From the Guidelines
Electrotherapy, specifically transcutaneous electrical nerve stimulation (TENS), can be used to stimulate recovery in patients with musculoskeletal injuries and neuropathic pain, as supported by low-certainty evidence from recent clinical guidelines 1.
Key Points to Consider
- The American College of Physicians and American Academy of Family Physicians suggest the use of TENS to reduce pain in patients with acute pain from non–low back, musculoskeletal injuries, based on low-certainty evidence 1.
- TENS has been shown to reduce pain at less than 2 hours compared with placebo, with a weighted mean difference of −1.94 cm on a 10-cm VAS, although the evidence is of low certainty 1.
- Electrotherapy modalities, including TENS, electrical muscle stimulation (EMS), interferential therapy (IFT), and pulsed electromagnetic field therapy (PEMF), can be effective in stimulating recovery, but the parameters and treatment protocols may vary depending on the specific condition and patient population.
- Patients should be properly assessed before treatment, and electrotherapy should be avoided over areas with metal implants, pacemakers, pregnancy, malignancy, or impaired sensation.
Recommendations for Use
- For musculoskeletal injuries, EMS can be applied at frequencies of 50-100 Hz for 15-30 minute sessions, 3-5 times weekly for 2-6 weeks to improve muscle strength and reduce atrophy.
- For neuropathic pain, TENS can be used with parameters of 80-120 Hz (high frequency) or 2-10 Hz (low frequency), pulse width of 50-200 microseconds, for 30-60 minute sessions daily.
- Electrotherapy should be used as part of a comprehensive rehabilitation program, combined with other interventions like exercise, manual therapy, and proper pain education, to achieve optimal outcomes.
From the Research
Electrotherapy for Recovery Stimulation
Electrotherapy can be used to stimulate recovery in patients with musculoskeletal injuries or neuropathic pain. The following points highlight its applications and benefits:
- Electrotherapy is a part of clinical intervention in the rehabilitation field, providing treatment for pain relief, strengthening, muscle education, wound recovery, or functional training 2.
- It has been used in conjunction with other therapeutic interventions to make a positive contribution to patient care, particularly for musculoskeletal and neurological problems 3.
- Different therapeutic modalities achieve their effects in different tissues, and the clinical decision-making process should employ available evidence to maximize the potential benefit for each patient 3.
- Electrotherapy has a well-established role within physiotherapy practice, with various modalities such as ultrasound and interferential therapy being utilized to bring about physiological effects 4.
- The use of electrotherapy has been part of physical therapy treatment for several decades, with numerous modalities being used, including TENS, interferential, diathermy, magnetic therapy, ultrasound, laser, and surface electromyography 5.
Applications and Indications
Electrotherapy has various applications and indications, including:
- Pain syndromes, muscle atrophy by loss of activity, and support of wound healing 6.
- Musculoskeletal and neurological problems, such as orthopedic and neurological rehabilitation 2, 3.
- Home-based electrotherapy may provide opportunities for the prevention of deterioration or extension of the original therapy, particularly during the coronavirus disease pandemic 2.
Effectiveness and Future Potential
The effectiveness and future potential of electrotherapy are:
- Emerging ES tools for brain modulation have shown potential for future home-based rehabilitation 2.
- Transcranial direct current stimulation has shown potential for future home-based rehabilitation due to its relatively small and simple design 2.
- There is a need for extensive research on each of the electrotherapy devices to determine their proper use 5.