Electro-modalities for Chronic Low Back Pain Study Title: Evidence-informed management of chronic low back pain with transcuta- neous electrical nerve stimulation, interferential current, electrical muscle stimulation, ultrasound, and thermotherapy Authors: Poitras S & Brosseau L Publication Information: The Spine Journal 2008; 8: 226-233. Society sponsored a special focus issue of The Spine Journal. This review of modalities was one of the papers featured in this issue. Many chiropractors utilize electro-modalities in their practices. Most of these devices deliv- er some type of electrical input to tissue with the goal of reducing infl ammation and swelling, controlling pain, modulating muscle activity, increasing or maintaining strength, and/or en- hancing healing. Such modalities are also frequently used by physiotherapists. Unfortunately, there is a dearth of evidence to support their effi cacy, particularly for chronic LBP. The state of the literature for each modality as it pertains to CLBP will be summarized below. Some may be surprised by the lack of research on these commonly used devices for CLBP, a condition commonly treated in most chiropractic offices. C Dr. Shawn Thistle is the founder and president of Research Review Service Inc., an online, subscription- based service designed to help busy practitioners to integrate current, relevant scientific evidence into their practice. Shawn graduated from CMCC and holds an Hon- ours Degree in Kinesiology from McMaster University. He also holds a certificate in Contemporary Medi- cal Acupuncture from McMaster University, and is a Certified Active Release Techniques (ART®) Pro- vider. For more information about the Research Review Service, visit www.researchreviewservice.com. • • • • TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) – SIX RCT AND A COCHRANE REVIEW: A Cochrane Collaboration Review concluded that there are too few studies on which to base recommendations. six other RCT identifi ed: number of treatments utilized and specific TENS parameters varied. all six studies included a control group – mostly sham TENS – and utilized low frequency/acupuncture or high frequency. two trials showed a significant pain reduction immediately following TENS • • • treatment (high frequency). contradictory fi ndings were noted in the other four studies in post-interven- tion period assessment. for low frequency TENS: pooled results indicate a clinically important improve- ment (without statistical significance) in pain intensity short-term follow-ups seem to dem- onstrate more benefi t than long-term follow-ups Interferential Current – no eligible studies found Electrical Muscle Stimulation – no eligible studies found Ultrasound – no eligible studies found Hot/Cold/Ice Packs (Thermotherapy) – no eligible studies found CONCLUSIONS AND PRACTICAL APPLICATION: Although electro-modalities are commonly used to treat CLBP, there is an alarming lack of evidence to support their use. Even the studies on TENS were generally of poor quality, (with 4 of 6 scoring < 2 on the commonly used Jadad Scale). Generally, high and low-frequency TENS seems to have an immediate impact on pain intensity (particularly high frequency), health status, and even acetaminophen use, but all of these fi ndings come from only one study. It should be noted that these results are tenuous at best, and TENS appears to have no effect on long-term pain, or perceived disability. It should also be noted that in both studies, results should be considered immediate, and not even short-term by traditional defi nitions. The re- sults suggest that at best, TENS should be used as an adjunct in short-term treatment plans. For the other modalities, the dearth of quality – or any! – research on their effectiveness for CLBP should suggest that clinicians utilize alternative treatment approaches. • For article with references please visit www.canadianchiropractor.ca 12 • CANADIAN CHIROPRACTOR | JULY/ AUGUST 2008 www.canadianchiropractor.ca hronic low back pain (CLBP) remains a challenging condition to manage, one that carries a signifi cant socioeconomic burden. In order to better understand the state of existing literature on non-surgical treatments for CLBP, the North American Spine Shawn Thistle, BKin (Hons), DC, CSCS
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