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Complementary & Alternative Medicine
Index Of Alternative Therapies And Modalities
Transcutaneous Electrical Nerve Stimulation
Transcutaneous Electrical Nerve Stimulation
When deciding to begin a complementary therapy or to see a complementary practitioner, first speak with your primary health care provider.
Transcutaneous Electrical Nerve Stimulation
Before engaging in any complementary medical technique, you should be aware that many of these techniques have not been evaluated in scientific studies. Often, only limited information is available about their safety and effectiveness. Each state and each discipline has its own rules about whether practitioners are required to be professionally licensed. If you plan to visit a practitioner, it is recommended that you choose one who is licensed by a recognized national organization and who abides by the organization's standards. It is always best to speak with your primary health care provider before starting any new therapeutic technique.
Transcutaneous electrical nerve stimulation (TENS) involves the passage of low-voltage electrical current to electrodes pasted on the skin. The current is delivered through wires from a small battery-powered power unit. The frequency and intensity of this treatment depend on the specific condition and treatment goals. Accordingly, the electrode pads are placed in various sites on the body. Frequency, intensity, and site of application are believed to be pivotal to achieving optimal effects during and after stimulation.
TENS is most commonly used for pain management. There are different types of TENS:
- Conventional TENS High- or low-frequency electrical current is applied, often near affected areas.
- Acupuncture-like TENS Lower-frequency current is used at specific trigger points.
- Auricular TENS Electrical current is applied to the ear
Electricity has been used medicinally for thousands of years. Stone carvings from ancient Egypt depict electric fish being used to treat pain. In ancient Greece, electrogenic torpedo fish were used to treat arthritis and headache.
There are several proposed explanations for how TENS may work:
- It may affect the nerves that perceive pain or light touch.
- It may interfere with nerve pathways.
- It may alter the natural chemicals (such as encephalins, endorphins, opioids or substance P) that affect the way pain is perceived and transmitted.
None of these mechanisms has been clearly demonstrated in scientific research, and the basis of potential activity of TENS is controversial.
Theories traditionally used to explain acupuncture, such as effects on flow of vital energy, have also been offered to explain TENS. It is sometimes suggested that TENS may affect the cardiovascular system, increasing heart rate and reducing blood pressure.
Scientists have studied TENS for the following health problems:
TENS is most often used to treat pain and is suggested to treat a wide variety of acute and chronic pain associated with cancer, cancer treatments, burns, amputation (phantom limb pain), and other causes. TENS has also been studied as anesthesia for medical procedures and surgeries. Several studies support the effectiveness of TENS for some types of pain. However, TENS as a pain treatment is controversial, and more conclusive research is needed.
There is some evidence that TENS may relieve various kinds of joint pain, such as knee osteoarthritis, patellofemoral syndrome, and temporomandibular joint pain. However, the long-term benefits are unclear. Better research is needed to make a strong recommendation.
A small amount of early research reports that TENS may improve some symptoms of Alzheimer's disease, such as mood, memory and cycles of daily rest and activity. Better studies are necessary to make a conclusion.
TENS may be used to treat cardiovascular conditions such as angina (chest pain from heart disease) and cardiac ischemia (lack of blood flow to the heart). Further study is needed before conclusions can be drawn regarding the effectiveness of TENS in this area. People with heart disease or chest pain are advised to seek immediate medical attention from a licensed physician. Many well-studied drugs for heart disease are available
TENS has used to treat numerous autoimmune disorders, including rheumatoid arthritis, ankylosing spondylitis (arthritis of the spine), and Sjögren's syndrome. However, there is not enough scientific evidence that TENS is an effective treatment for these conditions.
TENS or acupuncture-like TENS has been used to treat pain affecting the back, neck, and shoulders. TENS is also reported to reduce the recurrence of spinal disk hernias. However, it remains unclear if TENS is beneficial. Better research is needed to make a firm conclusion.
Dysmenorrhea (painful menstruation)
Several small studies report that TENS may reduce short-term discomfort and the need for pain medications. However, this research has not produced conclusive results. Better-designed trials are needed to make a firm conclusion.
