A study
published in Rheumatology International
in 2013, investigated the efficacy of supervised exercise combined with
transcutaneous electrical nerve stimulation in women with fibromyalgia. A total of 66 female participants diagnosed
with fibromyalgia according to the 1990 American College of Rheumatology
criteria were admitted to the study at the outpatient clinic of Istanbul
Physical Medicine and Rehabilitation Training Hospital, in Istanbul,
Turkey.
The
participants were randomized by binary block randomization into two treatment
groups with 30 participants each. All
participants participated in a 40 minute supervised combined exercise program
for 3 days a week for 12 weeks in the rehabilitation hospital. The median age in group 1 was 45.63 years
old, and the median age in group 2 was 43.30 years old. All participants in group 1 received TENS
treatment once a day on weekdays for the first 3 weeks of the study, for a
total of 15 treatments. The TENS
treatment sessions lasted for 30 minutes and were performed in the morning,
whereas the exercise treatments occurred in the afternoon. The same TENS apparatus was used on all participants
and the electrodes were placed around the most painful areas such as the neck,
shoulder, back and hip regions.
“Stimulation frequency was set at 80 Hz and intensity was set according
to the patient’s tolerance” (Multu, 2013, p. 650). All patients were evaluated at the
baseline, at the 3rd and then again at the 12th week. The physician performing the measurements was
blinded to the particpants’ groups.
The
measurements that were used were tender point count (TPC), myalgic pain score
(MPS), the Fibromyalgia Impact Questionnaire, and the short form 36 health
survey. TPC consisted of 18 tender
points that were measured by the same physician by palpation with the
thumb. The myalgic pain score evaluated the
degree of tenderness at each tender point on a 4 point scale: 0 = no pain, 1 =
mild pain, 2 = moderate pain with verbal exclamation and 3 = severe pain with
withdrawal reaction. “The Fibromyalgia
Impact Questionnaire is a self-administered questionnaire that helps to
evaluate physical function, work status and overall wellbeing in fibromyalgia
patients” (p. 651). It consists of 10
items and a total score that lies between 1 and 100. “The short form 36 health survey is a generic
test that measures quality of life through the perception of health by the
patient” (Multu, 2013, p. 651).
The
results of the study showed that TPC, MPS, FIQ, and SF-36 scores showed
statistically significant improvement at the end of the 3rd and 12th
weeks when compared with the baseline values at the beginning of the study. There was no statistically significant
difference between the scores of group 1 and group 2 with the exception of the
MPS score at the end of week 3, which had improved more for group 1. This result suggests that TENS provided
temporary myalgic pain relief while administered during the first 3 weeks. This supports the idea that TENS could be
useful to encourage compliance with exercise programs, since many fibromyalgia
patients develop a fear of movement due to anticipation of pain (Multu, 2013, p.
654).
Mutlu, B., Paker, N., Bugdayci, D., Tekdos, D., &
Kesiktas, N. (2012). Efficacy of supervised
exercise combined with transcutaneous electrical nerve
stimulation in women with
fibromyalgia: A prospective controlled study. Rheumatology
International, 33(3), 649-655. doi:10.1007/s00296-012-2390-8
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