Research Review Corner: Electro-modalities for Chronic Low Back Pain

Study Title: Evidence-informed management of chronic low back pain with transcutaneous electrical nerve stimulation, interferential current, electrical muscle stimulation, ultrasound, and thermotherapy
Authors: Poitras S & Brosseau L
Publication Information: The Spine Journal 2008; 8: 226-233.

Study Title: Evidence-informed management of chronic low back pain with transcutaneous electrical nerve stimulation, interferential current, electrical muscle stimulation, ultrasound, and thermotherapy
Authors: Poitras S & Brosseau L
Publication Information: The Spine Journal 2008; 8: 226-233.

Chronic low back pain (CLBP) remains a challenging condition to manage, one that carries a significant socioeconomic burden. In order to better understand the state of existing literature on non-surgical treatments for CLBP, the North American Spine Society sponsored a special focus issue of The Spine Journal. This review of modalities was one of the papers featured in this issue. 

Many chiropractors utilize electro-modalities in their practices. Most of these devices deliver some type of electrical input to tissue with the goal of reducing inflammation and swelling, controlling pain, modulating muscle activity, increasing or maintaining strength, and/or enhancing healing. Such modalities are also frequently used by physiotherapists. Unfortunately, there is a dearth of evidence to support their efficacy, particularly for chronic LBP. The state of the literature for each modality as it pertains to CLBP will be summarized below. Some may be surprised by the lack of research on these commonly used devices for CLBP, a condition commonly treated in most chiropractic offices.

TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) –SIX RCT AND A COCHRANE REVIEW
Interferential Current – no eligible studies found
Electrical Muscle Stimulation – no eligible studies found
Ultrasound – no eligible studies found
Hot/Cold/Ice Packs (Thermotherapy) – no eligible studies found
 
CONCLUSIONS AND PRACTICAL APPLICATION
Although electro-modalities are commonly used to treat CLBP, there is an alarming lack of evidence to support their use. Even the studies on TENS were generally of poor quality, (with 4 of 6 scoring < 2 on the commonly used Jadad Scale). Generally, high and low-frequency TENS seems to have an immediate impact on pain intensity (particularly high frequency), health status, and even acetaminophen use, but all of these findings come from only one study.  It should be noted that these results are tenuous at best, and TENS appears to have no effect on long-term pain, or perceived disability. It should also be noted that in both studies, results should be considered immediate, and not even short-term by traditional definitions. The results suggest that at best, TENS should be used as an adjunct in short-term treatment plans. 

For the other modalities, the dearth of quality – or any! – research on their effectiveness for CLBP should suggest that clinicians utilize alternative treatment approaches.

Dr. Shawn Thistle, BKin (Hons), DC, CSCS, is the founder and president of Research Review Service Inc., an online, subscription-based service designed to help busy practitioners to integrate current, relevant scientific evidence into  their practice. Shawn graduated from CMCC and holds an Honours Degree in Kinesiology from McMaster University. He also holds a certificate in Contemporary Medical Acupuncture from McMaster University, and is a Certified Active Release Techniques (ART®) Provider.  For more information about the Research Review Service, visit  http://www.researchreviewservice.com .