et al.  Full-thickness burn formation after the use of electrical stimulation for rehabilitation of unicompartmental knee arthroplasty. , 2005, The Journal of arthroplasty.

[139]  Tessa Gordon,et al.  Electrical Stimulation Promotes Motoneuron Regeneration without Increasing Its Speed or Conditioning the Neuron , 2002, The Journal of Neuroscience.

[140]  K. Sluka,et al.  Reduction in inflammation-induced sensitization of dorsal horn neurons by transcutaneous electrical nerve stimulation in anesthetized rats , 2001, Experimental Brain Research.

[141]  F. Tsai,et al.  Use of electrical stimulation at different current levels to promote recovery after peripheral nerve injury in rats. , 2009, The Journal of trauma.

[142]  T. Forst,et al.  Impact of low frequency transcutaneous electrical nerve stimulation on symptomatic diabetic neuropathy using the new Salutaris device. , 2004, Diabetes, nutrition & metabolism.

[143]  D. Walsh,et al.  Efficacy of Transcutaneous Electrical Nerve Stimulation (TENS) for Chronic Low-back Pain in a Multiple Sclerosis Population: A Randomized, Placebo-controlled Clinical Trial , 2006, The Clinical journal of pain.

[144]  J. Francischi,et al.  Local transcutaneous electrical stimulation (TENS) effects in experimental inflammatory edema and pain. , 2004, European journal of pharmacology.

[145]  K. Sluka,et al.  Cholecystokinin receptors mediate tolerance to the analgesic effect of TENS in arthritic rats , 2010, PAIN.

[146]  T Gordon,et al.  Brief Electrical Stimulation Promotes the Speed and Accuracy of Motor Axonal Regeneration , 2000, The Journal of Neuroscience.

[147]  Jan,et al.  Long-term TENS treatment improves tactile sensitivity in MS patients , 2013 .

[148]  K. Sluka,et al.  Blockade of NMDA receptors prevents analgesic tolerance to repeated transcutaneous electrical nerve stimulation (TENS) in rats. , 2008, The journal of pain : official journal of the American Pain Society.

[149]  K. Sluka,et al.  Transcutaneous Electrical Nerve Stimulation at Both High and Low Frequencies Reduces Primary Hyperalgesia in Rats With Joint Inflammation in a Time-Dependent Manner , 2007, Physical Therapy.

[150]  A. García‐Díez,et al.  Unusual allergic contact dermatitis produced by a transcutaneous electrical nerve stimulator , 2010, Contact dermatitis.

[151]  C. Norrbrink Transcutaneous electrical nerve stimulation for treatment of spinal cord injury neuropathic pain. , 2009, Journal of rehabilitation research and development.

[152]  L. Lazarou,et al.  Effects of Intensity of Transcutaneous Electrical Nerve Stimulation (TENS) on Pressure Pain Threshold and Blood Pressure in Healthy Humans: A Randomized, Double-blind, Placebo-controlled Trial , 2009, The Clinical journal of pain.

[153]  C. Shealy,et al.  Transcutaneous nerve stimulation for control of pain. — A preliminary technical note , 1975, Pain.

[154]  Martha L. Hall,et al.  Ottawa Panel Evidence-Based Clinical Practice Guidelines for Electrotherapy and Thermotherapy Interventions in the Management of Rheumatoid Arthritis in Adults , 2004 .

[155]  K. Sluka,et al.  Blockade of opioid receptors in rostral ventral medulla prevents antihyperalgesia produced by transcutaneous electrical nerve stimulation (TENS). , 2001, The Journal of pharmacology and experimental therapeutics.

[156]  K. Sluka,et al.  Spinal blockade of opioid receptors prevents the analgesia produced by TENS in arthritic rats. , 1999, The Journal of pharmacology and experimental therapeutics.

[157]  Mark I. Johnson,et al.  An investigation of the hypoalgesic effects of TENS delivered by a glove electrode. , 2009, The journal of pain : official journal of the American Pain Society.

[158]  L. Brosseau,et al.  Evidence-informed management of chronic low back pain with transcutaneous electrical nerve stimulation, interferential current, electrical muscle stimulation, ultrasound, and thermotherapy. , 2008, The spine journal : official journal of the North American Spine Society.

