Nursing Practice Today 2017. 4(1):35-43.

Effect of Transcutaneous Electrical Nerve Stimulation on pain intensity in reduced consciousness patients: A randomized clinical trial
Maryam Jalalmanesh, Shahin Heidari, Majid Kazemi, Farshid Rahimi-Bashar, Hamid-Reza Rostami


Background & Aim: Pain is the main stressful factor in patients hospitalized in intensive care units(ICU). Non-pharmacological methods for pain relief are preferred by ICU patients due to lack of considerable side effects. The present research aims to determine the effect of TENS on pain intensity followed by surgery in patients hospitalized in intensive care units. Setting of the study was Besat Hospital in Hamadan, Iran. In this cross over clinical trial, thirty five patients hospitalized in intensive care unit with level of consciousness 9-12 based on Glasgow Coma Scale (GCS), assigned randomly to active/placebo TENS(18 patients) or placebo/active TENS (17 patients) sequence.

Methods & Materials: Patients received each intervention for two hours by a random order. A card was allocated to each patient on which the order of interventions was written. In placebo TENS, the system was off and no electrical simulation was applied. Active TENS was applied by conventional TENS with frequency of 80 Hz within 330 milliseconds that is a subset of high TENS. Pain intensity were measured and recorded using Behavioural Pain Scale (PBS)before and 6 hours after intervention. Statistical analysis used: Data were analysed using SPSS 19 and independent t-test, chi square and Wilcoxon tests.

Results: Mean scores of pain intensity before and after active TENS was significantly different in both intervention order (P= 0.001). Mean scores of pain intensity after placebo TENS was not significantly different in both groups. None of patients suffered from side effects after using TENS.

Conclusion: Based on results, application of active TENS reduced significantly pain intensity in patients after surgery. Concerning the simplicity of using this method and lack of considerable side effects, it is suggested to be used as pain relief in similar situations.


pain; transcutaneous electrical nerve simulation; non-pharmacological methods; abdominal surgery; intensive care unit

Full Text:



Zandi S, Saghaei F, GhasemiPirbalooti A, Zandi E. Analgesic and anti-inflammatory effects of ethanolic extract of Thymus daenensis. Celak in mice. 2015; 30(6): 977-984. [Persian.]

Tomlison D, Baeyer V, Stinson N, Sung L . A Systematic review of faces scales for the self report of Transcutaneous Electrical Nerve Stimulation and pain intensity Nursing Practice Today. 2017; 4(1):35-43. 2 ain intensity in children. Paediatrics. 2010; 126(11): 68-98.

Sepehri GR, Sheibani V, Pahlavan Y, Afarineshkhaki MR. Effect of interacerebroventricular Injection of Aqueus Extract of Origanum Volgare L.ssp viride on Pain Threshold in Male Rats. Journal of Ardabil University of Medical Sciences. 2011; 11(1): 52-58. [Persian.]

YazdiMoghaddam H,Memarian R, Mohammadi I. The effect of pain management by nurses on the satisfaction rate of patients after abdominal surgery. Journal of Kerman University of Medical Sciences. 2006; 13(2): 121-8. [Persian.]

Topolovec-Vranic J, Gélinas C, Pollmann-Mudryj MA, Innis J. Validation and evaluation of two observational pain assessment tools in a trauma and neurosurgical intensive care unit. Pain Research & Management. 2013; 18(6): 107-114.

Brown L, Tabasam G, Bjordal JM, Johnson MI. An investigation into the effect of electrode placement of transcutaneous electrical nerve stimulation (TENS) on experimentally induced ischemic pain in healthy human participants.The Clinical journal of pain. 2007; 23(9): 735-43.

Claydon LS, Chesterton LS, Barlas P, Sim J. Dose-specific effects of transcutaneous electrical nerve stimulation (TENS) on experimental pain: a systematic review. The Clinical journal of pain. 2011; 27(7): 635-647.

Akbari L. The effect of music on post-operative pain and anxiety. Pain Management Nursing. 2010; 11(1): 1-25. [Persian.]

Ignelzi RJ. Electerical Stimulation on Peripheral nerve evoked activating. Journal of Neurosurgery. 1979; 45(4): 159-166.

Marmo L, Fowler S. Pain assessment tool in the critically ill post–open heart surgery patient population. Pain Management Nursing. 2010; 11(3): 134-40.

Lewis TW, Dammeyer J, Mekel S. Reliability and validity of the face, legs, activity, cry, consolability behavioural tool in

assessing acute pain in critically ill patients. American Journal Critical Care. 2010; 19(2): 55-65.

Ahleres S, Vanderveen A, Dongen H, Bruins P, Blitser S. comparison of different pain in scoring systems in critically ill patient in a general ICU. Critical Care Journal. 2008; 12(1): 15-23.