There is some evidence that TENS may have some benefits in patients with migraines, cluster headaches, or chronic headaches. However, the research has not produced conclusive results. Better research is needed to make a firm conclusion.
TENS has been proposed as a treatment for nerve disorders, such as hemiplegia (paralysis on one side of the body) and spasticity in multiple sclerosis. TENS has also been used to treat nerve pain (neuralgia) resulting from bruxism (teeth grinding) and spinal chord injuries. However, there is not enough evidence that TENS is effective in treating nerve disorders.
The use of TENS for labor pain is controversial. Although several studies have been conducted, the results have not been conclusive. More studies are needed to make a firm conclusion. It is not clear if passage of electricity using TENS has harmful effects on the fetus.
There is not enough high-quality scientific evidence to conclude whether TENS is effective in treating fibromyalgia.
TENS has been suggested as a treatment for nausea during pregnancy or after surgery. However, there is not enough high-quality scientific evidence to draw a firm conclusion about effectiveness of TENS for preventing nausea or vomiting. It is also unclear if TENS used during pregnancy is safe for the unborn child. More research is needed.
Pain from broken bones/acute trauma
There is some evidence that TENS may relieve pain from broken bones and other physical trauma. However, more research is needed before TENS can be recommended to treat pain from broken bones.
Diabetic peripheral neuropathy (nerve pain)
TENS has been suggested as a treatment for peripheral neuropathy in diabetics. However, there is not enough evidence that this is an effective treatment.
Shingles (post-herpetic neuralgia)
Early research does not provide enough high-quality scientific evidence to draw a firm conclusion about effectiveness of TENS in post-herpetic neuralgia.
There are multiple studies of TENS being used to treat pain after different types of surgery, including abdominal surgery, heart surgery, lung surgery, gynecologic surgery and orthopedic surgery. Some studies report benefits (less pain, less pain with movement, or less need for pain medications), and others find no improvements. Better-quality research is needed to make a firm conclusion.
There is some evidence that TENS is beneficial in stroke rehabilitation. TENS may improve motor function in stroke patients. Further research is needed to draw a firm conclusion about effectiveness.
TENS has been reported to help heal skin wounds and skin ulcers. However, there is not enough evidence that TENS is an effective treatment for wound healing.
Urinary incontinence, overactive bladder, detrusor instability
Although several studies have supported using TENS to treat urinary incontinence, high-quality evidence is lacking.
Spinal muscular atrophy (in children)
Although TENS therapy has been suggested for children with spinal muscular atrophy, the limited evidence does not support its effectiveness.
One small study of gastroparesis patients receiving percutaneous electrical nerve stimulation (similar to TENS) reported favorable effects. It is uncertain if these results would be seen with TENS therapy.
Some evidence suggests that TENS could be useful for breathing difficulties, such as in burn patients or in adjunct to other components in a rehabilitation program for chronic obstructive pulmonary disease (COPD). This early research does not provide enough high-quality scientific evidence to draw a firm conclusions.
Carpal tunnel syndrome
TENS therapy have been studied as a treatment for carpel tunnel syndrome. Although the early evidence is encouraging, more research is needed.
Soft tissue injury
TENS therapy has been used for treating soft tissue injuries, such as tendonitis and tendon injuries. However, results have been mixed. Further research is needed.
In a small study, patients with multiple sclerosis treated with TENS showed a trend toward improvement. Larger, well-designed studies are needed before conclusions can be drawn.
Claudication (leg pain due to poor blood flow)
Some evidence suggests chronic electrical muscle stimulation may be beneficial for the relief of intermittent claudication symptoms. Further evidence is needed before drawing a firm conclusion.
Attention-deficit hyperactivity disorder (ADHD)
A small study found a moderate benefit in children with ADHD, but further research is warranted before a firm conclusion can be drawn.
There is some evidence that TENS improves mood and mild cognitive impairment in otherwise healthy elderly patients. However, this early research does not provide enough high-quality scientific evidence about effectiveness.
