Brief Alert
PENS for Low Back Pain
Source: Ghoname EA, et al. Percutaneous electrical nerve stimulation for low back pain. JAMA 1999;281:818-823.
Percutaneous electrical nerve stimulation (PENS) therapy uses an acupuncture-like needle positioned in soft tissues or muscle to electrically stimulate dermatomal areas that correspond to levels of radicular pathology. In this single-blind, sham-controlled, cross-over study, 29 men and 31 women, mean age 43 years, with stable low back pain (LBP) for at least three months and radiologically confirmed lumbosacral degenerative disc disease, were randomized to one of four treatment groups: sham-PENS, PENS, transcutaneous electrical nerve stimulation (TENS), and flexion-extension exercises. Exclusionary criteria included acute sciatica, drug or alcohol abuse, long-term opioid use, previous use of alternative therapies (e.g., acupuncture), and pending litigation. All patients underwent all four therapies in one of four different, computer-generated sequences. Each treatment was administered three times weekly for 30 minutes for three weeks. A week-long respite was inserted before advancing to the next modality. End point measures included visual analog scores (VAS) for pain, physical activity level, sleep quality, analgesic use, global patient assessment questionnaire, and Health Status Survey Short Form (SF-36). Standard statistical testing provided analysis of the data.
VAS pain score and daily nonopioid analgesic use significantly dropped, and level of physical activity, sleep quality, and sense of well-being significantly improved with PENS but not with the other treatment modalities. These findings were confirmed on the SF-36 scoring. PENS is better than TENS or exercise in providing relief for long-term LBP.
Which of the following statements is true?
a. Sham-percutaneous electrical nerve stimulation (PENS) is no better than true percutaneous electrical nerve stimulation (PENS) for relief of low back pain
b. True PENS is no better than transcutaneous electrical nerve stimulation (TENS) for relief of low back pain
c. Percutaneous electrical nerve stimulation (PENS) is no better than flexion-extension exercises for relief of low back pain
d. Percutaneous electrical nerve stimulation (PENS) is significantly better than TENS or flexion-extension exercises for relief of low back pain
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