The effects of TENS,interferential stimulation,and combined interferential stimulation and pulsed ultrasound on patients with disc herniation-induced radicular pain
Restricted accessResearch articleFirst published online March, 2022
The effects of TENS,interferential stimulation,and combined interferential stimulation and pulsed ultrasound on patients with disc herniation-induced radicular pain
Electrotherapy is part of a physician’s toolbox for treating various musculoskeletal conditions, including radicular pain, but the preferred modality is yet unclear.
OBJECTIVE:
To compare the short-term efficacy of three electrotherapeutic modalities in relieving lumbar disc herniation (LDH)-induced radicular pain.
METHODS:
Fourteen patients with LDH-induced radicular pain attended a single session of electrotherapy, which included four 10-min consecutive treatments: transcutaneous electrical nerve stimulation (TENS), interferential (IF) stimulation, a combined treatment with pulsed ultrasound and IF current (CTPI), and a sham control. Treatments were randomized and the straight leg raise (SLR) degree was measured immediately before and after each treatment.
RESULTS:
Each of the three active modalities significantly improved the SLR score. The most prominent improvement was observed in the CTPI condition, followed by IF and, finally, TENS. The sham stimulation did not affect the SLR scores.
CONCLUSIONS:
A single session with either TENS, IF current or CTPI is sufficient to improve the range of motion and degree of radicular pain associated with LDH. CTPI appears to be the most effective modality of the three, possibly due to greater penetration efficiency of the induced current. The effects of a long-term treatment schedule are yet to be identified.
KreinerDSHwangSWEasaJEResnickDKBaisdenJLBessS, et al. An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J.2014; 14(1): 180-91.
2.
HoyDMarchLBrooksPBlythFWoolfABainC, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis.2014; 73(6): 968-74.
3.
FrymoyerJW. Back pain and sciatica. N Engl J Med.1988; 318(5): 291-300.
4.
WartenbergR. The signs of Brudzinski and of Kernig. J Pediatr.1950; 37(4): 679-84.
5.
BogdukN. On the definitions and physiology of back pain, referred pain, and radicular pain. Pain.2009; 147(1-3): 17-9.
6.
ArtsMPKursumovicAMillerLEWolfsJFCPerrinJMVan de KelftE, et al. Comparison of treatments for lumbar disc herniation: Systematic review with network meta-analysis. Medicine (Baltimore).2019; 98(7): e14410.
7.
BellewJWMichlovitzSLNolanTP. Jr. Michlovitz’s Modalities for Therapeutic Intervention: FA Davis; 2016.
8.
AlmeidaTFRoizenblattSBenedito-SilvaAATufikS. The effect of combined therapy (ultrasound and interferential current) on pain and sleep in fibromyalgia. Pain.2003; 104(3): 665-72.
9.
AuchstaetterNLucJLukyeSLyndKSchemenauerSWhittakerM, et al. Physical Therapists’ Use of Functional Electrical Stimulation for Clients With Stroke: Frequency, Barriers, and Facilitators. Physical Therapy.2016; 96(7): 995.
10.
MachadoASantanaEFTacaniPMLiebanoRE. The effects of transcutaneous electrical nerve stimulation on tissue repair: A literature review. Can J Plast Surg.2012; 20(4): 237-40.
11.
RushtonD. Electrical stimulation in the treatment of pain. Disability and Rsehabilitation.2002; 24(8): 407-15.
12.
FuentesJPArmijo OlivoSMageeDJGrossDP. Effectiveness of interferential current therapy in the management of musculoskeletal pain: a systematic review and meta-analysis. Phys Ther.2010; 90(9): 1219-38.
13.
DemirelAYorubulutMErgunN. Regression of lumbar disc herniation by physiotherapy. Does non-surgical spinal decompression therapy make a difference? Double-blind randomized controlled trial. J Back Musculoskelet Rehabil.2017; 30(5): 1015-22.
14.
MoustafaIMDiabAA. Extension traction treatment for patients with discogenic lumbosacral radiculopathy: a randomized controlled trial. Clin Rehabil.2013; 27(1): 51-62.
15.
RatajczakBHawrylakADemidasAKuciel-LewandowskaJBoernerE. Effectiveness of diadynamic currents and transcutaneous electrical nerve stimulation in disc disease lumbar part of spine. J Back Musculoskelet Rehabil.2011; 24(3): 155-9.