Low blood pressure
There is some evidence that TENS reduces the severity of low blood pressure in patients undergoing Cesarean section. More studies are needed to recommend TENS as a safe and effective treatment for low blood pressure.
Tinnitus (ringing in the ear)
TENS may relieve the symptoms of tinnitus, especially when the tinnitus is not caused by other conditions. More research is needed in this area.
TENS has been used in therapy for autistic children, although the benefits remain unclear. More research is needed to determine whether TENS is an effective form of therapy for autism.
TENS has been reported to aid weight loss in obese subjects. However, evidence is limited and the effectiveness of TENS in weight loss remains unclear.
TENS has been shown to help regulate hormonal balance in women undergoing menopause. However, the effect of TENS on menopausal symptoms has not been closely examined.
There is limited evidence that TENS effectively treats depression and increases the effectiveness of depression medications. However, the evidence thus far does not support the use of TENS alone or in combination therapies for depression.
Treatment with TENS has been reported to relieve constipation with no adverse effects. However, there is limited evidence that this treatment is effective or superior to other treatments.
TENS has been used to treat patients with acute pancreatitis. However, benefits are unclear, and there is not enough evidence to recommend TENS for treating pancreatic disorders.
TENS has been reported to relieve the symptoms of seasonal allergies, though the benefits are not well understood. More research is recommended.
Muscle strength (physical performance)
It has been reported that physical recovery after exercise improves with TENS therapy. TENS has been also used to increase muscle strength, suggesting potential benefits in physical therapy and rehabilitation. Although results have been encouraging, more research may support its use in physical rehabilitation programs.
TENS has been combined with magnet therapy for the treatment of heartburn. However, the effectiveness is unclear, and there is not enough evidence to recommend TENS for the treatment of stomach complaints.
Blood flow disorders
There is some evidence that TENS can enhance blood flow, especially after surgical procedures. However, it is unclear whether TENS is an effective treatment for blood flow disorders.
There is some evidence to suggest that TENS may improve the symptoms associated with Raynaud's disease. Further research is needed to determine effectiveness.
Relief from notalgia paresthetica, a type of itching, has been reported with TENS. More study is needed to recommend TENS as an effective treatment for itch.
There is limited evidence that TENS decreases uric acid levels in the blood, which suggests that it may be an effective treatment for gout. However, more evidence is needed to recommend TENS in the treatment or prevention of gout.
TENS has been suggested for many uses, based on tradition or on scientific theories. However, these uses have not been thoroughly studied in humans, and there is limited scientific evidence about safety or effectiveness. Some of these suggested uses are for conditions that are potentially life-threatening. Consult with a health care provider before using TENS for any use.
Enhanced blood flow in the brain
Enhanced blood perfusion of the uterus and placenta
High blood pressure
Irritable bowel syndrome
Sickle cell anemia pain
Sphincter of Oddi disorders
In general, TENS is reported as being well tolerated, although research on safety is limited. Skin irritation and redness are the most common side effects, occurring in up to one-third of people. Electrode paste may cause hives, welts or allergic skin reactions (contact dermatitis). Electrical burns may occur with excessive use or improper technique.
Because there is a risk of burns, TENS should be used with caution in people with decreased sensation, such as people with neuropathy. TENS should not be used in people with implanted medical devices such as cardiac defibrillators, pacemakers, intravenous infusion pumps or hepatic artery infusion pumps. Electrical shock or device malfunction may occur.
There are isolated reports of several other side effects, including fluid buildup in the lung, partial collapse of the lung, loss of sensation, pain or unpleasant sensations (near or away from the site of TENS), increased hair growth, headache, muscle aches, nausea, agitation and dizziness. It is not clear if TENS caused these problems. Seizures have been reported, and TENS should be used cautiously in people with seizure disorders. It is sometimes suggested that TENS may affect the cardiovascular system, increasing heart rate and reducing blood pressure.
