• Josefa Belén Alarcón, Priscila Belén Chuhuaicura, Kathleen Anne Sluka, VanceCarol G TCGTDepartment of Physical Therapy and Rehabilitation Science, Pain Research Program, The University of Iowa, Iowa City, IA, USA., Valéria Paula Sasoli Fazan, Karina Alejandra Godoy, Ramón Eduardo Fuentes, and Fernando José Dias.
• Research Centre in Dental Sciences (CICO-UFRO), Dental School-Facultad de Odontología, Universidad de La Frontera, Temuco, Chile.
• Neuromodulation. 2022 Dec 1; 25 (8): 124812581248-1258.

ObjectiveTranscutaneous electrical nerve stimulation (TENS) is a noninvasive electrical stimulation therapy indicated for pain control that has been applied for the regeneration of nerves. This systematic review aimed to analyze the evidence on TENS effectiveness on nerve regeneration.Materials And MethodsA systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria: PubMed/MEDLINE, Web of Science, ScienceDirect, and SciELO data bases. Primary research that evaluated TENS on nerve regeneration was considered.ResultsSeveral studies have investigated the use of TENS for pain treatment. A total of six animal studies analyzed TENS for nerve regeneration. The selected articles showed high quality (Animal Research: Reporting of In Vivo Experiments guidelines), with many unclear points related to bias opportunities (Systematic Review Center for Laboratory Animal Experimentation Risk of Bias tool). In general, TENS accelerated functional and motor recovery and increased axon quantity and diameter. More specifically, the application of low-frequency TENS resulted in a continuous basal lamina; a higher density of fibers with normal diameters, indicating normal myelination, showed signs of deterioration and delayed nerve regeneration. In contrast, the high-frequency TENS application stimulated motor regeneration and increased the diameter of the regenerated axons but revealed a small number of axons, demyelination, dark axoplasm, and an increase in the predisposition of neuropathic pain.ConclusionsAlthough there is some heterogeneous evidence in animal research, TENS seems to be a promising treatment for nerve injury that should be better explored. It is still necessary to improve the analysis of its application parameters, which can lead to the most satisfactory regeneration results and improve the understanding of its mechanisms on peripheral nerve regeneration.Copyright © 2021 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.

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