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Small study finds real TENS is more effective than sham TENS for pain relief in adults with renal colic
Clinical Question
Is transcutaneous electrical nerve stimulation effective to relieve pain in adults with renal colic?
Bottom line
In this well-done study, which took place in a single emergency department, real TENS resulted in greater degrees of clinically meaningful pain reduction than sham TENS in adults with renal colic. 1b
Reference
Study design: Randomized controlled trial (double-blinded)
Funding: Self-funded or unfunded
Setting: Emergency department
Synopsis
These researchers randomized adults with renal colic who arrived at a single academic emergency department in Turkey to real transcutaneous electrical nerve stimulation (TENS; n = 50) or sham TENS (n = 50). To aid in masking, the researchers told all participants that they may or may not feel sensations from the unit. All participants underwent noncontrast helical computed tomography to confirm the presence of stones. Additionally, all participants were given intravenous fentanyl (0.75 microgram/kg) if they had inadequate pain response within 30 minutes of applying the respective units. The participants in each group were comparable at baseline and had similar baseline pain scores (70/100 and 71/100, respectively). The average pain levels for participants treated with real TENS at 15 and 30 minutes were 40/100 and 10/100 compared with 60/100 and 60/100 for those receiving sham therapy. Only 4 (8%) patients treated with real TENS received rescue analgesia compared with 24 (48%) who received sham TENS. Although the average pain score reductions are impressive, here is a grievance: The goal of the study was to see if TENS would result in a clinically meaningful 20-point-greater reduction in pain, but the authors don’t actually report the proportion of participants in either group who achieved this. Finally, the average body mass index among the participants was 22 kg/m2, so these data may not apply in overweight or obese persons.
Reviewer
Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI
Comments
TENS for renal colic
Interesting study. Review does not indicate whether evaluators were blinded to the treatment the patient received. If they weren't there would have been significant bias and I wouldn't have confidence in the results. Also a very small study which always concerns me. Nevertheless an easy study to redo given the incidence of renal colic. If verified TENS would be a great alternative (or in many cases replacement) for opioids. Ideally I'd like to see a study using ketorolac +/- TENS with opioid rescue PRN.
what was done for ongoing stone management or pain relief?
a/a
real TENS better than sham tens for renal colic pain
more studies needed but may be very useful for pain control if it works