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J Pain Res. 2018 Oct 10;11:2269-2278. doi: 10.2147/JPR.S168297. eCollection 2018.

Development of a method to maximize the transcutaneous electrical nerve stimulation intensity in women with fibromyalgia.

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Department of Physical Therapy and Rehabilitation Science, The University of Iowa Carver College of Medicine, Iowa City, IA, USA,
Department of Anesthesia, College of Medicine, University of Iowa, Iowa City, IA, USA.
Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA.
Department of Medicine/Rheumatology & Immunology, Vanderbilt University, Nashville, TN, USA.
Department of Physical Therapy, New York University, New York, NY, USA.
College of Nursing, University of Iowa, Iowa City, IA, USA.



Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological intervention clinically used for pain relief. The importance of utilizing the adequate stimulation intensity is well documented; however, clinical methods to achieve the highest possible intensity are not established.


Our primary aim was to determine if exposure to the full range of clinical levels of stimulation, from sensory threshold to noxious, would result in higher final stimulation intensities. A secondary aim explored the association of pain, disease severity, and psychological variables with the ability to achieve higher final stimulation intensity.


Women with fibromyalgia (N=143) were recruited for a dual-site randomized controlled trial - Fibromyalgia Activity Study with TENS (FAST). TENS electrodes and stimulation were applied to the lumbar area, and intensity was increased to sensory threshold (ST), then to "strong but comfortable" (SC1), then to "noxious" (N). This was followed by a reduction to the final stimulation intensity of "strong but comfortable" (SC2). We called this the Setting of Intensity of TENS (SIT) test.


There was a significant increase from SC1 (37.5 mA IQR: 35.6-39.0) to SC2 (39.2 mA IQR: 37.1-45.3) (p<0.0001) with a mean increase of 1.7 mA (95% CI: 1.5, 2.2). Linear regression analysis showed that those with the largest increase between SC1 and N had the largest increase in SC2-SC1. Further, those with older age and higher anxiety were able to achieve greater increases in intensity (SC2-SC1) using the SIT test.


The SC2-SC1 increase was significantly associated with age and anxiety, with greater mean increases associated with older age and higher anxiety. Thus, although all patients may benefit from this protocol, older women and women with elevated anxiety receive the greatest benefit.


TENS; dosage; fibromyalgia; pain; transcutaneous electrical nerve stimulation

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