Frequencies of transcutaneous electrical nerve stimulation and interferential current for chronic low back pain: a network meta-analysis.

BACKGROUND

Chronic low back pain (CLBP) is a prevalent musculoskeletal disorder. Electrotherapy modalities such as high-frequency transcutaneous electrical nerve stimulation (HF-TENS), low-frequency transcutaneous electrical nerve stimulation (LF-TENS), and interferential current (IFC) are commonly used, yet their comparative effectiveness remains unclear.

OBJECTIVES

This systematic review and network meta-analysis aimed to evaluate the comparative efficacy of HF-TENS, LF-TENS, and IFC on pain relief and functional improvement in people with CLBP.

METHODS

We systematically searched PubMed, Embase, and Scopus from database inception to 31 July 2025 for randomized controlled trials evaluating pain intensity and functional outcomes in adults with CLBP receiving HF-TENS, LF-TENS, or IFC compared to control. Data were extracted independently by two reviewers, and methodological quality was assessed using Cochrane Risk of Bias (RoB) 2 and Confidence in Network Meta-Analysis (CINeMA) framework. Network meta-analysis employed a random-effects model, with sensitivity analyses and publication bias assessment.

RESULTS

15 randomized controlled trials were analyzed using a frequentist network meta-analysis. IFC showed the greatest pain reduction (standardized mean difference, SMD -0.96; 95 % confidence interval, CI -1.49 to -0.43) and functional improvement (Oswestry Disability Index, ODI, Mean difference, MD -7.28; Roland-Morris Disability Questionnaire, RBDQ, MD -3.13) compared to controls. HF-TENS also significantly reduced pain (SMD -0.81), while LF-TENS had a non-significant effect. IFC ranked highest by P-score across outcomes. No significant inconsistency was detected, and sensitivity analyses confirmed robustness.

CONCLUSIONS

This network meta-analysis indicates that IFC and HF-TENS are likely more effective in reducing pain in people with chronic low back pain, with IFC also showing a potential advantage in improving function. These results should be interpreted with caution, given the low certainty of evidence. Nevertheless, the findings provide clinically relevant insights and support further investigation through well-designed, head-to-head trials.

DATA REGISTRATION: This review was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420251000528).