Summary of findings for the main comparison. Transcutaneous Electrical Nerve Stimulation (TENS) compared to Sham for Chronic Back Pain in Multiple Sclerosis (MS).
| Transcutaneous electrical nerve stimulation (TENS) compared to sham for chronic back pain in MS | |||
| Patient or population: chronic back pain in MS Setting: participants from Multiple Sclerosis Society in Northern Ireland Intervention: TENS Comparison: sham | |||
| Outcomes | Impact | № of participants (studies) | Certainty of the evidence (GRADE) |
|
Reduction in pain intensity assessed with: VAS, MPQ |
Decrease in low back pain scores overtime for all groups, however, none reached clinical or statistical significance in VAS scores. No statistically significant changes in MPQ (Warke 2006). VAS mean reduction for TENS low frequency at week 6 was ‐16.59 (weekly low back pain) and ‐19.76 (average low back pain). | 90 (1 RCT) | ⊕⊝⊝⊝ VERY LOW1, 2 |
|
Reduction in disability assessed with: RMDQ, BI |
No significant changes in disability measured by RMDQ and BI between treatment and placebo groups and within‐groups (Warke 2006). | 90 (1 RCT) | ⊕⊝⊝⊝ VERY LOW1, 2 |
|
Quality of Life assessed with: LMSQoLQ, SF‐36 |
No significant difference in quality of life measured by LMSQoLQ or SF‐36 between treatment and placebo groups (Warke 2006). | 90 (1 RCT) | ⊕⊝⊝⊝ VERY LOW1, 2 |
| BI: Barthel Index; MPQ: McGill Pain Questionnaire; LMSQoLQ: Leeds Multiple Sclerosis Quality of Life Questionnaire; RMDQ: Roland Morris Disability Questionnaire; SF‐36: Short Form 36; VAS: Visual Analogue Scale | |||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | |||
1Downgraded two levels due to high risk for bias (unclear allocation concealment)
2Downgraded two levels due to high risk of bias for imprecision (singular study of small sample size)