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Three Part Question

IN [adults with post-operative shoulder pain] IS [TENS beneficial] AT [decreasing pain]?

Clinical Scenario

Clinical Scenario
Your musculoskeletal physiotherapy service is considering developing a supervised gym class for post-operative shoulder patients. Many patients experience post operative pain which impacts on their ability to perform exercises. Would the use of TENS machines during the class be beneficial in decreasing pain?

Search Strategy

Medline 1950 - 03/13, CINAHL 1981 – 03/13, AMED 1985 – 03/13, EMBASE 1996-09/04, PsycINFO 1970 – 03/13 databases individually via NHS evidence interface. This included selective dissemination of information (SDI) searches and use of MeSH.
Medline, CINHAL, AMED, PsycINFO, EMBASE: [{(exp shoulder* OR glenohumeral*)} AND [(exp TENS OR transcutaneous nerve stimulation OR transcutaneous electric nerve stimulation) LIMIT to human AND English language and adolescents/adults/65+.
In addition a general search using NHS evidence for (TENS) AND (pain) AND (meta-analysis) LIMIT to 2002 - present
Cochrane 2013 and SPORTDiscus 1830-09/04 searched: (pain) AND (TENS).
PEDro searched: (TENS) AND (pain) AND (upper arm, shoulder or shoulder girdle)

1 RCT found investigating the benefit of TENS for post operative shoulder pain but could not be included as it is in German language.

Search Outcome

There were no papers specifically studying the effect of TENS on post-operative shoulder pain.

Comment(s)

5 papers (including 2 RCTs) were found which studied the benefit of TENS in shoulder pain but not post-operative shoulder pain and were therefore not included. One meta-analysis investigated randomised placebo-controlled trials to find out if TENS can reduce analgesic consumption after surgery. This did not include shoulder procedures, although some of the trials studied orthopaedic procedures. Three related Cochrane reviews were found: One analysed Physiotherapy interventions for shoulder pain but did not include TENS; the other two related to chronic and acute pain but were not specific to the shoulder. These both concluded that there were insufficient studies of rigorous design and adequate size.

Clinical Bottom Line

There is insufficient evidence for conclusions on the benefit of TENS in post-operative shoulder pain.