Electrical Stimulation for Fibromyalgia

Kathleen Sluka, PT, PhD, on Perfect TENS For Fibromyalgia?

— Electrical stimulation device “another tool in our arsenal” to control FM pain, reduce fatigue

by Scott Harris, Contributing Writer, MedPage Today March 31, 2020

Kathleen Sluka, PT, PhD, is professor of physical therapy and rehabilitation science at the University of Iowa Carver College of Medicine. She served as co-author of a report, published in Arthritis & Rheumatology, that examined Transcutaneous Electrical Nerve Stimulation or TENS — a wearable device that delivers low-voltage electricity for pain control — as a potential pain management tool for people with fibromyalgia (FM). Specifically, she and her colleagues looked at whether the use of TENS during activity would diminish movement‐evoked pain and other patient‐reported outcomes in women who have FM.

During the double-blinded, randomized, controlled trial, women with FM received TENS (n=103), a placebo version of TENS (n=99), or no TENS at all (n=99).

After four weeks, the active-TENS group reported greater reductions in movement-related pain and fatigue compared with the placebo-TENS group (pain (95% CI): -1.0(-1.8, -0.2), P=0.008; fatigue: -1.4(-2.4, -0.4), P=0.001) and no-TENS group (pain: -1.8(-2.6. -1.0), P<0.0001; fatigue: -1.9(-2.9, -0.9), P<0.0001).

No serious adverse events were reported; minor events were reported by fewer than 5% of participants.

Sluka recently spoke with MedPage Today about the study, its findings, and implications for clinicians who care for individuals with FM.

Why did you decide to study TENS in FM?

Sluka: There’s no cure for FM, and people with FM need to manage their pain.

This was an interesting study to us because of how TENS and FM match up, if you will. Animal studies had shown that TENS activates endogenous inhibitory mechanisms, which reduces central excitability. At the same time, in FM there is reduced endogenous inhibition and enhanced central excitability. So, based on that mechanism of action, it sounded like an ideal match.

We also picked FM because people with this disorder say it hurts when they are active, but activity is so important to helping these patients feel better. It’s the famous vicious cycle. So we were looking for a treatment that could work well with activity-induced pain.

What were your key findings? Were there any surprises?

Sluka: The study confirmed our hypothesis, so we are thrilled. TENS is another tool in our arsenal for controlling FM pain — one that does not involve drugs.

But there were also reductions in fatigue that left us all a bit surprised. This will definitely be an area for a closer look moving forward. TENS had no big effect on function or sleep, however.

What does the future hold for TENS and FM from a clinical and/or a research perspective?

Sluka: We are now working on a new study that puts TENS into physical therapy clinics. We want to get people more functional with their pain. This could be a great tool for physical therapists. One day instead of reaching for drugs, people could reach for TENS. It’s low cost, it’s safe, and this evidence shows that, for women with FM, it works.

You can read an abstract of the report here and expert commentary about the clinical implications here.