PAIN+ CPN

Ahern BJ, Miller CL, Somma JB, et al. Emergency department use of cross-channel TENS for acute low back pain: A randomized controlled trial. Am J Emerg Med. 2025 Aug 26;98:234-238. doi: 10.1016/j.ajem.2025.08.053. (Original study)
Abstract

BACKGROUND: Transcutaneous Electrical Nerve Stimulation (TENS) is established for chronic lower back pain but less studied in acute settings. This study evaluated the efficacy of cross-channel TENS for acute lower back pain in the emergency department (ED).

METHODS: This single-blinded, randomized controlled trial enrolled ED patients aged 18-59 with acute lower back pain and Emergency Severity Index scores of 4 or 5. Participants were randomized to receive either active or placebo cross-channel TENS. The primary outcome was change in pain scores on a 100 mm visual analog scale (VAS) after 30 min of treatment. A clinically meaningful difference was defined as =13 mm. Secondary outcomes included the proportion of patients with clinically significant improvement, patient satisfaction (0-10 scale), and placebo effect assessment. Power analysis was based on a standard deviation of 15 mm, requiring a sample size of 42.

RESULTS: Forty-two subjects completed the study (22 active, 20 placebo). Median pain reduction was 17 mm (IQR 6-29.5) in the active group and 5.5 mm (IQR 1.75-18.25) in the placebo group (difference: 11.5 mm; P = .06). Clinically significant improvement occurred in 68 % of the active group vs. 30 % of the placebo group (P = .03). Median satisfaction was 8 in both groups (P = .81).

CONCLUSIONS: Although overall pain reduction was not statistically significant between groups, a higher proportion of patients receiving active TENS achieved clinically meaningful relief. Patient satisfaction was high in both groups. Cross-channel TENS may be a useful adjunct in managing acute lower back pain in lower acuity ED patients. Future studies should explore TENS impact on length of stay and broader ED applications.

Ratings
Discipline Area Score
Physician 5 / 7
Show me more articles about:
  Acute Low Back Pain   Back Pain
Comments from MORE raters

Physician rater

This is a tiny and incompletely reported study. No information is provided regarding the administration of co-interventions such as medications. It is therefore unclear what TENS adds to current ED treatment of these patients.

Physician rater

This small RCT suggests a possible benefit for TENS in acute low back pain. As a low cost intervention for a common ED presentation, it would be very interesting to see wheher this could be replicated/be statistically significant in a larger trial.
Comments from PAIN+ CPN subscribers

Prof. Mike Poling (10/7/2025 7:31 AM)

There was no statistical significance. You can’t conclude the intervention may be helpful when the study findings do not support that.