Reduction in movement-evoked pain and fatigue during initial 30-minute transcutaneous electrical nerve stimulation treatment predicts transcutaneous electrical nerve stimulation responders in women with fibromyalgia

Carol G T Vance; M Bridget Zimmerman; Dana L Dailey; Barbara A Rakel; Katharine M Geasland; Ruth L Chimenti; Jon M Williams; Meenakshi Golchha; Leslie J Crofford; Kathleen A Sluka

doi:10.1097/j.pain.0000000000002144

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Reduction in movement-evoked pain and fatigue during initial 30-minute transcutaneous electrical nerve stimulation treatment predicts transcutaneous electrical nerve stimulation responders in women with fibromyalgia

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Reduction in movement-evoked pain and fatigue during initial 30-minute transcutaneous electrical nerve stimulation treatment predicts transcutaneous electrical nerve stimulation responders in women with fibromyalgia

Carol G T Vance, M Bridget Zimmerman, Dana L Dailey, Barbara A Rakel, Katharine M Geasland, Ruth L Chimenti, Jon M Williams, Meenakshi Golchha, Leslie J Crofford and Kathleen A Sluka

Pain (Amsterdam), Vol.162(5), pp.1545-1555

05/01/2021

DOI: 10.1097/j.pain.0000000000002144

PMCID: PMC8049882

PMID: 33230010

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https://www.ncbi.nlm.nih.gov/pmc/articles/8049882View

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Abstract

We previously showed that 1 month of transcutaneous electrical nerve stimulation (TENS) reduces movement-evoked pain and fatigue in women with fibromyalgia (FM). Using data from this study (Fibromyalgia Activity Study with TENS [FAST]), we performed a responder analysis to identify predictors of clinical improvement in pain and fatigue with TENS, validated these models using receiver operator characteristic, and determined number needed to treat and number needed to harm. Participants were randomly assigned to active-TENS (2-125 Hz; highest-tolerable intensity), placebo-TENS, or no-TENS for 1 month. At the end of the randomized phase, placebo-TENS and no-TENS groups received active-TENS for 1 month. The predictor model was developed using data from the randomized phase for the active-TENS group (n = 103) and validated using data from placebo-TENS and no-TENS groups after active-TENS for 1 month (n = 155). Participant characteristics, initial response to TENS for pain and fatigue, sleep, psychological factors, and function were screened for association with changes in pain or fatigue using a logistic regression model. Predictors of clinical improvement in pain were initial response to pain and widespread pain index (area under the curve was 0.80; 95% confidence interval: 0.73-0.87). Predictors of clinical improvement in fatigue were marital status, sleep impairment, and initial response to TENS (area under the curve was 0.67; 95% confidence interval: 0.58-0.75). Number needed to treat for pain and fatigue ranged between 3.3 and 5.3. Number needed to harm ranged from 20 to 100 for minor TENS-related adverse events. The response to an initial 30-minute TENS treatment predicts who responds to longer-term TENS use in women with FM, making this a clinically useful procedure. Number needed to treat and number needed to harm suggest that TENS is effective and safe for managing pain and fatigue in FM.

Details

Title: Subtitle: Reduction in movement-evoked pain and fatigue during initial 30-minute transcutaneous electrical nerve stimulation treatment predicts transcutaneous electrical nerve stimulation responders in women with fibromyalgia
Creators: Carol G T Vance - Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, United States
M Bridget Zimmerman - College of Public Health, University of Iowa, Iowa City, IA, United States
Dana L Dailey - Department of Physical Therapy, St. Ambrose University, Davenport, IA, United States
Barbara A Rakel - College of Nursing, University of Iowa, Iowa City, IA, United States
Katharine M Geasland - Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, United States
Ruth L Chimenti - Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, United States
Jon M Williams - Department of Medicine/Rheumatology and Immunology, Vanderbilt Medical Center, Nashville, TN, United States
Meenakshi Golchha - Department of Medicine/Rheumatology and Immunology, Vanderbilt Medical Center, Nashville, TN, United States
Leslie J Crofford - Department of Medicine/Rheumatology and Immunology, Vanderbilt Medical Center, Nashville, TN, United States
Kathleen A Sluka - College of Public Health, University of Iowa, Iowa City, IA, United States
Resource Type: Journal article
Publication Details: Pain (Amsterdam), Vol.162(5), pp.1545-1555
DOI: 10.1097/j.pain.0000000000002144
PMID: 33230010
PMCID: PMC8049882
NLM abbreviation: Pain
ISSN: 0304-3959
eISSN: 1872-6623
Publisher: United States
Grant note: UM1 AR063381 / NIAMS NIH HHS T32 NS045549 / NINDS NIH HHS U54 TR001356 / NCATS NIH HHS UL1 TR000445 / NCATS NIH HHS U54 TR001013 / NCATS NIH HHS K99 AR071517 / NIAMS NIH HHS
Language: English
Date published: 05/01/2021
Academic Unit: Clinical Research Unit; Iowa Neuroscience Institute; Biostatistics; Nursing; Physical Therapy and Rehabilitation Science; Neuroscience and Pharmacology
Record Identifier: 9984070223802771

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