16.
PopTAustrupHPreussRNiedzialekMZaniewskaASobolewskiM, et al. Effect of TENS on pain relief in patients with degenerative disc disease in lumbosacral spine. Ortop Traumatol Rehabil.2010; 12(4): 289-300.
17.
FrancaFJRCallegariBRamosLAVBurkeTNMagalhaesMOComachioJ, et al. Motor Control Training Compared With Transcutaneous Electrical Nerve Stimulation in Patients With Disc Herniation With Associated Radiculopathy: A Randomized Controlled Trial. Am J Phys Med Rehabil.2019; 98(3): 207-14.
18.
GhonameEAWhitePFAhmedHEHamzaMACraigWFNoeCE. Percutaneous electrical nerve stimulation: an alternative to TENS in the management of sciatica. Pain.1999; 83(2): 193-9.
19.
RamosLAVCallegariBFrançaFJRMagalhãesMOBurkeTNCarvalhoAPdMC, et al. Comparison between transcutaneous electrical nerve stimulation and stabilization exercises in fatigue and transversus abdominis activation in patients with lumbar disk herniation: A randomized study. Journal of Manipulative and Physiological Therapeutics.2018; 41(4): 323-31.
20.
WernersRPynsentPBBulstrodeCJ. Randomized trial comparing interferential therapy with motorized lumbar traction and massage in the management of low back pain in a primary care setting. Spine (Phila Pa 1976). 1999; 24(15): 1579-84.
21.
LiLCBombardierC. Physical therapy management of low back pain: an exploratory survey of therapist approaches. Phys Ther.2001; 81(4): 1018-28.
22.
Çıtak-KarakayaİAkbayrakTDemirtürkFEkiciGBakarY. Short and long-term results of connective tissue manipulation and combined ultrasound therapy in patients with fibromyalgia. Journal of Manipulative and Physiological Therapeutics.2006; 29(7): 524-8.
23.
MorettiFAMarcondesFBProvenzaJRFukudaTYVasconcelosRARoizenblattS. Combined therapy (ultrasound and interferential current) in patients with fibromyalgia: once or twice in a week? Physiotherapy Research International.2012; 17(3): 142-9.
24.
WaschlSMorrisseyMCRugeljD. The Efficacy of Ultrasound-facilitated Electrical Stimulation as an Adjunct to Exercise in Treating Chronic Neck and Shoulder Pain. Journal of Musculoskeletal Pain.2014; 22(1): 78-88.
25.
ArielERatmanskyMLevkovitzYGoor-AryehI. Efficiency of Tissue Penetration by Currents Induced by Three Electrotherapeutic Techniques: A Comparative Study Using a Novel Deep-Tissue Measuring Technique. Phys Ther.2019; 99(5): 540-8.
26.
SatoskarSRGoelAAMehtaPHGoelA. Quantitative morphometric analysis of the lumbar vertebral facets and evaluation of feasibility of lumbar spinal nerve root and spinal canal decompression using the Goel intraarticular facetal spacer distraction technique: A lumbar/cervical facet comparison. J Craniovertebr Junction Spine.2014; 5(4): 157-62.
27.
DixonJKKeatingJL. Variability in straight leg raise measurements. Physiotherapy.2000; 86(7): 361-70.
28.
KouryMJScarpelliE. A manual therapy approach to evaluation and treatment of a patient with a chronic lumbar nerve root irritation. Phys Ther.1994; 74(6): 548-60.
29.
ChowRAdamsRHerbertR. Straight leg raise test high reliability is not a motor memory artefact. Aust J Physiother.1994; 40(2): 107-11.
30.
Camino WillhuberGOPiuzziNS. Straight Leg Raise Test. StatPearls. Treasure Island (FL), 2019.
31.
BoydBS. Measurement properties of a hand-held inclinometer during straight leg raise neurodynamic testing. Physiotherapy.2012; 98(2): 174-9.
32.
BolandRAAdamsRD. Effects of ankle dorsiflexion on range and reliability of straight leg raising. Australian Journal of Physiotherapy.2000; 46(3): 191-200.
33.
