Transcutaneous electrical nerve stimulation (TENS) consists of a generic application of low-frequency, pulsed electrical currents transmitted by electrodes through the skin surface. It is a therapeutic modality that is nonpharmacological, noninvasive, inexpensive, easy to use and widely applied in clinical practice.
Objective
To narratively review the scientific evidence of the effects of TENS on tissue repair with respect to wound healing, skin flap viability and tendinous repair.
Methods
The study was conducted using the MEDLINE, Lilacs and Scielo databases, without limit to the period of publication, and was completed in November 2011. Inclusion criteria were randomized or nonrandomized, controlled or noncontrolled clinical trials, and experimental trials involving rats subjected to TENS for tissue repair.
Results
Thirty articles on tissue repair were found and, among these, 14 reported on wound healing, 14 reported on skin flaps and two analyzed tedinous repair.
Discussion
It was suggested that TENS stimulates skin wound healing and tendon repair, as well as the viability of random skin flaps. Such effects may be due to the release of substance P and calcitonin gene-related peptide, which would increase blood flow and, consequently, hasten the events leading to tissue repair.
Conclusions
Based on the scientific evidence regarding the effects of TENS on tissue repair, the findings of the present literature review were inconclusive because data from the randomized controlled clinical trials were insufficient to confirm such effects.
LiebanoREFerreiraLMSabino NetoM. Experimental model for transcutaneous electrical nerve stimulation on ischemic random skin flap in rats.Acta Cir Bras2003; 18: 54–9.
2.
BuonocoreMCamuzziniN. Increase of the threshold during and after high-frequency transcutaneous peripheral nerve stimulation in a group of normal subjects.EURA2007; 47: 155–60.
3.
LiebanoREAblaLEFFerreiraLM. Effect of low-frequency transcutaneous electrical nerve stimulation (TENS) on the viability of ischemic skin flaps in the rat: An amplitude study.Wound Rep Reg2008; 16: 65–9.
4.
JonesIJohnsonM. Transcutaneous electrical nerve stimulation (TENS). Continuing education in anaesthesia.Crit Care Pain2009; 9: 130–5.
5.
ChenCJohnsonMI. A comparison of transcutaneous electrical nerve stimulation (TENS) at 3 and 80 pulses per second on cold-pressor pain in healthy human participants.Clin Physiol Funct Imaging2010; 30: 260–8.
6.
LiebanoRERakelBVanceCGWalshDMSlukaKA. An investigation of the development of analgesic tolerance to TENS in humans.Pain2011; 152: 335–42.
7.
ChenCJohnsonMIMcDonoughSCrampF. The effect of transcutaneous electrical nerve stimulation on local and distal cutaneous blood flow following a prolonged heat stimulus in healthy subjects.Clin Physiol Funct Imaging2007; 27: 154–61.
8.
DeSantanaJMWalshDMVanceCRakelBASlukaKA. Effectiveness of transcutaneous electrical nerve stimulation for treatment of hyperalgesia and pain.Curr Rheumatol Rep2008; 10: 492–9.
MelzackRWallP. Pain mechanisms: A new theory.Science1965; 150: 971–9.
14.
ScuddsRJHelewaAScuddsRA. The effects of transcutaneous electrical nerve stimulation on skin temperature in assintomatic subjects.Phys Ther1995; 75: 622–8.
15.
AtalayCYilmazKB. The effect of transcutaneous electrical nerve stimulation on postmastectomy skin flap necrosis.Breast Cancer Res Treat2009; 117: 611–4.
16.
SherryJEOehrleinKMHeggeKSMorganBJ. Effect of burst-mode transcutaneous electrical nerve stimulation on peripheral vascular resistance.Phys Ther2001; 81: 1183–91.
17.
FerreiraLMHochmanBBarbosaMVJ. Modelos experimentais em pesquisa.Acta Cir Bras2005; 20(Suppl);2: 28–34.
18.
HochmanBNahasFXOliveira FilhoRSFerreiraLM. Desenhos de pesquisa.Acta Cir Bras2005; 20(Suppl);2:2–9.
19.
MarquesMAPeccinMS. Pesquisa em fisioterapia: A prática baseada em evidências e modelos de estudos.Fisioter Pesq2005; 11: 43–8.
20.
LundebergTKjartanssonJSamuelssonU. Effect of electrical nerve stimulation on healing of ischemic skin flaps.Lancet1988; 24: 712–4.
21.
KjartanssonJLundebergT. Effects of electrical nerve stimulation (ENS) in ischemic tissue.Scand J Plast Reconstr Hand Surg1990; 24: 129–34.
22.
NiinaYIkedaKIwaMSakitaM. Effects of electroacupuncture and transcutaneous electrical nerve stimulation on survival of musculocutaneous flap in rats.Am J Chin Med1997; 25: 273–80.
23.
KhalilZMerhiM. Effects of aging on neurogenic vasodilator responses evoked by transcutaneous electrical nerve stimulation: Relevance to wound healing.J Gerontol Biol Sci2000; 55A: B257–63.
24.
KhalilZMerhiMLivettBG. Differential involvement of conotoxin-sensitive mechanisms in neurogenic vasodilatation responses: Effects of age.J Gerontol Biol Sci Med Sci2001; 56: B356–63.
25.
LiebanoREFerreiraLMSabino NetoM. The effect of the transcutaneous electrical nerve stimulation on the viability of random skin flaps in rats.Can J Plast Surg2002; 10: 151–4.
26.
AtalayCKoçkayaEACetinBKismetKAkayMT. Efficacy of topical nitroglycerin and transcutaneous electrical nerve stimulation on survival of random-pattern skin flaps in rats.Scand J Plast Reconstr Surg Hand Surg2003; 37: 10–13.
