• Peter William Gladwell, Kathryn Badlan, Fiona Cramp, and Shea Palmer.
• P.W. Gladwell, PhD, MCSP, BScHons, Pain Management Service, North Bristol NHS Trust, Southmead Hospital, Southmead Road, Bristol, United Kingdom BS10 5NB. peter.gladwell@nbt.nhs.uk.
• Phys Ther. 2015 Nov 1; 95 (11): 1518-28.

BackgroundThere is no consensus regarding the effectiveness of transcutaneous electrical nerve stimulation (TENS) for management of chronic musculoskeletal pain or chronic low back pain. A recent review of previous trial methodology identified significant problems with low treatment fidelity. There is little information available to guide selection of patient-reported outcome measures appropriate for TENS evaluation.ObjectivesThe purpose of this study was to explore the experiences of patients at a secondary care pain clinic who successfully used TENS to help manage chronic musculoskeletal pain. These key informants were selected because they had the potential to generate knowledge that could inform research design and clinical practice.DesignA qualitative method using individual semistructured interviews with open questions was selected for its capacity to generate rich data.MethodsA mini focus group informed the development of a discussion guide for semistructured interviews with 9 patients (6 women, 3 men). Thematic analysis was used as the primary data analysis method, and this analysis was enhanced by a case-level analysis of the context and processes of TENS use of each individual.ResultsData analysis indicated that distraction from pain and a reduction in the sensations associated with muscle tension or spasm should be considered as separate outcomes from pain relief. These direct benefits led to a wide range of indirect benefits dependent on patient decision making, including medication reduction, enhanced function, psychological benefits, and enhanced ability to rest.ConclusionsThe findings indicate that evaluating TENS using a unidimensional pain scale is likely to overlook potential benefits. The complex pattern of TENS usage, as well as multiple direct and indirect outcomes, indicates that TENS could be considered as a complex intervention.© 2015 American Physical Therapy Association.

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