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I wonder whether transcutaneous electrical nerve stimulation (TENS) are of any use for a tendinopathy. I am mostly interested in the epicondyles of the humerus.

A Cochrane Systematic Review (1) in 2008 concluded that evidence was missing. A more recent study (2) seemed to show TENS is useless but is quite inconclusive due to patients' adherence to the treatment. They also pointed to a few other studies, but all seem inconclusive:

Comparison with relevant findings from other published work

Two previous trials have evaluated TENS in patients with tennis elbow,45 46 but these trials had different objectives, included small patient samples (20 and 12 participants per group, respectively), assessed very short term effects (24 hours and five days), and insufficiently reported details of the TENS intervention. Our study is the first adequately powered primary care study in which evidence based TENS treatment protocols were used. Hence, interpretation of our findings through direct comparisons with results from these previous trials is problematic.

The results of Cochrane reviews are inconsistent in terms of the strength of evidence for the efficacy of TENS in musculoskeletal conditions, reporting either positive effects or inconclusive evidence.47 48 49 These reviews have been criticised for failing to give adequate consideration to the fidelity of delivering the TENS intervention within individual trials in terms of treatment frequency and dose. A meta-analysis of the use of TENS in chronic musculoskeletal conditions (38 studies; 1227 participants), which explicitly considered methodological rigour and fidelity of TENS application, reported highly significant reductions in pain with the use of TENS compared with placebo.21 Abundant laboratory studies also show identifiable and dose dependent physiological pain reducing effects of TENS compared with placebo, although the vast majority of these studies reported only very short term effects (1-24 hours).29 30 31 32 33 34 35 36 37 Despite this support for efficacy of treatment, in our pragmatic trial TENS failed to show additional pain relieving effects even in the very short term, over and above the effect of primary care management alone.

I wonder whether there have been more conclusive studies published since then.


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