Although multiple studies have used TENS for pain relief during childbirth, evidence about its safety is limited, and a theoretical risk of harm to the fetus exists. Elevations in fetal heart rate and interference with fetal heart monitoring equipment have been reported. This technique should not be used unless under the strict supervision of an experienced licensed health care practitioner. Safety of TENS is not established in children.
TENS is most commonly used to manage pain, although it has been recommended or studied for many other medical conditions. Preliminary evidence suggests that TENS may be beneficial in the control of dental procedure pain and knee osteoarthritis symptoms. Other uses of TENS have not been sufficiently studied to draw firm conclusions. Skin reactions may occur. People with implanted medical devices should avoid TENS. TENS should be used cautiously and only under medical supervision in pregnant women, children and people with seizure disorders.
The information in this monograph was prepared by the professional staff at Natural Standard, based on thorough systematic review of scientific evidence. The material was reviewed by the Faculty of the Harvard Medical School with final editing approved by Natural Standard.
- Natural Standard: An organization that produces scientifically based reviews of complementary and alternative medicine (CAM) topics
- National Center for Complementary and Alternative Medicine (NCCAM): A division of the U.S. Department of Health & Human Services dedicated to research
Selected Scientific Studies: Transcutaneous Electrical Nerve Stimulation
Natural Standard has reviewed all of the currently available medical literature to prepare the professional monograph from which this version was created.
Some of the more recent studies are listed below:
- Abell TL, Van Cutsem E, Abrahamsson H, et al. Gastric electrical stimulation in intractable symptomatic gastroparesis. Digestion 2002;66(4):204-212.
- Allais G, De Lorenzo C, Quirico PE, et al. Non-pharmacological approaches to chronic headaches: transcutaneous electrical nerve stimulation, lasertherapy and acupuncture in transformed migraine treatment. Neurol Sci 2003;May, 24(Suppl 2):138-142.
- Al-Smadi J, Warke K, Wilson, et al. A pilot investigation of the hypoalgesic effects of transcutaneous electrical nerve stimulation upon low back pain in people with multiple sclerosis. Clin Rehabil 2003;17(7):742-749.
- Alvarez-Arenal A, Junquera LM, Fernandez JP, et al. Effect of occlusal splint and transcutaneous electric nerve stimulation on the signs and symptoms of temporomandibular disorders in patients with bruxism. J Oral Rehabil 2002;Sep, 29(9):858-863.
- Amarenco G, Ismael SS, Even-Schneider A, et al. Urodynamic effect of acute transcutaneous posterior tibial nerve stimulation in overactive bladder. J Urol 2003;Jun, 169(6):2210-2215.
- Anderson SI, Whatling P, Hudlicka O, et al. Chronic transcutaneous electrical stimulation of calf muscles improves functional capacity without inducing systemic inflammation in claudicants. Eur J Vasc Endovasc Surg 2004;27(2):201-209.
- Arai YC, Kato N, Matsura M, et al. Transcutaneous electrical nerve stimulation at the PC-5 and PC-6 acupoints reduced the severity of hypotension after spinal anaesthesia in patients undergoing Caesarean section. Br J Anaesth 2008;Jan, 100(1):78-81.
- Avraham F, Aviv S, Ya'akobi P, et al. The efficacy of treatment of different intervention programs for patellofemoral pain syndrome: a single blinded randomized clinical trial. Pilot study. ScientificWorldJournal 2007;Aug 24, 7:1256-1262.
- Bloodworth DM, Nguyen BN, Garver W, et al. Comparison of stochastic vs. conventional transcutaneous electrical stimulation for pain modulation in patients with electromyographically documented radiculopathy. Am J Phys Med Rehabil 2004;83(8):584-5591.
- Bodofsky E. Treating carpal tunnel syndrome with lasers and TENS. Arch Phys Med Rehabil 2003;83(12):1806-1807.
- Bourjeily-Habr G, Rochester CL, Alermo F, et al. Randomised controlled trial of transcutaneous electrical muscle stimulation of the lower extremities in patients with chronic obstructive pulmonary disease. Thorax 2002;Dec, 57(12):1045-1049.
