Professional Documents
Culture Documents
Ahmed B1, Alam S2, Rashid I3, Rahman N4, Rahman A5, Uddin T6, Azad GN7
Abstract Keywords: Transcutaneous electrical nerve stimulation
Background: Acute low back pain (LBP) affects a (TENS), acute low back pain (LBP)
significant proportion of the population. Transcutaneous
electrical nerve stimulation (TENS) was introduced more Introduction
than 30 years ago as an adjunct to the pharmacological Acute low back pain is the fifth most common reason for
management of pain. However, despite its widespread all physician visits1. Acute LBP is usually defined by a
use, the usefulness of TENS in LBP is still controversial. period of complaints (LBP) of six weeks or shorter2.
Introduction: LBP is a common problem in Bangladesh. Low back pain is the most common reason that adults
Acute LBP is usually defined by a period of complaints of seek out patients' physical therapy3. Low back pain is an
LBP of six weeks or shorter. TENS may improve acute uncomfortable sensation in the lumbar and buttock
LBP. region originated from neurons near or around the spinal
Objective: To evaluate the effectiveness of TENS on acute canal that are injured or irritated by one or more
LBP and also to ensure the patients wellbeing by pathologic process4. In United State approximately 90%
shortening recovery time who have acute LBP. of persons in the working population have back pain
Methods: A prospective study was carried out in the every year5 .In United Kingdom back pain is the second
Department of Physical Medicine and Rehabilitation, most common cause of physical disability after cardio
Bangubandhu Sheikh Mujib Medical University vascular disease5. Even in Bangladesh it is the
(BSMMU), Dhaka, Bangladesh, from July 2008 to commonest cause of disability. Causes of Acute LBP are
December 2008. The patients were divided into two due to back strain, acute disc herniation, osteoarthritis,
groups (A and B). Patients of Group A (30 patients) were spinal stenosis, spondylolysthesis, ankylosing
treated with TENS, Non-steroidal anti-inflammatory spondylitis, infection and malignancy6. In case of acute
drugs (NSAIDs) and activities of daily living (ADLs) LBP 5-10% of cases become chronic7. The impact of
instruction. Patients of group B (28 patients) were treated surgery on the management of acute LBP is low8. For the
with NSAIDs and ADLs instructions. majority of non surgical patients, activity modification,
Results: A total of 58 Patients of acute LBP were included analgesics, muscle relaxant, education, spinal
in this study. The mean age of the patients was 38.5 ± 9.01 manipulation therapy and epidural injections are
years. Main causes of pain were muscle strain (39.65%), recommended to shorten recovery time and as
nonspecific LBP (22.41%), prolapsed lumber symptomatic therapy9. In contrast with these well
intervertebral disc (17.24%), lumbar spondylosis established concepts TENS therapy can be used in the
(13.79%) and sciatica (6.91%). After treatment the result management of acute LBP. For, TENS is the appropriate
was compared and student's 't' test was done to see the treatment for acute and chronic low back pain which can
level of significance. Method was found significant after not be treated less expensively, more safely or more
treatment (p<0.05). Twenty four (80%) patients were effectively by other means10. For more than four decades
improved in group A and 18 (64.28%) patients in group TENS has been applied in the treatment of acute and
B. Patient compliances of group A were better than that chronic pain syndrome11,12. Role of other therapeutic
in group B. modality (Short wave diathermy, ultrasound therapy) in
Conclusion: Effect of TENS on patients with acute low management of LBP in aspect of our country has been
back pain is beneficial. studied, which are not sufficient enough in management
1. Dr Badrunnese Ahamed MBBS, MCPS, Medical Officer, Department of Physical Medicine & Rehabilitation, BSMMU, Dhaka; 2. Lt Col Md
Shafiqul Alam MBBS, MS, Classified Specialist in Orthopaedic Surgeon, CMH, Dhaka; 3. Dr Imamur Rahasid MBBS, MCPS, Medical Officer,
Department of Physical Medicine & Rehabilitation, BSMMU, Dhaka; 4. Dr Nadia Rahman MBBS, MCPS, Medical Officer, Department of
Physical Medicine & Rehabilitation, BSMMU, Dhaka; 5. Dr Azizur Rahman MBBS, FCPS, Consultant Physician, Adhunik Sadar Hospital,
Kishoregonj; 6. Dr Md Taslim Uddin MBBS, FCPS, Professor Department of Physical Medicine & Rehabilitation, BSMMU, Dhaka; 7. Dr Golam
Nabi Azad MBBS, MCPS, Medical Officer, Department of Physical Medicine & Rehabilitation, BSMMU, Dhaka.
Melzack & Wall described the "Gate control theory"; Patients were first examined at day 1 (pretreatment) and
according to that (a) Cells within the substantia at day 15 (post treatment) follow up and the outcomes
gelatinosa are stimulated by both small diameter were recorded in the assessment data shit. All the
nociceptive and large diameter sensory neurons; (b) these outcome assessment data were analyzed by using the
cells serve as gate by inhibiting the relaying of computer. The numerical data were analyzed statistically
nociceptive information to the brain if non painful by using the SPSS-package program (verstion-10) for
sensory stimuli present. Low frequency-high intensity windows. Student's 't' test was done to evaluate the level
TENS stimulate central nervous system (CNS) to secrete of significance. The results were expressed as mean
body's own natural morphine like substances known as ±standard deviation (SD) and p<0.05 was considered as
endorphin. These endorphins work as similar manner to the level of significance. All categorical data were
conventional narcotics to provide the body with overall expressed in percentage (%) and frequency (f).
pain relief. It also raises the pain threshold level10.