Percutaneous Electric Nerve Stimulation Appears Effective Treatment for Some Types of Lower Back Pain
Since chronic lower back pain is one of the most common complaints of pain in the developed world, researchers are constantly looking for better ways to treat the pain and reduce its recurrence. The cost of back pain is high in terms of employer/employment cost, but also in life value.
Normally, adults with lower back pain are first treated with oral analgesics, pills or tablets to help relieve the inflammation and pain. They may also be given special exercises to strengthen their back. If these don't work, then other treatments could involve alternative treatments, such as chiropractics, acupuncture, and others.
An important issue when dealing with chronic back pain is that patients can become used to having the pain and they need to learn other ways to remove the pain and make them get used to not having pain again. This is a goal in rehabilitation of back pain patients.
One type of treatment that is proving helpful for some with lower back pain is called percutaneous electrical nerve stimulation, or PENS. It's like acupuncture with electrical impulses. Patients who have undergone PENS seem to have a quick reduction in pain, particularly in the younger patients. The authors of this article studied how effective the pain reduction lasted over three months in older adults with lower back pain.
Researchers evaluated 200 men and women who were 65 years old or older. They were divided into four groups: one group received PENS alone, the second received PENS and general conditioning and exercise, and the final two groups were control groups, one for the PENS group and the other did just conditioning and exercise. All patients were evaluated before participating in the study.
The PENS group received PENS for 30 minute sessions and the number of treatments were decided on by the acupuncturist in relation to how the patients reacted to the treatment. The control PENS group had acupuncture needles applied, but received only minimal stimulation to simulate receiving the treatment. The PENS and conditioning and exercise group received the PENS and participated in on-site conditioning with treadmill or stationary bicycle. At home, they performed flexibility exercises and a graded walking program.
The efficacy of the treatments on physical function was measured using the Functional Status Index and the Physical Activity Scale for the Elderly, and psychosocial function was measured using the Geriatric Depression Scale, the Chronic Pain Self-Efficacy Scale, the Catastrophizing Scale of the Cognitive Strategies Questionnaire, and the Fear Avoidance Beliefs Questionnaire. Quality of sleep was measured using the Pittsburgh Sleep Quality Index, and the health related quality of life was measured using the Medical Outcomes Study 36 Short Form Health Survey. Researchers also looked at physical function by asking the patients to walk, get in and out of a chair a certain number of times, and climbing stairs.
When the results were tabulated, the researchers found that all of the patients had some pain relief and improved disability, as well as speed of walking. The groups that participated in conditioning and exercise had fewer issues with avoiding pain. None of the groups had any side effects or complications from the treatments. Because both the PENS group and the control PENS group reported pain relief, the researchers weren't able to tell what type of dosage was the most effective.
The authors concluded that PENS, twice a week for six weeks, for people over 65 years old, combined with conditioning and exercise was a safe and well-tolerated treatment and provided lasting effects after six months. PENS alone also provided the same relief. However, general conditioning and exercise, alone, did not reduce pain, nor did it improve function.
Debra K. Weiner, et al. Efficacy of percutaneous electrical nerve stimulation and therapeutic exercise for older adults with chronic low back pain: A randomized controlled trial. In Pain. December 2008. Vol. 140. Pp. 344 to 357.