27.
LiebanoREAblaLEFFerreiraLM. Effect of high frequency transcutaneous electrical nerve stimulation on viability of random skin flap in rats.Acta Cir Bras2006; 21: 133–8.
28.
RussoCRALeiteMTGomesHCFerreiraLM. Transcutaneous electrical nerve stimulation in viability of a random skin flap in nicotine-treated rats.Ann Plast Surg2006; 57: 670–2.
29.
KaadaB. Vasodilation induced by transcutaneous nerve stimulation in peripheral ischemia (Raynaud's phenomenon and diabetic polyneuropathy).Eur Heart J1982; 3: 303–14.
30.
BiedebachM. Accelerated healing of skin ulcers by electrical stimulation and intracellular physiological mechanisms involved.Acupunct Electrother Res1989; 14: 43–60.
31.
FinsenLPersenLLøvlienM. Transcutaneous electrical nerve stimulation after major amputation.J Bone Joint Surg Br1988; 70-B: 109–12.
32.
KaadaB. Emru M. Promoted healing of leprous ulcers by transcutaneous nerve stimulation.Acupunct Electrother Res1988; 13: 165–76.
DebreceniLGyulaiMDebreceniASzabóK. Results of transcutaneous electrical stimulation (TES) in cure of lower extremity arterial disease.Angiology1995; 46: 613–8.
35.
BakerLLChambersRDemuthSKVillarF. Effects of electrical stimulation on wound healing in patients with diabetic ulcers.Diabetes Care1997; 20: 405–12.
36.
BakerLLRubayiSVillarFDemuthSK. Effect of electrical stimulation waveform on healing of ulcers in human beings with spinal cord injury.Wound Rep Reg1996; 4: 21–8.
37.
ForstTPfütznerABauersachsR. Comparison of the microvascular response to transcutaneous electrical nerve stimulation and postocclusive ischemia in the diabetic foot.J Diabetes Complications1997; 11: 291–7.
38.
WikströmOSSvedmanPHenrySTanweerAS. Effect of transcutaneous nerve stimulation on microcirculation in intact skin and blister wounds in healthy volunteers.Scand J Plast Reconstr Hand Surg1999; 33: 195–201.
39.
CosmoPSvenssonHBornmyrSWikströmS. Effects of transcutaneous nerve stimulation on the microcirculation in chronic leg ulcers.Scand J Plast Reconstr Hand Surg2000; 34: 61–4.
40.
KarbaRBenkoHSavrinRVodovnikL. Combination of occlusive dressings and electrical stimulation in pressure ulcer treatment.Med Sci Res1995; 23: 671–3.
41.
KaadaBOlsenEEielsenO. In search of mediators of skin vasodilation induced by transcutaneous nerve stimulation:, III. Increase in plasma VIP in normal subjects and in Raynaud's disease.Gen Pharmacol1984; 15: 107–13.
42.
KaadaBHelleKB. In search of mediators of skin vasodilation induced by transcutaneous nerve stimulation: IV. In vitro bioassay of the vasoinhibitory activity of sera from patients suffering from peripheral ischemia.Gen Pharmacol1984; 15: 115–22.
43.
AbramSEAsiddaoCBReynoldsAC. Increased skin temperature during transcutaneous electrical stimulation.Anesth Analg1980; 59: 22–5.
44.
NolanMFHartsfieldJKWittersDMWasonPJ. Failure of transcutaneous electrical nerve stimulation in the conventional and burst modes to alter digital skin temperature.Arch Phys Med Rehab1993; 74: 182–7.
45.
CrampAFLGilsenanCLoweASWalshDM. The effect of high- and low-frequency transcutaneous electrical nerve stimulation upon cutaneous blood flow and skin temperature in healthy subjects.Clin Physiol2000; 20: 150–7.
46.
CrampAFNobleJGLoweASWalshDM. Transcutaneous electrical nerve stimulation (TENS): The effect of electrode placement upon cutaneous blood flow and skin temperature.Acupunct Electrother Res2001; 26: 25–37.
47.
CrampFLMcCulloughGRLoweASWalshDM. Transcutaneous electric nerve stimulation: The effect of intensity on local and distal cutaneous blood flow and skin temperature in healthy subjects.Arch Phys Med Rehabil2002; 83: 5–9.
48.
SimpsonKHJason WardJ. A Randomized, double-blind, crossover study of the use of transcutaneous spinal electroanalgesia in patients with pain from chronic critical limb ischemia.J Pain Symptom Manage2004; 28: 511–6.
49.
BurssensPForsythRSteyaertAVan OvostEPraetMVerdonkR. Influence of burst TENS stimulation on the healing of Achilles tendon suture in man.Acta Orthop Belg2003; 69: 528–32.
50.
JenbeckJDaslgaardCJ. Calcitonin gene-related peptide treatment of flaps with compromised circulation in humans.Plast Reconstr Surg1993; 91: 236–44.
51.
BurssensPForsythRSteyaertAVan OvostEPraetMVerdonkR. Influence of burst TENS stimulation on collagen formation after Achilles tendon suture in man. A histological evaluation with Movat's pentachrome stain.Acta Orthop Belg2005; 71: 342–6.
52.
CettiRChristensenSEEjstedRJensenNMJorgensenU. Operative versus nonoperative treatment of Achilles tendon rupture. A prospective randomized study and review of the literature.Am J Sports Med1993; 21: 791–9.
53.
Stehno-BittelLReddyGKGumSEnwemekaCS. Biochemistry and biomechanics of healing tendon: Part I. Effects of rigid plaster casts and functional casts.Med Sci Sports Exerc1998; 30: 788–93.
