PMID- 36130064
OWN - NLM
STAT- MEDLINE
DCOM- 20230405
LR  - 20230503
IS  - 1526-4637 (Electronic)
IS  - 1526-2375 (Linking)
VI  - 24
IP  - 4
DP  - 2023 Apr 3
TI  - Effects of Percutaneous and Transcutaneous Electrical Nerve Stimulation on 
      Endogenous Pain Mechanisms in Patients with Musculoskeletal Pain: A Systematic 
      Review and Meta-Analysis.
PG  - 397-414
LID - 10.1093/pm/pnac140 [doi]
AB  - OBJECTIVES: The main aim was to determine the effects of percutaneous electrical 
      nerve stimulation (PENS) and transcutaneous electrical nerve stimulation (TENS) 
      on endogenous pain mechanisms in patients with musculoskeletal pain. DESIGN: A 
      systematic review and meta-analysis. METHODS: The search was conducted on March 
      1, 2022, in the EMBASE, CINAHL, PubMed, PEDro, Cochrane Library, Web of Science, 
      Medline, and SCOPUS databases. Randomized controlled trials comparing the use of 
      transcutaneous or percutaneous electrostimulation with a placebo, control group, 
      or standard treatment in patients with musculoskeletal pain were included. 
      Outcome measurements were quantitative sensory testing somatosensory variables 
      like pressure pain threshold (PPT), conditioned pain modulation, and temporal 
      summation of pain. The pooled data were evaluated in Review Manager 5.4. RESULTS: 
      Twenty-four randomized controlled trials (n = 24) were included in the 
      qualitative analysis and 23 in the meta-analysis. The immediate effects of PENS 
      and TENS on local PPTs were significant, with a moderate effect size 
      (standardized mean difference [SMD] 0.53; 95% confidence interval [CI]: 0.34 to 
      0.72; P < 0.00001). When only studies with a lower risk of bias were analyzed, 
      the heterogeneity decreased from I2 = 58% (P < 0.00001) to I2 = 15% (P = 0.01), 
      and a decrease in the overall effect was observed (SMD 0.33; 95% CI: 0.7 to 
      0.58). The short-term effects on local PPTs were not significant when compared 
      with the control group (P = 0.13). The mid-term effects on local PPTs were 
      significant, showing a large effect size (SMD 0.55; 95% CI: 0.9 to 1.00; 
      P = 0.02). The immediate effects on conditioned pain modulation were significant, 
      with a large effect size (SMD 0.94; 95% CI: 0.48 to 1.41; P < 0.0001). 
      CONCLUSION: PENS and TENS have a mild-moderate immediate effect on local 
      mechanical hyperalgesia in patients with musculoskeletal pain. It appears that 
      these effects are not sustained over time. Analyses suggest an effect on central 
      pain mechanisms producing a moderate increase in remote PPT, an increase in 
      conditioned pain modulation, but further studies are needed to draw clearer 
      conclusions.
CI  - (c) The Author(s) 2022. Published by Oxford University Press on behalf of the 
      American Academy of Pain Medicine. All rights reserved. For permissions, please 
      e-mail: journals.permissions@oup.com.
FAU - Rodriguez Lagos, Leonardo
AU  - Rodriguez Lagos L
AD  - Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational 
      Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 
      Alcorcon, Spain.
FAU - Arribas-Romano, Alberto
AU  - Arribas-Romano A
AD  - Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational 
      Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 
      Alcorcon, Spain.
AD  - Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical 
      Medicine, Universidad Rey Juan Carlos, Madrid, Spain.
FAU - Fernandez-Carnero, Josue
AU  - Fernandez-Carnero J
AUID- ORCID: 0000-0002-1314-624X
AD  - Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical 
      Medicine, Universidad Rey Juan Carlos, Madrid, Spain.
AD  - Motion in Brains Research Group, Institute of Neuroscience and Sciences of the 
      Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, 
      Universidad Autonoma de Madrid, Madrid, Spain.
AD  - Grupo Multidisciplinar de Investigacion y Tratamiento del Dolor, Grupo de 
      Excelencia Investigadora URJC-Banco de Santander, Madrid, Spain.
AD  - La Paz Hospital Institute for Health Research, IdiPAZ, Madrid, Spain.
FAU - Gonzalez-Zamorano, Yeray
AU  - Gonzalez-Zamorano Y
AD  - Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational 
      Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 
      Alcorcon, Spain.
AD  - Grupo de Investigacion en Neurorrehabilitacion del Dano Cerebral y los Trastornos 
      del Movimiento (GINDAT), Facultad de Ciencias Experimentales, Universidad 
      Francisco de Vitoria, Pozuelo de Alcorcon, Madrid, Spain.
FAU - Laguarta Val, Sofia
AU  - Laguarta Val S
AD  - Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical 
      Medicine, Universidad Rey Juan Carlos, Madrid, Spain.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
PL  - England
TA  - Pain Med
JT  - Pain medicine (Malden, Mass.)
JID - 100894201
SB  - IM
MH  - Humans
MH  - *Transcutaneous Electric Nerve Stimulation
MH  - *Musculoskeletal Pain/therapy
MH  - *Neuralgia
MH  - Control Groups
MH  - Hyperalgesia
OTO - NOTNLM
OT  - Conditioned Pain Modulation
OT  - Electroacupuncture
OT  - Musculoskeletal Pain
OT  - Percutaneous Electrical Nerve Stimulation
OT  - Pressure Pain Thresholds
OT  - Transcutaneous Electrical Nerve Stimulation
EDAT- 2022/09/22 06:00
MHDA- 2023/04/05 06:42
CRDT- 2022/09/21 14:43
PHST- 2022/07/26 00:00 [received]
PHST- 2022/09/05 00:00 [revised]
PHST- 2022/09/07 00:00 [accepted]
PHST- 2023/04/05 06:42 [medline]
PHST- 2022/09/22 06:00 [pubmed]
PHST- 2022/09/21 14:43 [entrez]
AID - 6706814 [pii]
AID - 10.1093/pm/pnac140 [doi]
PST - ppublish
SO  - Pain Med. 2023 Apr 3;24(4):397-414. doi: 10.1093/pm/pnac140.