Transcutaneous Electrical Nerve Stimulation (TENS) and Low Back Pain

NCT ID: NCT05812885

Last Updated: 2024-12-04

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

34 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-11-15

Study Completion Date

2025-07-31

Brief Summary

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Low back pain is a significant public health problem, is very prevalent, and is often characterized by the persistence of symptoms. Unfortunately, substantial improvements in people with chronic low back pain are rare, causing most people to live with the pain. People with chronic low back pain may have an exaggerated pain response to nociceptive input into tissues that may also cause symptoms distant from the site of the primary symptoms. Historically, these symptoms were thought to be related to pathoanatomic changes to the muscles, ligaments, or joints. However, the severity of these structural changes weakly correlates with the clinical presentation and, in most cases, is not directly related to diagnostic image findings. Patients with chronic musculoskeletal pain, in general, show signs of local/central sensitization. The central sensitization may appear to be directly correlated with the intensity and duration of pain. Therefore, it is essential to reduce pain intensity and minimize the duration of pain to prevent this from happening.

Pain relief for chronic low back pain patients should be aimed at treatments that reduce central excitability and increase central inhibition. Research into chronic low back pain treatment has demonstrated strong evidence that different types of exercise decrease pain and improve quality of life. However, exercise itself may be painful, preventing a person from exercising. Thus, treatments aimed at decreasing pain will improve a person's ability to exercise and participate in activities of daily living.

One treatment aimed at reducing central excitability and increasing central inhibition is transcutaneous electrical nerve stimulation (TENS). TENS is a "non-pharmacological" treatment for pain that is inexpensive, safe, and easy to use. Prior studies show that TENS utilizes opioid receptors both spinally and supraspinally to inhibit nociceptive dorsal horn neurons, reduce excitatory neurotransmitter release, and reduce hyperalgesia. Thus, TENS may be particularly useful in people with chronic low back pain because it can activate descending inhibitory pathways (reduced in chronic low back pain patients) and inhibit central excitability (increased in chronic low back pain patients).

Previous studies that have investigated the effects of TENS on pain in low back pain patients have failed to use proper intensities of current, and the assessment of pain was not performed during the peak of the analgesic response. Previous studies show inadequate intensities do not reduce pain or increase pressure pain thresholds. Further, TENS typically does not affect resting pain, while changes in pressure pain thresholds and pain with movement are reduced. Thus, the current study proposes to assess the effects of TENS on measures of pain, function, and descending inhibition using the maximal tolerable intensity of TENS applied to a large area of the trunk.

Detailed Description

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The study will be a simple crossover design with the following three treatments (1) active TENS, (2) placebo TENS or (3) no treatment control randomly assigned. Each subject will receive all 3 interventions in random order.

The following tools will be used to measure pain (Numeric Rating Scale), central excitability (pressure pain thresholds, temporal summation and CPM) and function (sit-to-stand test and repeated trunk flexion).

Conditions

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Chronic Low-back Pain

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Crossover Assignment
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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Active TENS

Active TENS: 100 Hz, 200 μs at maximal tolerable intensity

Group Type EXPERIMENTAL

TENS

Intervention Type DEVICE

Active TENS

Placebo TENS

Placebo TENS: 100 Hz, 200 μs on for 45 seconds and then ramps off.

Group Type PLACEBO_COMPARATOR

TENS

Intervention Type DEVICE

Active TENS

No TENS

Participants will wear a TENS unit that will be turned off to blind the outcome assessor

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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TENS

Active TENS

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* people who have experienced back pain for at least 3 months
* and have reported a minimal pain level of 3 on the 0-10 Pain Numerical Rating Scale (NRS)
* age from 18-60
* TENS naive or have not used TENS for 5 years.
* Both men and women may participate in the study

Exclusion Criteria

* Serious spinal disorders, such as fractures, tumors, or inflammatory arthritis disease
* nerve root disorders confirmed by neurological tests;
* neurological diseases
* severe cardiorespiratory disease
* pregnancy
* skin infection or lesions or change in sensation at the TENS application site
* cancer
* cardiac pacemaker
* allergy to electrodes
* use of opioids.
Minimum Eligible Age

18 Years

Maximum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Hartford

OTHER

Sponsor Role lead

Responsible Party

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Richard Liebano

Associate Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Richard E Liebano, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Hartford

Locations

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University of Hartford

West Hartford, Connecticut, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Richard E Liebano, PhD

Role: CONTACT

860.768.5181

Richard E Liebano, PhD

Role: CONTACT

8608105563

Facility Contacts

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Richard Liebano

Role: primary

References

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Liebano RE, Sluka KA, Roy J, Savinelli M, Dailey DL, Riley SP. Effects of transcutaneous electrical nerve stimulation on pain, function, and descending inhibition in people with non-specific chronic low-back pain: a study protocol for a randomized crossover trial. Trials. 2024 Apr 6;25(1):242. doi: 10.1186/s13063-024-08089-7.

Reference Type DERIVED
PMID: 38582874 (View on PubMed)

Other Identifiers

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23-03-187

Identifier Type: -

Identifier Source: org_study_id