RecommendationDo not offer the following interventions to manage stable angina:
  • transcutaneous electrical nerve stimulation (TENS)
  • enhanced external counterpulsation (EECP)
  • acupuncture.
Relative values of different outcomesThe outcomes considered as important during the development of the review protocol for pain interventions included: improvement in anginal symptoms (angina frequency and nitroglycerin consumption), exercise tolerance, mortality, major cardiac events, hospitalisation, revascularisation, QoL and adverse events.
Trade off between clinical benefits and harmsThe evidence identified on TENS reported on three outcomes including frequency of anginal attacks, exercise tolerance and nitroglycerin consumption. TENS is not clinically effective with respect to any of these three outcomes.

There is no evidence of clinical benefit arising from the use of TENS in stable angina patients.
Economic considerationsNo published health-economic evaluation of TENS was identified. The intervention is associated with costs to the NHS but there is no evidence of clinical benefit. TENS was therefore considered not cost-effective.
Quality of evidenceThe available evidence was of low quality as assessed by GRADE with a very small sample size (n=23) and short follow- up period (2 weeks).
Other considerationsThe GDG considered that current evidence base is weak and shows no effectiveness of TENS. TENS should not be used unless new evidence emerges that demonstrates that TENS is clinically and cost-effective in people with stable angina.

From: 18, Pain Interventions and Refractory angina

Cover of Stable Angina
Stable Angina: Methods, Evidence & Guidance [Internet].
NICE Clinical Guidelines, No. 126.
National Clinical Guidelines Centre (UK).
Copyright © 2011, National Clinical Guidelines Centre.

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