Efficacy of Selected Electrical Therapies on Chronic Low Back Pain: A Comparative Clinical Pilot Study
Rajfur J, Pasternok M, Rajfur K, Walewicz K, Fras B, Bolach B, Dymarek R, Rosinczuk J, Halski T, & Taradaj J. Med Sci Monit. 23: 85-100. doi: 10.12659/MSM.899461
Take Home Message: Various electrical stimulation treatments over the course of 3 weeks resulted in improved low back pain. Interferential stimulation seemed to have the best outcomes in patients with low back disc degeneration.
Low back pain can be very debilitating and cause significant pain. Clinicians often use various transcutaneous electrical nerve stimulation (TENS) techniques to help manage chronic low back pain. There is little research to support TENS use, therefore these authors compared the effects of various electrical stimulation treatments on pain, range of motion, and function among individuals with low back pain. Patients with low back pain due to disc degeneration were randomized to treatment groups for approximately 3 weeks: conventional TENS (20 participants), Acupuncture-like TENS (20 participants), high-voltage electrical stimulation (20 participants), interferential (21 participants), diadynamic (22 participants), & control/rehabilitation-only (21 participants). All participants, regardless of group, performed basic rehabilitation exercises. Their pain, disability, mobility, and postural stability were measured before and after the 3-week treatment period. All groups improved in pain, disability, mobility, and postural stability. Upon closer investigation, the authors reported better results for participants in the interferential treatment group in all areas, and the least amount of improvements for the patients in the diadynamic treatment group. While there were improvements over the 3 weeks, the largest disparity appeared to be that diadynamic and control groups showed significantly lower improvements than the other 4 electrical stimulation treatments.
These findings are interesting because it shows that there are significant improvements after 3 weeks of treatment with various electrical stimulation treatments or rehabilitation alone. Interestingly, the authors appeared to have the best outcomes among participants who received a 20-minute interferential treatment 3 times per week, with the theory that this treatment penetrates deeper into the tissues. This is somewhat surprising since the interferential treatment parameters were only sensory in nature, and was the shortest treatment time – with other treatments ranging from 50 to 60 minutes. It would be interesting to see what clinical outcomes might be if a clinician performed an interferential treatment with a lower frequency to try to stimulate the a-delta nerve fibers. The theory about interferential treatment penetrating deeper into tissues is one that is often referenced, but it would be interesting if a research study could prove this more definitively. The authors also noted that the diadynamic therapy appeared to have the least effect and failed to provide much of a clinical benefit, especially with other options available. Diadynamic therapy was one that I was less familiar with, and it appears that it is not a valuable addition into clinical practice. Overall, electrical stimulation treatments appear to improve symptoms and function over the course of a 3-week time frame, with interferential having the most optimal outcomes. However, these results should be interpreted with caution given the exploratory nature of this study.
Questions for Discussion: What are your thoughts on sensory electrical stimulation? What modalities do you typically use for chronic low back pain?
Written by: Nicole Cattano
Reviewed by: Jeffrey Driban