- Breit R, Van der Wall H. Transcutaneous electrical nerve stimulation for postoperative pain relief after total knee arthroplasty. J Arthroplasty 2004;19(1):45-48.
- Brosseau L, Milne S, Robinson V, et al. Efficacy of the transcutaneous electrical nerve stimulation for the treatment of chronic low back pain: a meta-analysis. Spine 2003;27(6):596-603.
- Burssens P, Forsyth R, Steyaert A, et al. Influence of burst TENS stimulation on the healing of Achilles tendon suture in man. Acta Ortho Belg 2003;69(6):528-532.
- Cabioglu MT, Ergene N, Tan U. Electroacupuncture treatment of obesity with psychological symptoms. Int J Neurosci 2007;May, 117(5):579-590.
- Campbell TS, Ditto B. Exaggeration of blood pressure-related hypoalgesia and reduction of blood pressure with low frequency transcutaneous electrical nerve stimulation. Psychophysiology 2002;Jul, 39(4):473-481.
- Carroll D, Moore RA, McQuay HJ, et al. Transcutaneous electrical nerve stimulation (TENS) for chronic pain (Cochrane Review). Cochrane Database of Systemic Reviews 2001;4.
- Cheing GL, Hui-Chan CW, Chan KM. Does four weeks of TENS and/or isometric exercise produce cumulative reduction of osteoarthritic knee pain? Clin Rehabil 2003;16(7):749-760.
- Cheing GL, Hui-Chan CW. Would the addition of TENS to exercise training produce better physical performance outcomes in people with knee osteoarthritis than either interventioin alone. Clin Rehabil 2004;18(5):487-497.
- Cheing GL, Tsui AY, Lo SK, et al. Optimal stimulation duration of tens in the management of osteoarthritic knee pain. J Rehabil Med 2003;Mar, 35(2):62-68.
- Chesterton LS, Barlas P, Foster NE, et al. Sensory stimulation (TENS): effects of parameter manipulation on mechanical pain thresholds in healthy human subjects. Pain 2002;Sep, 99(1-2):253-262.
- Chesterton LS, Foster NE, Wright CC, et al. Effects of TENS frequency, intensity and stimulation site parameter manipulation on pressure pain thresholds in healthy human subjects. Pain 2003;106(1-2):73-80.
- Cheung LC, Jones AY. Effect of Acu-TENS on recovery heart rate after treadmill running exercise in subjects with normal health. Complement Ther Med 2007;Jun, 15(2):109-114.
- Coloma M, White PF, Ogunnaike BO, et al. Comparison of acustimulation and ondansetron for the treatment of established postoperative nausea and vomiting. Anesthesiology 2002;Dec, 97(6):1387-1392.
- Cramp FL, McCullough GR, Lowe AS, et al. Transcutaneous electric nerve stimulation: the effect of intensity on local and distal cutaneous blood flow and skin temperature in healthy subjects. Arch Phys Med Rehabil 2002;Jan, 83(1):5-9.
- Crevenna R, Posch M, Sochor A, et al. Optimizing electrotherapy: a comparative study of 3 different currents [Article in German]. Wien Klin Wochenschr 2002;Jun 14, 114(10-11):400-404.
- De Angelis C, Perrone G, Santoro G, et al. Suppression of pelvic pain during hysteroscopy with a transcutaneous electrical nerve stimulation device. Fertil Steril 2003;Jun, 79(6):1422-1427.
- de Tommaso M, Fiore P, Camporeale A, et al. High and low frequency transcutaneous electrical nerve stimulation inhibits nociceptive responses induced by CO2 laser stimulation in humans. Neurosci Lett 2003;May 15, 342(1-2):17-20.
- Fagade OO, Obilade TO. Therapeutic effect of TENS on post-IMF trismus and pain. Afr J Med Med Sci 2003;32(4):391-394.
