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Panel findings and recommendations: 
 -   Transcutaneous electrical nerve stimulation (TENS) is not recommended in the treatment of patients with low back problems.  (Strength of Evidence = C.)  
  A TENS unit is a small battery-operated device worn by the patient.  It provides continuous pulses of electricity by way of surface electrodes.  Presumably, TENS produces a counter-stimulation of the nervous system, which can modify pain perception.  The therapeutic objective of TENS in patients with low back problems is to provide symptomatic pain relief.   
Transcutaneous Electrical Nerve Stimulation 
Literature Reviewed     Evidence on Efficacy     Potential Harms and Costs   Summary of Findings    Author's Example 
Transcutaneous Electrical Nerve Stimulation 
   Literature Reviewed.  Of 34 articles screened for this topic, 9 articles reporting on 8 RCTs met criteria for review. 156, 157, 158, 159, 160, 161, 162, 163, 164  Only one study evaluated patients with acute low back pain. 160 
  Evidence on Efficacy.    Hackett, Seddon, and Kaminski160 evaluated a treatment called "electroacupuncture," which consisted of low-amplitude pulsed electrical current administered by way of surface electrodes rather than by needles.  The panel considered this a variation of TENS rather than a type of acupuncture since no needling was involved.  For the study, 37 patients with low back pain of less than 3 days' duration were randomly assigned to groups receiving either two 15-minute treatments of electroacupuncture and placebo tablets or paracetamol tablets and placebo electroacupuncture with no current applied.  There was no difference in results at 1 and 2 weeks.  By the sixth week after the initial treatment, patients who had electroacupuncture reported significantly less pain, measured on a visual analog pain-rating scale, compared with those who took paracetamol. 
  The other studies reviewed focused on patients with chronic low back pain or other types of chronic pain or on a mixture of acute and chronic low back pain patients.  The largest randomized study of TENS was carefully blinded and found no benefit for TENS over sham TENS in patients with chronic low back problems. 
157  The remaining studies were of variable quality and were inconclusive regarding efficacy of TENS for relieving chronic pain. 
  Potential Harms and Costs.  The risks of TENS are considered low.  The cost of this treatment is considered low to moderate (depending upon whether the equipment is rented or owned by the patient). 
  Summary of Findings.  There is inconclusive evidence of the efficacy of TENS in patients with acute low back problems.  Only one published study addresses this issue, and its findings are considered weak. 
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