Keskin EA, Onur O, Keskin HL, Gumus II, Kafali H, Turhan N. Transcutaneous Electrical Nerve Stimulation Improves Low Back Pain during Pregnancy. Gynecol Obstet Invest. 2012; 74:76-83.
1. Level of evidence of the article: Level II
2. Target population: Women with uncomplicated pregnancies, who are 32 weeks or farther along in their pregnancy, with low back pain. The participants did not have any history of any previous low back pain or lumbar pathology, nor any history of disease that would have affected the lumbar spine. The participants also had a VAS score greater than or equal to 5 and a Roland-Morris Disability Questionnaire score ranging from 0 to 24.
3. Type of electrotherapy used in article: TENS
4. Specific electrotherapy parameters used in the article: A portable, dual-channel TENS unit was utilized. “Four 5 cm2 surface electrodes were placed on the painful lumbar region of each patient.” The protocol used “continuous waves of stimulation at a frequency of 120 Hz and duration of 100 μ.s. The intensity was adjusted to produce a tingling sensation approximately 2-3 times above the sensory threshold. Patient’s received a total of six TENS therapy sessions (twice weekly) during 3 weeks.”
5. Protocol used in the article: Eighty-eight pregnant females with low back pain were equally and randomly assigned to either a control group, an exercise group, an acetaminophen group, or a TENS group. Participants in the exercise group were given a HEP consisting of pelvic tilts, lower extremity stretching, postural exercises, and isometric abdominal contractions. This group of participants performed 10 repetitions of each exercise, two times per day, for three weeks. Participants in the acetaminophen group took one 500 mg pill two times per day for 3 weeks. Women in the TENS group received TENS treatment, based on the above protocol, to their areas of low back pain, two times per week for three weeks.
6. Outcome found with the protocol: Participants in the TENS group did not experience any adverse effects during the study. At the conclusion of the study, participants in the control group either had unchanged pain or increased pain while the other three groups experienced a decrease in pain. In the exercise group, 18 participants had decreased pain, 19 people had decreased pain in the acetaminophen group, yet all remaining members (20 people) of the TENS group had decreased pain. After the treatment the TENS group had an overall decrease of 3 points in the VAS score and 8 points on the RMDQ, while the other treatment groups only had 1 or 2 points decrease in both outcome measures.
7. Your opinion on whether or not you would use an electrotherapeutic intervention given a similar patient problem in the future: If I had to make a decision regarding the use of TENS on pregnant women based solely on this one article, I would definitely give it a try in the clinic if a woman were open to the idea. I would definitely want to consult with physicians to make sure everything is safe with the fetus and that they do not see any contraindications to the treatment before I progressed with TENS. Since low back pain is such a predominant issue with pregnant females, and TENS is an easily accessible unit, it would make sense to try this specific treatment to help lower their level of back pain. I also think it is a great tool to use, because based on this article, it is not something that needs to be utilized multiple times per day, as it was only used twice per week. People are more open to trying treatments that do not require a lot of their time but produce beneficial results. Also, this article did not find a participant who completed the study, to have unchanged or increased pain with the TENS treatment, so yes, I would be open to trying it in the clinic.
8. Anything they did not include that you thought would be beneficial: I think it would have been beneficial for the article to include information regarding how long the TENS unit was placed on a person’s lower back. The article states how often the TENS unit is used, but does not describe the amount of time the unit is used for each session.