Electrical Nerve Stimulation/TENS

Injury type: Acute/ Chronic

Category: Allied Health Options

Rating: Not effective

What is it?

An alternating electrical current (AC) or modulated direct current (DC) underpins all stimulating forms of electrotherapy. The electrical current, rectified to a safe, low-voltage level is applied to the body via electrodes placed on the skin. Transcutaneous electrical nerve stimulation (TENS) is one form of electrical nerve stimulation. TENS machines come in various sizes but most are small enough to clip onto your belt and wear whilst walking around.

How does it work?

The current may inhibit pain in the tissues surrounding the electrodes by inhibiting pain impulses (the so-called ‘pain gate theory’). It works by distracting your nerves and brain from the pain sensations.

Is it effective?

There is mixed evidence on the effectiveness of TENS following whiplash. A systematic review of existing whiplash related clinical practice guidelines¹ found conflicting recommendations relevant to the use of TENS, ranging from ‘recommended for consideration’ (for acute/ subacute whiplash) to ‘no evidence’ or ‘recommended against’ (for chronic whiplash). Another systematic review² which updated evidence on passive physical modalities suggested that TENS is ‘likely not helpful/ not worth considering’ as a management option for persistent grade I-II whiplash. More recently, a revised clinical practice guideline underpinned by a systematic review of literature³ revealed a weak level of evidence, suggesting that health care professionals may provide TENS to patients with acute and chronic whiplash.

Are there any disadvantages?

There has been no research on the disadvantages associated with electrical nerve stimulation. TENS machines are available to purchase however they may be costly, and may not be suitable for everyone.

Where do you get it?

TENS units are available to purchase from various sources (i.e. internet, medical suppliers, pharmacies/chemists) or through your treating therapist.

Recommendations

The use of TENS for whiplash is not recommended due to limited current research evidence. More research is required.

References

3. Blanpied PR, Gross AR, Elliott JM, Devaney LL, Clewley D, Walton DM, Sparks C, Robertson EK, Altman RD, Beattie P, Boeglin E. Neck pain: revision 2017: clinical practice guidelines linked to the international classification of functioning, disability and health from the orthopaedic section of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy. 2017 Jul;47(7):A1-83.

Guzman, J, Haldeman, S, Carroll, LJ, Carragee, EJ, Hurwitz, EL, Peloso, P, Nordin, M, Cassidy, JD, Holm, LW, Côté, P, Velde, G & Hogg-Johnson, S 2009, ‘Task force on neck pain and its associated disorders’, Journal of Manipulative and Physiological Therapeutics, vol. 32, pp. 227-243.

Kroeling, P, Gross, A, Goldsmith, CH, Cervical Overview Group, ‘Electrotherapy for neck disorders’, Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD004251. DOI: 10.1002/14651858.CD004251.pub3.

Leaver, AM, Refshauge, KM, Maher, CG & McAuley, JH 2010, ‘Conservative interventions provide short-term relief for non-specific neck pain: a systematic review’, Journal of Physiotherapy, vol. 56, pp. 73–85.

Mercer, C, Jackson, A & Moore, A 2007, ‘Developing clinical guidelines for the physiotherapy management of whiplash associated disorder (WAD)’, International Journal of Osteopathic Medicine, vol. 10, no. 2-3, pp. 50-54.

1. Wong JJ, Côté P, Shearer HM, Carroll LJ, Yu H, Varatharajan S, Southerst D, van der Velde G, Jacobs C, Taylor-Vaisey A. Clinical practice guidelines for the management of conditions related to traffic collisions: a systematic review by the OPTIMa Collaboration. Disability and rehabilitation. 2015 Mar 13;37(6):471-89.

2. Wong JJ, Shearer HM, Mior S, Jacobs C, Côté P, Randhawa K, Yu H, Southerst D, Varatharajan S, Sutton D, van der Velde G. Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration. The Spine Journal. 2016 Dec 1;16(12):1598-630.