A CONTROLLED TRIAL OF TRANSCUTANEOUS ELECTRICAL NERVE-STIMULATION (TENS) AND EXERCISE FOR CHRONIC LOW-BACK-PAIN
A CONTROLLED TRIAL OF TRANSCUTANEOUS ELECTRICAL NERVE-STIMULATION (TENS) AND EXERCISE FOR CHRONIC LOW-BACK-PAIN
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DOI：
10.1056/nejm199006073222303
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发表时间：
1990-06-07
影响因子：
158.5
通讯作者：
RAMAMURTHY, S
中科院分区：
文献类型：
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作者：
DEYO, RA;WALSH, NE;RAMAMURTHY, S
许多治疗慢性背痛的方法被广泛使用，但很少经过严格评估。我们检查了经皮神经电刺激 (TENS)、伸展运动计划或两者结合治疗腰痛的有效性。慢性腰痛患者（中位持续时间为 4.1 年）被随机分配接受每日 TENS 治疗（n = 36）、假 TENS（n = 36）、TENS 加锻炼计划（n = 37）或假 TENS 加锻炼（n = 36）。一个月后，在测量疼痛、功能和背屈的 11 项结果指标中，没有发现 TENS 具有临床或统计学上显着的治疗效果； TENS 与运动没有交互作用。 TENS 组疼痛指标的总体改善率为 47%，假 TENS 组疼痛指标的总体改善率为 42%（P 不显着）。组间差异的 95% 置信区间排除了 TENS 对大多数结果的主要临床益处。相比之下，一个月后，与不锻炼组的患者相比，锻炼组的患者自评疼痛评分显着改善，疼痛频率减少，活动水平更高。据报道，运动组的疼痛评分平均改善了 52%，非运动组的疼痛评分平均改善了 37%（P = 0.02）。然而，在积极干预两个月后，大多数患者停止了锻炼，最初的改善也消失了。我们的结论是，对于慢性腰痛患者，TENS 治疗并不比安慰剂治疗更有效，而且 TENS 与单独运动相比并没有明显的益处。
A number of treatments are widely prescribed for chronic back pain, but few have been rigorously evaluated. We examined the effectiveness of transcutaneous electrical nerve stimulation (TENS), a program of stretching exercises, or a combination of both for low back pain. Patients with chronic low back pain (median duration, 4.1 years) were randomly assigned to receive daily treatment with TENS (n = 36), sham TENS (n = 36), TENS plus a program of exericises (n = 37), or sham TENS plus exercises (n = 36). After one month no clinically or statistically significant treatment effect of TENS was found on any of 11 indicators of outcome measuring pain, function, and back flexion; there was no interactive effect of TENS with exercise. Overall improvement in pain indicators was 47 percent with TENS and 42 percent with sham TENS (P not significant). The 95 percent confidence intervals for group differences excluded a major clinical benefit of TENS for most outcomes. By contrast, after one month patients in the exercise groups had significant improvement in self-rated pain scores, reduction in the frequency of pain, and greater levels of activity as compared with patients in the groups that did not exercise. The mean reported improvement in pain scores was 52 percent in the exercise groups and 37 percent in the nonexercise groups (P = 0.02). Two months after the active intervention, however, most patients had discontinued the exercises, and the initial improvements were gone. We conclude that for patients with chronic low back pain, treatment with TENS is no more effective than treatment with a placebo, and TENS adds no apparent benefit to that of exercise alone.