Editorial: Transcutaneous electrical nerve stimulation (TENS) for chronic pain: the opportunity to begin again : Travers, Eccleston et al Apr 2020

Sly Saint

Sly Saint

Senior Member (Voting Rights)

Chronic pain is notoriously difficult to treat. Patients and clinicians have multiple potential treatment options but no clear guidance on comparative effectiveness and safety. Transcutaneous electrical nerve stimulation (TENS) is one such option.

TENS entails the application of electrical currents, usually generated by small portable devices to achieve the stimulation of nerves through the skin with the goal of reducing the experience of pain.[6]

TENS is far from a recent clinical innovation and as such we might expect that its value and safety would be well established. A new overview of Cochrane Reviews sought to address the therapeutic value and safety of TENS by synthesizing and summarizing the evidence from Cochrane Reviews of TENS for chronic pain.[7]
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The overview looked at eight Cochrane Reviews, including 51 discrete TENS‐related randomized controlled trials (RCTs) with 2895 participants.[7] With such a large body of evidence one might expect a precise and reliable estimate of the treatment effect of TENS for chronic pain. Rather, the overview found that it was not possible to conclude with confidence whether TENS was beneficial or safe for pain control, disability, health‐related quality of life, or analgesic use.
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The included reviews all scored high on the AMSTAR (A MeaSurement Tool to Assess systematic Reviews) checklist, indicating they were well conducted and reported.[8]
But the evidence reported within each review was consistently rated by the overview authors as very low quality with major concerns regarding imprecision of the estimates due to small sample sizes, uncontrolled risks of bias, and important insufficiencies in the interventions delivered.

So, while the reviews themselves may be of high quality, the data derived from the existing body of RCTs included in the reviews is of such low quality that they hamper progress.
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To use a culinary metaphor, it really does not matter how good the chef is, or how creative and skilled she is at making soup, if the ingredients are rotten the soup will ultimately be unpalatable.
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https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.ED000139/full
 
To use a culinary metaphor, it really does not matter how good the chef is, or how creative and skilled she is at making soup, if the ingredients are rotten the soup will ultimately be unpalatable.
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This. So much this. GIGO syndrome.

Although, Cochrane, you know:

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Although, the metaphor is to not throw the stones from your glasshouse because you're just as likely to destroy it than your enemy's but in this case I say go nuts, throw all the damn rocks, indiscriminately and as hard as you can.
 
Only just skimmed this, but very heartening insofar as the overview does what it should - identify cr*p Cochrane reviews as it finds them, and calls for much better in the future.

Disheartening that the reviews were so dire, but that's no surprise to most of us here anyway.

ETA: See correction to my comment by @Jonathan Edwards below.
 
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Barry said:
Only just skimmed this, but very heartening insofar as the overview does what it should - identify cr*p Cochrane reviews as it finds them, and calls for much better in the future.

Disheartening that the reviews were so dire, but that's no surprise to most of us here anyway.
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Doesn't it say that the Cochrane reviews were fine but the trials they reviewed were not?

My question would be why begin again with a treatment that has not accrued any worthwhile evidence over forty years?
 
Jonathan Edwards said:
Doesn't it say that the Cochrane reviews were fine but the trials they reviewed were not?

My question would be why begin again with a treatment that has not accrued any worthwhile evidence over forty years?
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Cochrane never do overviews of all available treatments for a single patient population. These would be potentially quite useful, even if they only highlighted how there aren't any treatments with any decent evidence behind them (eg for ME). Instead they elect to do "overview reviews" of Cochrane reviews, on single well established treatments for loads of different patient populations. To conclude that all the trials of said well established treatment are garbage. No shit Sherlock. Utterly useless.
 
Caroline Struthers said:
Cochrane never do overviews of all available treatments for a single patient population. These would be potentially quite useful, even if they only highlighted how there aren't any treatments with any decent evidence behind them (eg for ME). Instead they elect to do "overview reviews" of Cochrane reviews, on single well established treatments for loads of different patient populations. To conclude that all the trials of said well established treatment are garbage. No shit Sherlock. Utterly useless.
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Actually - at least they specify how future research on TENS should be done. But should it be done?? It would now be unethical to do research on GET for ME. Maybe the same is true for TENS...? I don't know.
 
not TENs per se but there is an article in the Daily Mail
on a similar product Arc4Health which is being touted as a potential treatment for LC.
https://www.dailymail.co.uk/health/...200-device-used-treat-injured-racehorses.html

At first I thought yeah right, another 'cure story with a gimmicky title', but looking on their website this bit jumped out
In addition to the ability of Microcurrent Therapy to enhance the natural endogenous bioelectric activity, there is evidence that it increases the amount of ATP available in the stimulated tissue, further enhancing the energy available to the cells involved in repair [4, 23-25]. The bioelectric and ATP pathways are almost certainly not mutually exclusive, and most likely work in tandem and are co-supportive [4].
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https://arcmicrotech.com/arc4health/science-of-microcurrent/

I've not looked into this further but would be interested to know if there is anything to back up this claim.
 
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