Escortell-Mayor E, Riesgo-Fuertes R, Garrido-Elustondo S, Asúnsolo-del Barco A, Díaz-Pulido B, Blanco-Díaz M, et al. Primary care randomized clinical trial: manual therapy effectiveness in comparison with TENS in patients with neck pain. Manual therapy. 2011; 16(1): 66-73.

Boldt HI, Brinkhof WG, Bie RA, Von Elm E. Non-pharmacological interventions for chronic pain in people with spinal cord injury. Cochrane Pain, Palliative and Supportive Care Group Cochrane . Database of Systematic Reviews. 2014; 11(2): 15-65.

Zolfaghari MA, Zaherimogadam M, Ajri Kh E, Farokhnezhad P. The effect of preferred music on physiological parameters of pain in unconscious patients admitted to Intensive care unit. Journal of School Nursing martyr Beheshti University. 2014; 24(2): 1-8. [Persian.]

Erstad PK, Gilbert HC, Grap MJ, Medina J, Mularski RA, et al. Pain management principles in critically ill. Chest Journal. 2009; 135(6): 1075-86.

Pudas-Tähkä S, Axelin A, Aantaa R, Lund V, Salanterä, S. Translation and cultural adaptation of an objective pain assessment tool for Finnish ICU patients. Scandinavian Journal of Caring Sciences. 2014; 28(4): 885-94.

Asgari MR, HoshmandMotlagh N, Soleimani M, Ghorbani R. The effect of transcutaneous electrical nerve stimulation on the pain intensity during insertion of vascular needles in hemodialysis patient. Journal of Critical Nursing. 2012; 5(3), 117-240. [Persian.]

Abram SE, Haddox L, David J. Pain Clinical Manual. USA: McCaffery & Pasero; 2008. P. 35-85.

Rostami Nejad A, Karimi Z, MohammadHoseini S, Ghafarian H, Sheikhi F, Bahadori,L. Transcutaneus Electrical Nerve Stimulation (TENS) on Post Caesarean Section Pain. Journal of Knowledge. 2010; 6(3): 58-63. [Persian.]

Gerson C, Antonio C, Camargo DE, Carvalho GF, Paulo A, Bashirian S. Short-term transcutaneous electrical nerve stimulation after cardiac surgery: effect on pain, pulmonary function and electrical muscle activity. Interactive CardioVascular and Thoracic Surgery. 2008; 44(2): 90-112.

Macedo L, Josué A, Maia P, Camara A, Brasileiro J. Effect of burst TENS and conventional TENS combined with cryotherapy on pressure pain threshold: randomised, controlled, clinical trial. Physiotherapy. 2015; 101(2). 155-160.

Vance GT, Dailey LL ,Rakel AB, Sluka AK.Using TENS for pain control: the state of the evidence. Pain Management. 2014 ; 4(3). 197–209 .

Beckwée D, Bautmans I, Swinnen E, Vermet Y, Lefeber N, Lievens P, Vaes P. A systematic review investigating the relationship between efficacy and stimulation parameters when using transcutaneous electrical nerve stimulation after knee arthroplasty. SAGE Open Medicine. 2014; 2(1): 1-13.

Tucker L D, Rockett M, Mehedi H, Poplar S, Rule S.Does transcutaneous electrical nerve stimulation (TENS) alleviate the pain experienced during marrow sampling in addition to standard techniques? A randomised, double-blinded, controlled trial. J Clin Pathol. 2015; 20(4): 290-298.

Rakel B, Zimmerman B, Geasland K, Embree J, Clark R Ch, Noiseux O, Callaghan JJ, Herr H, Walsh D, Sluka K A. Transcutaneous Electrical Nerve Stimulation (TENS) for the Control of Pain during Rehabilitation Following Total Knee Arthroplasty (TKA): A Randomized, Blinded, Placebo-Controlled Trial. Pain J. 2014 Dec; 155(12): 2599–2611 .

Parsa P, Bashirian S. Effect of transcutaneous electrical nerve stimulation (TENS) on primary dysmenorrhea in adolescent girls. JPMI. 2013; 27(13): 326-30 [Persian].

Higgins Julian PT , Green Sally. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0[updated March 2011 .]

Soltanzade M, Latifi CM, Shirazi M, Fayazi S.The effect of TENS for pain control in patients after coronary artery bypass graft surgery hospital Golestan. Journal of Ahvaz University of Medical Sciences. 2001; 28(4): 28-40.

Goyler SJ, Santana CG, Inocêncio KR, Orsini M, Machado S, Bergmann A. Electrocortical analysis of patients with Intercostobrachial pain treated with TENS after breast cancersurgery. Journal of Physical Therapy Science. 2014; 26(3): 349-360.


  • There are currently no refbacks.

Creative Commons Attribution-NonCommercial 3.0

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.