ThelanderUFagerlundMFribergSLarssonS. Straight leg raising test versus radiologic size, shape, and position of lumbar disc hernias. Spine (Phila Pa 1976).1992; 17(4): 395-9.
34.
EkedahlHJönssonBFrobellRB. Fingertip-to-Floor Test and Straight Leg Raising Test: Validity, Responsiveness, and Predictive Value in Patients With Acute/Subacute Low Back Pain. Archives of Physical Medicine and Rehabilitation.2012; 93(12): 2210-5.
35.
SupikLFBroomMJ. Sciatic tension signs and lumbar disc herniation. Spine (Phila Pa 1976).1994; 19(9): 1066-9.
36.
XinSQZhangQZFanDH. Significance of the straight-leg-raising test in the diagnosis and clinical evaluation of lower lumbar intervertebral-disc protrusion. J Bone Joint Surg Am.1987; 69(4): 517-22.
37.
TroupJD. Biomechanics of the lumbar spinal canal. Clin Biomech (Bristol, Avon).1986; 1(1): 31-43.
38.
DefrinRArielEPeretzC. Segmental noxious versus innocuous electrical stimulation for chronic pain relief and the effect of fading sensation during treatment. Pain.2005; 115(1): 152-60.
39.
MeszarosTFOlsonRKuligKCreightonDCzarneckiE. Effect of 10%, 30%, and 60% body weight traction on the straight leg raise test of symptomatic patients with low back pain. J Orthop Sports Phys Ther.2000; 30(10): 595-601.
40.
Medrik-GoldbergTLifschitzDPudDAdlerREisenbergE. Intravenous lidocaine, amantadine, and placebo in the treatment of sciatica: a double-blind, randomized, controlled study. Reg Anesth Pain Med.1999; 24(6): 534-40.
41.
KimNHHongYLeeSH. Two-year clinical outcomes of radiofrequency focal ablation using a navigable plasma disc decompression device in patients with lumbar disc herniation: efficacy and complications. J Pain Res.2018; 11: 2229-37.
42.
TambekarNSabnisSPhadkeABedekarN. Effect of Butler’s neural tissue mobilization and Mulligan’s bent leg raise on pain and straight leg raise in patients of low back ache. J Bodyw Mov Ther.2016; 20(2): 280-5.
43.
GovindJ. Lumbar radicular pain. Aust Fam Physician.2004; 33(6): 409-12.
44.
GoupillePJaysonMIValatJPFreemontAJ. The role of inflammation in disk herniation-associated radiculopathy. Semin Arthritis Rheum.1998; 28(1): 60-71.
MelzackRWallPD. Pain mechanisms: a new theory. Science.1965; 150(3699): 971-9.
51.
KalraAUrbanMOSlukaKA. Blockade of opioid receptors in rostral ventral medulla prevents antihyperalgesia produced by transcutaneous electrical nerve stimulation (TENS). J Pharmacol Exp Ther.2001; 298(1): 257-63.
52.
SlukaKADeaconMStibalAStrisselSTerpstraA. Spinal blockade of opioid receptors prevents the analgesia produced by TENS in arthritic rats. J Pharmacol Exp Ther.1999; 289(2): 840-6.
RadhakrishnanRKingEWDickmanJKHeroldCAJohnstonNFSpurginML, et al. Spinal 5-HT(2) and 5-HT(3) receptors mediate low, but not high, frequency TENS-induced antihyperalgesia in rats. Pain.2003; 105(1-2): 205-13.
55.
RadhakrishnanRSlukaKA. Spinal muscarinic receptors are activated during low or high frequency TENS-induced antihyperalgesia in rats. Neuropharmacology.2003; 45(8): 1111-9.
56.
VenaDRubiantoJPopovicMRFernieGRYadollahiA. The Effect of Electrical Stimulation of the Calf Muscle on Leg Fluid Accumulation over a Long Period of Sitting. Sci Rep.2017; 7(1): 6055.
57.
RadhakrishnanRSlukaKA. Deep tissue afferents, but not cutaneous afferents, mediate transcutaneous electrical nerve Stimulation – Induced antihyperalgesia. The Journal of Pain.2005; 6(10): 673-80.
58.
KhadilkarAOdebiyiDOBrosseauLWellsGA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database Syst Rev.2008; (4): CD003008.
