Effect of acupuncture TENS versus conventional TENS on post cesarean section incision pain
Keywords:Acupuncture TENS, Conventional TENS, LSCS, Pain
Background: There is evidence regarding beneficial use of Transcutaneous Electrical Nerve Stimulation (TENS) on post Lower Segment Caesarean Section (LSCS) incision pain. However, efficacy of different types of TENS following C section pain has not yet been explored adequately.
Methods: 96 women who had recently undergone LSCS were included for the study. The subjects were in the age group of 20 to 40 years (25.84±3.96); having pain intensity 4 or more on Numerical Pain Rating Scale (NPRS). They were divided into three groups by random allocation method; namely Group A: Acupuncture (Low/Motor) TENS, Group B: Conventional (High/Sensory) TENS and Group C: Control group. Group A and B received specific type of TENS twice a day for 15 minutes. Control group C did not receive any TENS intervention. All subjects received standard post-operative medications and physiotherapy. Pain intensity was recorded on NPRS pre and post intervention.
Results: Both Acupuncture TENS and Conventional TENS significantly decreased post-operative pain intensity as compared to control group (p value <0.0001).
Conclusions: Both, acupuncture and conventional TENS are equally effective in reducing post LSCS incision pain at a strong and non-painful intensity.
WHO statements of caesarean section rates. April 2015. WHO reference No. WHO/RHR/15.02. Available at: http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/cs-statement/en/
Barton S. The Postnatal Period. In: Mantle J, Haslam J, Barton S, editors. Physiotherapy in Obstetrics and Gynecology. 2nd edition. Edinburgh: Elsevier; 2004. 237-240..
Dutta DC. Textbook of Obstetrics including perinatology and Contraception. 7th Edition. Kolkata: New Central Book agency Pvt Ltd;2011. Chapter 26, Operative Obstetrics;588-591.
Lima LE, Lima AS, Rocha CM, Santos GF, Bezerra AJ, Hazime FA, et al. High and low frequency transcutaneous electrical nerve stimulation in post-caesarean pain intensity. Fisioter Pesq. 2014;21(3):243-8.
Johnson M. Transcutaneous electrical nerve stimulation (TENS). In: Kitchen S, editor. Electrotherapy Evidence Based Practice. 11th ed. New Delhi: Elsevier; 2006. 259-275.
Alves E, Nazario R, Ries S, Guimaraes S, Leite L, Santos S. Transcutaneous electric nerve stimulation for post-Caesarean section analgesia. Rev Dor. 2015;16(4):263-6.
Low J, Reed A. Electrotherapy Explained Principles and Practice. 3rd Edition. Oxford: Butterworth-Heinemann; 2000. Chapter 3, Electrical Stimulation of Nerve and Muscle;113-118.
Robertson V, Ward A, Low J, Reed A. Electrotherapy Explained Principles and Practice. 4th Edition. New Delhi: Elsevier; 2006. Chapter 6, Sensory Stimulation and other uses; p. 171-183.
Josimari M, Kathleen A, Gabriela R. High and low frequency TENS reduce postoperative pain intensity after laparoscopic tubal ligation: a randomized controlled trial. Clinic J Pain. 2009;25(1):12-9.
White DJ. Musculoskeletal Examination. In: O’Sullivan S, Schmitz T, editors. Physical Rehabilitation. 5th Edition. Philadelphia. F. A. Davis Company. 2007. 163-164.
Moran F, Leonard T, Hawthorne S, Hughes CM, McCrum-Gardner E, Johnson MI, et al. Hypoalgesia in response to TENS depends on stimulation intensity. J Pain. 2011;12(8):929-35.
Kahn J. Principles and Practice of Electrotherapy. 3rd Edition. New York: Churchill Livingstone; 1994. Chapter 6, Transcutaneous Electrical Nerve Stimulation;123-124.
Polden M, Mantle J. Physiotherapy in Obstetrics and Gynaecology. New Delhi: Jaypee Brothers Medical Publishers; 1994.Chapter 7, The Postnatal Period; 223-243.
Vance C, Dailey D, Rakel B, Sluka K. Using TENS for pain control: the state of the evidence. Pain Management. 2014;4(3):197-209.
Michlovitz S, Nolan T. Modalities for therapeutic intervention. 4th Edition. New Delhi: Jaypee Brothers Medical Publishers (P), Ltd. 2008. Chapter 6, Electrotherapeutic Modalities: Electrotherapy and Iontophoresis; 109-113.
Knight K, Draper D. Therapeutic Modalities The Art and Science. 2nd Edition. Philadelphia: Lippincott Williams and Wilkins; 2013. Chapter 17, Application procedures: Electrotherapy; 334-338.
Sluka K, Walsh D. Transcutaneous Electrical Nerve Stimulation and Interferential Therapy. In: Sluka K, editor. Mechanisms and Management of Pain for the Physical Therapist. 2nd Edition. p.206-215.
Emmiler M, Solak O, Kocogullari C, Dundar U, Ayva E, Ela Y, et al. Control of acute postoperative pain by transcutaneous electrical nerve stimulation after open cardiac operations: a randomized placebo-controlled prospective study. Heart Surg Forum. 2008;11(5):E300-3.
Binder P, Gustafsson A, Uvnäs-Moberg K, Nissen E. Hi-TENS combined with PCA-morphine as post caesarean pain relief. Midwifery. 2011;27(4):547-52.
Chandra A, Banavaliker J, Das P, Hasti S. Use of transcutaneous electrical nerve stimulation as an adjunctive to epidural analgesia in the management of acute thoracotomy pain. Indian J Anesth. 2010;54(2):116-20.
Forster A, Palastanga N. Clayton’s Electrotherapy Theory And Practice. 9th Edition. London: Bailliere Tindall, 2006. Chapter 3, Electrical Stimulation of Nerve and Muscle; p.102-106.
Cameron M, Shapiro S, Ocelnik M. Electrical Currents for Pain Control. In: Cameron M., editor. Physical Agents in Rehabilitation An Evidence Based Approach To Practice. 5th Edition. Missouri: Elsevier; 2018:258-262.