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Remote Analgesic Effects Of Conventional Transcutaneous Electrical Nerve Stimulation: A Scientific And Clinical Review With A Focus On Chronic Pain

Authors Gozani SN

Received 9 August 2019

Accepted for publication 2 November 2019

Published 26 November 2019 Volume 2019:12 Pages 3185—3201

DOI https://doi.org/10.2147/JPR.S226600

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

Editor who approved publication: Dr Michael Schatman


Shai N Gozani

NeuroMetrix, Waltham, MA, USA

Correspondence: Shai N Gozani
NeuroMetrix, 1000 Winter Street, Waltham, MA 02451, USA Tel +1 781 314 2789
Fax +1 781 890 1556
Email gozani@neurometrix.com

Background: Transcutaneous electrical nerve stimulation (TENS) is a safe, noninvasive treatment for chronic pain that can be self-administered. Conventional TENS involves stimulation of peripheral sensory nerves at a strong, non-painful level. Following the original gate-control theory of pain, stimulation is typically near the target pain. As another option, remote stimulation may also be effective and offers potential advantages.
Objective: This narrative review examines mechanisms underlying the remote analgesic effects of conventional TENS and appraises the clinical evidence.
Methods: A literature search for English-language articles was performed on PubMed. Keywords included terms related to the location of TENS . Citations from primary references and textbooks were examined for additional articles.
Results: Over 30 studies reported remote analgesic effects of conventional TENS. The evidence included studies using animal models of pain, experimental pain in humans, and clinical studies in subjects with chronic pain. Three types of remote analgesia were identified: at the contralateral homologous site, at sites distant from stimulation but innervated by overlapping spinal segments, and at unrelated extrasegmental sites.
Conclusion: There is scientific and clinical evidence that conventional TENS has remote analgesic effects. This may occur through modulation of pain processing at the level of the dorsal horn, in brainstem centers mediating descending inhibition, and within the pain matrix. A broadening of perspectives on how conventional TENS produces analgesia may encourage researchers, clinicians, and medical-device manufacturers to develop novel ways of using this safe, cost-effective neuromodulation technique for chronic pain.

Keywords: transcutaneous electrical nerve stimulation, TENS, chronic pain, electrode, remote, widespread

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