- Fehlings DL, Kirsch S, McComas A, et al. Evaluation of therapeutic electrical stimulation to improve muscle strength and function in children with types II/III spinal muscular atrophy. Dev Med Child Neurol 2002;Nov, 44(11):741-744.
- Forst T, Nguyen M, Forst S. Impact of low frequency transcutaneous electrical nerve stimulation on symptomatic diabetic neuropathy using a new Salutaris device. Diabetes Nutr Metab 2004;17(3):163-168.
- Guo Y, Shi X, Uchiyama H, et al. A study on the rehabilitation of cognitive function and short-term memory in patients with Alzheimer's disease using transcutaneous electrical nerve stimulation. Front Med Biol Eng 2002;11(4):237-247.
- Hardy SG, Spaulding TB, Liu H, et al. The effect of transcutaneous electrical stimulation on spinal motor neuron excitability in people without known neuromuscular diseases: the roles of stimulus intensity and location. Phys Ther 2002;Apr, 82(4):354-363. Erratum in: Phys Ther 2002;May, 82(5):527.
- Herraiz C, Toledano A, Diges I. Trans-electrical nerve stimulation (TENS) for somatic tinnitus. Prog Brain Res 2007;166:389-394.
- Hettrick HH, O'Brien K, Laznick H, et al. Effect of transcutaneous electrical nerve stimulation for the management of burn pruritus: a pilot study. J Burn Care Rehabil 2004;25(3):236-240.
- Hou CR, Tsai LC, Cheng KF, et al. Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity. Arch Phys Med Rehabil 2002;Oct, 83(10):1406-1414.
- Hsieh RL, Lee WC. One-shot percutaneous electrical nerve stimulation vs. transcutaneous electrical nerve stimulation for low back pain: comparison of therapeutic effects. Am J Phys Med Rehabil 2003;81(11):838-843.
- Hsieh RL, Wang LY, Lee WC. Additional therapeutic effects of electroacupuncture in conjunction with conventional rehabilitation for patients with first-ever ischaemic stroke. J Rehabil Med 2007;Apr, 39(3):205-211.
- Huang LP, Zhou S, Lu Z, et al. Bilateral effect of unilateral electroacupuncture on muscle strength. J Altern Complement Med 2007;Jun, 13(5):539-546.
- Johansson BB, Haker E, von Arbin M, et al. Acupuncture and transcutaneous nerve stimulation in stroke rehabilitation: a randomized, controlled trial. Stroke 2001;32(3):707-713.
- Johnson CA, Wood DE, Swain ID, et al. A pilot study to investigate the combined use of botulinum neurotoxin type a and functional electrical stimulation, with physiotherapy, in the treatment of spastic dropped foot in subacute stroke. Artif Organs 2002;Mar, 26(3):263-266.
- Johnson M, Martinson M. Efficacy of electrical nerve stimulation for chronic musculoskeletal pain: a meta-analysis of randomized controlled trials. Pain 2007;Jul, 130(1-2):157-165. Epub 2007;Mar 23.
- Jonsdottir S, Bouma A, Sergeant JA, et al. Effects of transcutaneous electrical stimulation (TENS) on cognition, behavior, and the rest-activity rhythm in children with attention deficit hyperactivity disorder, combined type. Neurorehabil Neural Repair 2004;18(4):212-221.
- Koke AJ, Schouten JS, Lamerichs-Geelen MJ, et al. Pain reducing effect of three types of transcutaneous electrical nerve stimulation in patients with chronic pain: a randomized crossover trial. Pain 2004;108(1-2):36-42.
- Law PP, Cheing GL. Optimal stimulation frequency of transcutaneous electrical nerve stimulation on people with knee osteoarthritis. J Rehabil Med 2004;36 (5):220-225.
- Luijpen MW, Swaab DF, Sergeant JA, et al. Effects of transcutaneous electrical nerve stimulation (TENS) on self-efficacy and mood in elderly with mild cognitive impairment. Neurorehabil Neural Repair 2004;18(3):166-175.
