Neuropathic Pain Relief Through Transcutaneous Electrical Neuromuscular Stimulation: Insights From a Systematic Review and Meta-Analysis of Clinical Evidence.

OBJECTIVE

Transcutaneous electrical neuromuscular stimulation (TENS) is a noninvasive, nonpharmacological, and least expensive technique to improve sensitivity and reduce pain in patients with neuropathy. Evidence reported on the effectiveness of TENS on neuropathy was inconclusive. This study was aimed at providing recent evidence on the effectiveness of TENS for neuropathic pain, using data from randomized controlled trials and nonrandomized studies.

METHODS

We conducted a comprehensive search across Scopus, CINAHL, Web of Science, Medline, Embase, Cochrane Central Register of Control Trials (CENTRAL), Physiotherapy Evidence Database (Pedro), and Google Scholar from January 1, 1999, to May 5, 2024. Eligible studies included randomized controlled trials and nonrandomized studies on TENS for neuropathic pain, without restrictions based on language or country. Key inclusion criteria were studies on TENS for neuropathic pain, while exclusion criteria included studies on neuropathic pain due to cancer, HIV infection, or stroke. Two independent reviewers selected studies, extracted data, and assessed quality using the GRADE tool.

RESULTS

Thirty articles met the eligibility criteria, and 25 were included in the meta-analysis. Overall, TENS slightly reduced neuropathic pain compared to placebo, but this was not clinically significant (SMD = -0.35; 95% CI: -0.90 to 0.10, p = 0.13). For patients with diabetic neuropathic pain, TENS was similar to placebo and other electrotherapies. However, it was better than placebo and other interventions for reducing neuropathic pain in spinal cord injury patients (SMD = -1.14; 95% CI: -2.22 to -0.06, p = 0.04).

CONCLUSIONS

TENS generally seems to provide a small reduction in neuropathic pain compared with a placebo, other electrotherapies, or other interventions.