Development of a method to maximize the transcutaneous electrical nerve stimulation intensity in women with fibromyalgia

Carol Gt Vance; Ruth L Chimenti; Dana L Dailey; Katherine Hadlandsmyth; M Bridget Zimmerman; Katharine M Geasland; Jonathan M Williams; Ericka N Merriwether; Li Alemo Munters; Barbara A Rakel; Leslie J Crofford; Kathleen A Sluka

doi:10.2147/jpr.s168297

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Development of a method to maximize the transcutaneous electrical nerve stimulation intensity in women with fibromyalgia

Journal article

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Development of a method to maximize the transcutaneous electrical nerve stimulation intensity in women with fibromyalgia

Carol Gt Vance, Ruth L Chimenti, Dana L Dailey, Katherine Hadlandsmyth, M Bridget Zimmerman, Katharine M Geasland, Jonathan M Williams, Ericka N Merriwether, Li Alemo Munters, Barbara A Rakel, …

Journal of pain research, Vol.11, pp.2269-2278

2018

DOI: 10.2147/jpr.s168297

PMCID: PMC6188186

PMID: 30349353

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Abstract

Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological intervention clinically used for pain relief. The importance of utilizing the adequate stimulation intensity is well documented; however, clinical methods to achieve the highest possible intensity are not established. Our primary aim was to determine if exposure to the full range of clinical levels of stimulation, from sensory threshold to noxious, would result in higher final stimulation intensities. A secondary aim explored the association of pain, disease severity, and psychological variables with the ability to achieve higher final stimulation intensity. Women with fibromyalgia (N=143) were recruited for a dual-site randomized controlled trial - Fibromyalgia Activity Study with TENS (FAST). TENS electrodes and stimulation were applied to the lumbar area, and intensity was increased to sensory threshold (ST), then to "strong but comfortable" (SC1), then to "noxious" (N). This was followed by a reduction to the final stimulation intensity of "strong but comfortable" (SC2). We called this the Setting of Intensity of TENS (SIT) test. There was a significant increase from SC1 (37.5 mA IQR: 35.6-39.0) to SC2 (39.2 mA IQR: 37.1-45.3) ( <0.0001) with a mean increase of 1.7 mA (95% CI: 1.5, 2.2). Linear regression analysis showed that those with the largest increase between SC1 and N had the largest increase in SC2-SC1. Further, those with older age and higher anxiety were able to achieve greater increases in intensity (SC2-SC1) using the SIT test. The SC2-SC1 increase was significantly associated with age and anxiety, with greater mean increases associated with older age and higher anxiety. Thus, although all patients may benefit from this protocol, older women and women with elevated anxiety receive the greatest benefit.

TENS

dosage

pain

fibromyalgia

transcutaneous electrical nerve stimulation

Details

Title: Subtitle: Development of a method to maximize the transcutaneous electrical nerve stimulation intensity in women with fibromyalgia
Creators: Carol Gt Vance - Department of Physical Therapy and Rehabilitation Science, The University of Iowa Carver College of Medicine, Iowa City, IA, USA, carol-vance@uiowa.edu
Ruth L Chimenti - Department of Physical Therapy and Rehabilitation Science, The University of Iowa Carver College of Medicine, Iowa City, IA, USA, carol-vance@uiowa.edu
Dana L Dailey - Department of Physical Therapy and Rehabilitation Science, The University of Iowa Carver College of Medicine, Iowa City, IA, USA, carol-vance@uiowa.edu
Katherine Hadlandsmyth - Department of Anesthesia, College of Medicine, University of Iowa, Iowa City, IA, USA
M Bridget Zimmerman - Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
Katharine M Geasland - Department of Physical Therapy and Rehabilitation Science, The University of Iowa Carver College of Medicine, Iowa City, IA, USA, carol-vance@uiowa.edu
Jonathan M Williams - Department of Medicine/Rheumatology & Immunology, Vanderbilt University, Nashville, TN, USA
Ericka N Merriwether - Department of Physical Therapy, New York University, New York, NY, USA
Li Alemo Munters - Department of Medicine/Rheumatology & Immunology, Vanderbilt University, Nashville, TN, USA
Barbara A Rakel - College of Nursing, University of Iowa, Iowa City, IA, USA
Leslie J Crofford - Department of Medicine/Rheumatology & Immunology, Vanderbilt University, Nashville, TN, USA
Kathleen A Sluka - Department of Physical Therapy and Rehabilitation Science, The University of Iowa Carver College of Medicine, Iowa City, IA, USA, carol-vance@uiowa.edu
Resource Type: Journal article
Publication Details: Journal of pain research, Vol.11, pp.2269-2278
DOI: 10.2147/jpr.s168297
PMID: 30349353
PMCID: PMC6188186
NLM abbreviation: J Pain Res
ISSN: 1178-7090
eISSN: 1178-7090
Publisher: New Zealand
Grant note: UM1 AR063381 / NIAMS NIH HHS T32 NS045549 / NINDS NIH HHS UL1 TR000445 / NCATS NIH HHS K99 AR071517 / NIAMS NIH HHS R00 AR071517 / NIAMS NIH HHS
Language: English
Date published: 2018
Academic Unit: Psychiatry; Clinical Research Unit; Iowa Neuroscience Institute; Biostatistics; Nursing; Anesthesia; Physical Therapy and Rehabilitation Science; Neuroscience and Pharmacology
Record Identifier: 9984006492802771

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