Gulacti U, Algin A, Turgut K, et al. Transcutaneous Electrical Nerve Stimulation (TENS) for the Treatment of Renal Colic in the ED: A Randomized, Double-Blind, Placebo-Controlled Trial. Am J Emerg Med. 2022 Jun;56:127-132. doi: 10.1016/j.ajem.2022.02.044. Epub 2022 Mar 29. (Original study)

STUDY OBJECTIVE: To determine the analgesic efficacy of TENS treatment in patients with renal colic in the emergency department (ED).

METHODS: This double-blind, randomized controlled trial was conducted in a tertiary care ED. Patients with a definitive diagnosis of renal colic were assigned (1:1) as randomized to receive the real TENS with frequency 100 Hz, pulse width 200 microseconds, voltage 2 mA, or placebo with sham TENS. Pain intensity was measured using visual analog scales (VAS) at baseline, after 15 and 30th minutes.

RESULTS: A total of 100 patients were included in the final analysis: 50 patients treated with real TENS and 50 patients treated with sham TENS. VAS scores in both groups were similar at baseline. The mean reduction in VAS score at 15 min was 33.3 ± 17.6 (95% Confidence interval (CI): 28.3 to 38.3) for the real TENS group and 14.9 ± 11.6 (95% CI 11.6 to 18.2) for the sham TENS group (mean difference: 18.4 (95% CI: 12.5 to 24.4, P < 0.0001). The mean reduction in VAS score at 30 min was 63.7 ± 21.1 (95% CI: 57.7 to 69.7) for the real TENS group and 14.9 ± 16.2 (95% CI: 19.5 to 10.3) for the sham TENS group (mean difference: 48.8, 95% CI: 41.4 to 56.3, P < 0.0001). Four patients (8%) in the real TENS group and 24 patients (48%) in the sham TENS group required the rescue medication after 30th minutes.

CONCLUSIONS: TENS is effective for acute pain treatment in renal colic patients in the ED. TENS therapy could be a treatment option for renal colic.

Discipline Area Score
Physician 5 / 7
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Comments from MORE raters

Physician rater

A demonstration that real TENS works better than sham TENS is unlikely to have impact on clinical practice in a clinical setting in which there are a plethora of well validated treatments.

Physician rater

This was a placebo-controlled trial. The participants do not appear to have been offered any analgesia until fentanyl rescue medication at 30 minutes, despite good evidence that NSAIDs provide effective pain relief for renal colic. So, we do not know whether TENS is effective when compared with an acceptable standard of care.

Physician rater

A well-performed initial study but not ready at this point for practical application. Limitations clearly stated: question about blinding; what happens after 30 minutes (patient takes device home?); comparison to NSAIDs (standard of care) not established. Hard to interpret change in pain scores. Continued attempts to avoid prescription of opioids for renal colic are welcome.

Physician rater

Interesting study with impressive results favoring TENS unit for acute renal colic pain. This study is too small to really be practice-changing, but serves as a nice pilot study. It's unclear whether they were actually able to blind patients despite having a sham TENS unit, but, more importantly, they only measured pain out to 30 minutes, which is how long the unit was applied. Duration of pain relief would be an essential endpoint - it's usually not that difficult to get people with renal colic feeling better quickly with traditional methods. The question is: If this is truly effective, how long does the pain relief last?

Physician rater

My concern with this study is the timing to start pain treatment itself. Pain should be treated even before the diagnostic confirmation. Although it is easier to appreciate this intervention without baseline analgesia, we have a pain treatment with proven efficacy that we must apply. Since fentanyl has a short half-life and poor safety profile, using another opioid agent would be preferable for this indication.

Physician rater

An RCT with good protocol and methodology. The results showing a significant effect in pain reduction in the TENS group provides practitioners with an option for effective pain relief in patients with renal colic without having to use oral analgesics, especially NSAIDs AND opioids.
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