- Miller L, Mattison P, Paul L, Wood L. The effects of transcutaneous electrical nerve stimulation (TENS) on spasticity in multiple sclerosis. Mult Scler 2007;May, 13(4):527-533. Epub 2007;Jan 29.
- Milne S, Welch V, Brosseau L, et al. Transcutaneous electrical nerve stimulation (TENS) for chronic low back pain (Cochrane Review). Cochrane Database Syst Rev 2001;2:CD003008.
- Munhoz RP, Hanajima R, Ashby P, et al. Acute effect of transcutaneous electrical nerve stimulation on tremor. Mov Disord 2003;18(2):191-194.
- Murray S, Collins PD, James MA. An investigation ingo the 'carry over' effect of neurostimulation in the treatment of angina pectoris. Int J Clin Pract 2004;58(7):669-674.
- Naeser MA, Hahn KA, Lieberman BE, Branco KF. Carpal tunnel syndrome pain treated with low-level laser and microamperes transcutaneous electric nerve stimulation: a controlled study. Arch Phys Med Rehabil 2002;Jul, 83(7):978-988. Comment in: Arch Phys Med Rehabil 2002;Dec, 83(12):1806. Author reply, 1806-1807.
- Ng MM Leung MC, Poon DM. The effects of electro-acupuncture and transcutaneous electrical nerve stimulation on patients with painful osteoarthritic knees: a randomized controlled trial with follow-up evaluation. J Altern Complement Med 2003;9(5):641-649.
- Ng SS, Hui-Chan CW. Transcutaneous electrical nerve stimulation combined with task-related training improves lower limb functions in subjects with chronic stroke. Stroke 2007;Nov, 38(11):2953-2959. Epub 2007;Sep 27.
- Olyaei GR, Talebian S, Hadian MR, et al. The effect of transcutaneous electrical nerve stimulation on sympathetic skin response. Electromyogr Clin Neurophysiol 2004;44(1):23-28.
- Oncel M, Sencan S, Yildiz H, et al. Transcutaneous electrical nerve stimulation for pain management in patients with uncomplicated minor rib fractures. Eur J Cardiothorac Surg 2003;22(1):13-17.
- Osiri M, Welch V, V, Brosseau L, et al. Transcutaneous electrical nerve stimulation for knee osteoarthritis (Cochrane Review). Cochrane Database Syst Rev 2000;4:CD002823.
- Pan PJ, Chou CL, Chiou HJ, et al. Extracorporeal shock wave therapy for chronic calcific tendinitis of the shoulders: a functional and sonographic study. Arch Phys Med Rehabil 2003;Jul, 84(7):988-993.
- Peters EJ, Lavery LA, Armstrong DG, et al. Electric stimulation as an adjunct to heal diabetic foot ulcers: a randomized clinical trial. Arch Phys Med Rehabil 2001;82(6):721-725.
- Poletto CJ, Van Doren CL. Elevating pain thresholds in humans using depolarizing prepulses. IEEE Trans Biomed Eng 2002;Oct, 49(10):1221-1224.
- Price CIM, Pandyan AD. Electrical stimulation for preventing and treating post-stroke shoulder pain (Cochrane Review). Cochrane Database of Systemic Reviews 2001;4:CD001698.
- Proctor ML, Smith CA, Farquhar CM, et al. Transcutaneous electrical nerve stimulation and acupuncture for primary dysmenorrhoea. Cochrane Database Syst Rev 2003;4:CD002123. Last updated 2003-02-28.
- Rakel B, Frantz R. Effectiveness of trancutaneous electrical nerve stimulation on postoperative pain with movement. J Pain 2003;4(8):455-464.
- Robb KA, Newham DJ, Williams JE. Transcutaneous electrical nerve stimulation vs. transcutaneous spinal electroanalgesia for chronic pain associated with breast cancer treatments. J Pain Symptom Manage 2007;Apr, 33(4):410-419.
- Savk E, Savk O, Sendur F. Transcutaneous electrical nerve stimulation offers partial relief in notalgia paresthetica patients with a relevant spinal pathology. J Dermatol 2007;May, 34(5):315-319.