[159]  Mark I. Johnson,et al.  Does the pulse frequency of transcutaneous electrical nerve stimulation (TENS) influence hypoalgesia?: A systematic review of studies using experimental pain and healthy human participants , 2008 .

[160]  T. Le,et al.  Epidemiology, public health burden, and treatment of diabetic peripheral neuropathic pain: a review. , 2007, Pain medicine.

[161]  Mark I. Johnson,et al.  A comparison of transcutaneous electrical nerve stimulation (TENS) at 3 and 80 pulses per second on cold‐pressor pain in healthy human participants , 2010, Clinical physiology and functional imaging.

[162]  E. Hendriks,et al.  Transcutaneous electrostimulation for osteoarthritis of the knee. , 2009, The Cochrane database of systematic reviews.

[163]  G. Wasner,et al.  Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment , 2010, The Lancet Neurology.

[164]  B. Sjölund,et al.  ACUPUNCTURELIKE ELECTROANALGESIA IN TNS-RESISTANT CHRONIC PAIN , 1976 .

[165]  A. Köke,et al.  Pain reducing effect of three types of transcutaneous electrical nerve stimulation in patients with chronic pain: a randomized crossover trial , 2004, Pain.

[166]  J. Mortimer,et al.  Electrical Inhibition of Pain by Stimulation of the Dorsal Columns: Preliminary Clinical Report , 1967, Anesthesia and analgesia.

[167]  A. Vickers,et al.  Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting. , 2006, The Cochrane database of systematic reviews.

[168]  R. Foreman,et al.  Effects of transcutaneous electrical nerve stimulation (TENS) on spontaneous and noxiously evoked dorsal horn cell activity in cats with transected spinal cords , 1996, Neuroscience Letters.

[169]  Mark I. Johnson Transcutaneous Electrical Nerve Stimulation (TENS) , 2012 .

[170]  Mark I. Johnson,et al.  A cochrane systematic review of transcutaneous electrical nerve stimulation for cancer pain. , 2009, Journal of pain and symptom management.

[171]  Mark I. Johnson,et al.  An investigation into the effects of frequency-modulated transcutaneous electrical nerve stimulation (TENS) on experimentally-induced pressure pain in healthy human participants. , 2009, The journal of pain : official journal of the American Pain Society.

[172]  Blair H. Smith,et al.  NeuPSIG guidelines on neuropathic pain assessment , 2011, PAIN®.

[173]  C. Farquhar,et al.  Transcutaneous electrical nerve stimulation and acupuncture for primary dysmenorrhoea. , 2002, The Cochrane database of systematic reviews.

[174]  R. Verdonk,et al.  Influence of burst TENS stimulation on the healing of Achilles tendon suture in man. , 2003, Acta orthopaedica Belgica.

[175]  R. Foreman,et al.  Effects of prolonged transcutaneous electrical nerve stimulation (TENS) and variation of stimulation variables on dorsal horn cell activity in cats , 1997 .

[176]  M. Somers,et al.  Treatment of neuropathic pain in a patient with diabetic neuropathy using transcutaneous electrical nerve stimulation applied to the skin of the lumbar region. , 1999, Physical therapy.

[177]  C. Price,et al.  Electrical stimulation for preventing and treating post-stroke shoulder pain: a systematic Cochrane review , 2001, Clinical rehabilitation.

[178]  K. Sluka,et al.  Modulation between high- and low-frequency transcutaneous electric nerve stimulation delays the development of analgesic tolerance in arthritic rats. , 2008, Archives of physical medicine and rehabilitation.

[179]  M. Leandri,et al.  Comparison of TENS treatments in hemiplegic shoulder pain. , 2015, Scandinavian journal of rehabilitation medicine.

[180]  T. Yan,et al.  Effect of transcutaneous electrical nerve stimulation on symptomatic diabetic peripheral neuropathy: a meta-analysis of randomized controlled trials. , 2010, Diabetes research and clinical practice.

[181]  J. Sim,et al.  Effects of simultaneous dual‐site TENS stimulation on experimental pain , 2008, European journal of pain.

[182]  Panos Barlas,et al.  Effects of TENS frequency, intensity and stimulation site parameter manipulation on pressure pain thresholds in healthy human subjects , 2003, Pain.

[183]  K. Paik,et al.  Differential antinociceptive effect of transcutaneous electrical stimulation on pain behavior sensitive or insensitive to phentolamine in neuropathic rats , 2001, Neuroscience Letters.