Effects of transcutaneous electrical nerve stimulation in patients with fibromyalgia syndrome - literature review

Uvod: Fibromialgija je kronična bolezen, ki jo v osnovi zaznamuje razpršena mišično-skeletna bolečina po telesu. Sočasno se lahko pojavljajo tudi sistemski simptomi, kot so utrujenost, depresija in kognitivne motnje. Pri bolnikih je lahko prisotna difuzna hiperalgezija ali alodinija. Cilji zdravljenja so lajšanje simptomov, ohranjanje telesne funkcije in izboljšanje kvalitete življenja. Zdravljenje je priporočljivo začeti z nefarmakološkimi pristopi in aktivnim vključevanjem bolnika v proces. Transkutana električna živčna stimulacija (TENS) je nefarmakološka terapija, ki se pogosto uporablja za lajšanje kroničnih bolečin in je primerna za samostojno uporabo. Namen: Namen diplomskega dela je bil opredeliti učinke TENS-a pri osebah s fibromialgijo. Metode dela: Opravljen je bil pregled literature z uporabljeno opisno metodo. Iskanje literature je potekalo v podatkovni zbirki PubMed z izbranimi ključnimi besedami in postavljenimi kriteriji. Rezultati: V pregled je bilo vključenih šest randomiziranih nadzorovanih raziskav in ena nadzorovana klinična raziskava. V treh raziskavah so primerjali učinke TENS-a v primerjavi s placebom ali brez stimulacije, v dveh so raziskovali učinke TENS-a kot dodatek k edukaciji in vadbenemu programu ter v dveh so primerjali učinke TENS-a z učinki površinskega ogrevanja in suhega iglanja. Jakost bolečine se je statistično pomembno zmanjšala znotraj skupin s TENS-om. Izboljšanje je bilo večje v primerjavi s placebom in brez stimulacije ter v primerjavi z vadbo brez TENS-a. Pri tem pa je bil enako učinkovit kakor površinsko ogrevanje in manj kakor suho iglanje. TENS je bil prav tako učinkovit pri lajšanju občutka utrujenosti, vendar ne pri izboljšanju telesne zmogljivosti. Rezultati o učinku TENS-a na kvaliteto življenja so bili nasprotujoči. Razprava in zaključek: Na podlagi pregleda literature lahko sklenemo, da je TENS učinkovit za lajšanje bolečine in občutka utrujenosti pri osebah s fibromialgijo. Zaradi raznolikosti raziskav ne moremo opredeliti natančnih parametrov TENS-a, je pa priporočljiva njegova dolgotrajna in redna uporaba.Introduction: Fibromyalgia is a chronic condition with widespread pain throughout the body as its defining characteristic. Other symptoms like fatigue, depression and cognitive dysfunction are commonly present as well. Patients can also display diffuse hyperalgesia and allodynia. Goals of treatment are to reduce symptoms, maintain function and improve the quality of life. It is recommended that the treatment should focus firstly on nonpharmacologic modalities with active patient participation. Transcutaneous electrical nerve stimulation (TENS) is a nonpharmacological intervention that is commonly used in treatment of chronic pain conditions. It is suitable for independent use. Purpose: Purpose of diploma work was to determine the effects of TENS in patients with fibromyalgia. Methods: Overview of literature was carried out using descriptive method. The literature search was conducted in PubMed database with chosen keywords and set criteria. Results: One clinical controlled trial and six randomized controlled trials were included in this review. Three studies examined effects of TENS compared to placebo or no TENS. Two studies investigated effects of TENS combined with exercise and patient education. And two studies explored effects of TENS in comparison to superficial heating and dry needling. Pain intensity was significantly reduced in groups with TENS. Pain relief was greater compared to placebo or no TENS and compared to exercise without TENS. TENS reduced pain as effectively as superficial heating but was less effective than dry needling. Furthermore, TENS reduced fatigue, but did not affect function. Results whether TENS is effective in improving quality of life were conflicting. Discussion and conclusion: Based on the results presented in this review we can conclude that TENS is effective for reducing pain and fatigue in patients with fibromyalgia. Because of the diversity of the studies, it is unclear which parameters of TENS are most effective, but its use should be long-term and regular