Cite as: Reeve J, Corabian P. Transcutaneous Electrical Nerve Stimulation (Tens)and Pain Management. Ottawa: Canadian Coordinating Office for Health Technology Assessment (CCOHTA); 1995.
This report is the result of a study conducted by CCOHTA to assess the effectiveness and cost-effectiveness of transcutaneous electrical nerve stimulation (TENS) used in its various applications, to determine TENS utilization in Canadian hospitals, and methods of payment for TENS services across Canada.
The use of TENS for the management of pain began in the mid-1960s and was based on the "gate control theory" that suggests pain impulses to the brain may be blocked or interrupted by the stimulation of nerve fibres. A TENS unit consists of an electronic stimulus generator and electrodes which are placed directly on the skin. It has been reported that this technology is effective in controlling pain in a number of applications and thus has been adopted by many health professionals. In Canada, TENS is usually provided by physiotherapists, in hospitals and clinics. No major adverse effects have been reported with the use of TENS.
To determine the effectiveness of TENS, a total of 55 clinical studies of TENS for acute pain, chronic pain and labour and delivery were reviewed independently by two reviewers. The studies were rated and ranked on the basis of two sets of previously published quality criteria and information was gathered in the areas of participants' characteristics, intervention/comparison groups' characteristics and outcomes. As well, to determine the methods of payment and the utilization of TENS in Canada, two surveys were developed. The first survey was sent to Ministries of Health of the twelve provincial and territorial Ministries of Health and the second survey was sent to a stratified sample of 50 public general hospitals with more than 200 beds.
According to the critical appraisal of the literature, published evidence is equivocal in acute pain treatment and there is little evidence of the effectiveness of TENS in treating chronic pain. The bulk of evidence in labour and delivery indicates that TENS is not effective; however, there is a strong component of patient satisfaction. There are no cost-effectiveness data published to date. There is a need for rigorous prospective evaluations of TENS.
Regarding reimbursement by provinces and territorial governments for TENS services, the survey reveals wide variations. Physicians are paid either for TENS services specifically or for bundles of services including TENS. Other health professionals are also paid, in various ways, for TENS services. The hospital survey indicates that TENS is administered predominantly by physiotherapists and actual utilization rates vary greatly from hospital to hospital as well as by application. The most frequent use, however, is for managing chronic pain.