- Smart R. A prospective randomized controlled study of VAX-D and TENS for the treatment of chronic low back pain. Neurol Res 2001;23(7):780-784.
- Sonde L, Kalimo H, Fernaeus SE, et al. Low TENS treatment on post-stroke paretic arm: a three-year follow-up. Clin Rehabil 2000;14(1):14-19.
- Soomro NA, Khadra MH, Robson W, et al. A crossover randomized trial of transcutaneous electrical nerve stimulation and oxybutynin in patients with detrusorinstability. J Urol 2001;166(1):146-149.
- Svihra J, Kurca E, Luptak J, et al. Neuromodulative treatment of overactive bladder: noninvasive tibial nerve stimulation. Bratisl Lek Listy 2002;103(12):480-483.
- Tong KC, Lo SK, Cheing GL. Alternating frequencies of transcutaneous electric nerve stimulation: does it produce greater analgesic effects on mechanical and thermal pain thresholds? Arch Phys Med Rehabil 2007;Oct, 88(10):1344-1349.
- Tsukayama H, Yamashita H, Amagai H, et al. Randomised controlled trial comparing the effectiveness of electroacupuncture and TENS for low back pain: a preliminary study for a pragmatic trial. Acupunct Med 2002;Dec, 20(4):175-180.
- Tugay N, Akbayrak T, Demirtürk F, et al. Effectiveness of transcutaneous electrical nerve stimulation and interferential current in primary dysmenorrhea. Pain Med 2007;May-Jun, 8(4):295-300.
- Tunc M, Gunal H, Bilgili T, et al. The effect of TENS on epidural patient controlled analgesia with tramadol for postthoracotomy pain relief. Turk Anesteziyoloji Ve Reanimasyon 2003;30(7):315-321.
- van Balken MR, Vandoninck V, Messelink BJ, et al. Percutaneous tibial nerve stimulation as neuromodulative treatment of chronic pelvic pain. Eur Urol 2003;Feb, 43(2):158-163. Discussion, 163.
- van der Spank JT, Cambier DC, De Paepe HM, et al. Pain relief in labour by transcutaneous electrical nerve stimulation (TENS). Arch Gynecol Obstet 2000;264(3):131-136.
- van Dijk KR, Scherder EJ, Scheltens P, et al. Effects of transcutaneous electrical nerve stimulation (TENS) on non-pain related cognitive and behavioural functioning. Rev Neurosci 2003;13(3):257-270.
- Vandoninck V, Van Balken MR, Finazzi Agro E, et al. Posterior tibial nerve stimulation in the treatment of urge incontinence. Neurourol Urodyn 2003;22(1):17-23.
- Wong RK, Jones GW, Sagar SM, et al. A Phase I-II study in the use of acupuncture-like transcutaneous nerve stimulation in the treatment of radiation-induced xerostomia in head-and-neck cancer patients treated with radical radiotherapy. Int J Radiat Oncol Biol Phys 2003;57(2):472-480.
- Xiao WB, Liu YL. Rectal hypersensitivity reduced by acupoint TENS in patients with diarrhea-predominant irritable bowel syndrome: a pilot study. Dig Dis Sci 2004;49(2):312-319.
- Yokoyama M, Sun X, Oku S, et al. Comparison of percutaneous electrical nerve stimulation with transcutaneous electrical nerve stimulation for long-term pain relief in patients with chronic low back pain. Anesth Analg 2004;98(6):1552-1556.
- Yuan CS, Attele AS, Dey L, et al. Transcutaneous electrical acupoint stimulation potentiates analgesic effect of morphine. J Clin Pharmacol 2002;Aug, 42(8):899-903.
- Zhang GJ, Shi ZY, Liu S, et al. Clinical observation on treatment of depression by electro-acupuncture combined with Paroxetine. Chin J Integr Med 2007;Sep, 13(3):228-230.
Last updated May 07, 2008
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