TENS (v no intervention) on pain in people with SCI | SCI Physiotherapy Clinical Practice Guidelines

	TENS (v no intervention) on pain in people with SCI
P	People with SCI	Evidence recommendation Weak for (95%)		Weak evidence recommendation FOR Evidence recommendation: TENS may be provided for pain in people with SCI.
I	TENS	Evidence recommendation Weak for (95%)
C	No intervention	Consensus-based opinion statement No opinion statements
O	Pain	Consensus-based opinion statement No opinion statements
	SUMMARY	2 RCTs (see references)		Mean difference (95% CI): Pain (VAS) -2 (-3 to -1) Favours TENS
	GRADE Very low certainty ⨁◯◯◯	Risk of bias Very serious	Inconsistency Serious	Imprecision No serious	Indirectness Serious	Publication bias Serious

TENS FOR PAIN: GRADE Evidence to Decision
PROBLEM	No	Probably no	Probably yes	Yes		Don't know
DESIRABLE EFFECTS	Trivial	Small	Moderate	Large		Don't know
UNDESIRABLE EFFECTS	Large	Moderate	Small	Trivial		Don't know
CERTAINTY OF EVIDENCE	Very low	Low	Moderate	High		No included studies
HOW MUCH PEOPLE VALUE THE MAIN OUTCOME	Important uncertainty or variability	Possibly important uncertainty or variability	Probably no important uncertainty or variability	No important uncertainty or variability
BALANCE OF EFFECTS	Favours the Control	Probably favours the Control	Does not favour either the intervention (I) or the comparison (C)	Probably favours the I	Favours the I	Don't know
RESOURCES REQUIRED	Large costs	Moderate costs	Negligible costs and savings	Moderate savings	Large savings	Don't know
CERTAINTY OF EVIDENCE OF REQUIRED RESOURCES	Very low	Low	Moderate	High		No included studies
COST EFFECTIVENESS	Favours the comparison	Probably favours the comparison	Does not favour either the intervention or the comparison	Probably favours the intervention	Favours the intervention	No included studies
EQUITY	Reduced	Probably reduced	Probably no impact	Probably increased	Increased	Don't know
ACCEPTABILITY	No	Probably no	Probably yes	Yes		Don't know
FEASIBILITY	No	Probably no	Probably yes	Yes		Don't know

TENS FOR PAIN: Randomised Controlled Trial Details
STUDY	COMPARISON	DOSAGE/DETAILS	PARTICIPANTS	N (Rx/C)	OUTCOME	ROB 2 PEDRo
BI 2015	TENS V Sham TENS	TENS 20 minutes, 3 x per week for 12 weeks	People with SCI	24/24	Visual Analogue Pain scale	Some Concerns of Risk of Bias PEDro = 7/10
CELIK 2013	TENS V Sham TENS	30 mins per day for 10 days	People with SCI	17/16	Visual Analogue Pain scale	High Risk of Bias PEDro = 4/10

The Australian and NZ SCI Physiotherapy guideline committee recommends TENS may be provided for pain in people with SCI. This is an evidence recommendation supported by the results of 2 randomised controlled trials. The guideline states:

TENS may be provided for pain in people with SCI.

This recommendation was formed by considering the results of two randomised controlled trials alongside other factors. The combined trial results indicate that TENS is better than no TENS for pain in people with SCI. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility.

This is an evidence-based recommendation. Evidence-based recommendations are more robust than consensus-based opinion statements. They can be strong or weak. This is a weak evidence-based recommendation which means the guideline panel is confident that they can probably recommend TENS for pain in people with SCI based on the evidence.

To learn more about this recommendation go to the research summary.

Bi X, Lv H, Chen B-L, Li X, Wang X-Q. Effects of transcutaneous electrical nerve stimulation on pain in patients with spinal cord injury: a randomized controlled trial. Journal of Physical Therapy Science 2015; 27: 23-25.
Celik EC, Erhan B, Gunduz B, Lakse E. The effect of low-frequency TENS in the treatment of neuropathic pain in patients with spinal cord injury. Spinal cord 2013; 51: 334.