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Hemodynamic Effects Induced by Transcutaneous Electrical Nerve Stimulation in Apparently Healthy Individuals

A Systematic Review With Meta-Analysis
Published:September 15, 2015DOI:https://doi.org/10.1016/j.apmr.2015.08.433

      Abstract

      Objective

      To determine the immediate effects of transcutaneous electrical nerve stimulation (TENS) on heart rate, systolic blood pressure (SBP), and diastolic blood pressure (DBP) in apparently healthy adults (age ≥18y).

      Data Sources

      The Cochrane Library (online version 2014), PubMed (1962–2014), EMBASE (1980–2014), and LILACS (1980–2014) electronic databases were searched.

      Study Selection

      Randomized controlled trials were included when TENS was administered noninvasively with surface electrodes during rest, and the effect of TENS was compared with that of control or placebo TENS. A sensitive search strategy for identifying randomized controlled trials was used by 2 independent reviewers. The initial search led to the identification of 432 studies, of which 5 articles met the eligibility criteria.

      Data Extraction

      Two independent reviewers extracted data from the selected studies. Quality was evaluated using the PEDro scale. Mean differences or standardized mean differences in outcomes were calculated.

      Data Synthesis

      Five eligible articles involved a total of 142 apparently healthy individuals. Four studies used high-frequency TENS and 3 used low-frequency TENS and evaluated the effect on SBP. Three studies using high-frequency TENS and 2 using low-frequency TENS evaluated the effect on DBP. Three studies using high-frequency TENS and 1 study using low-frequency TENS evaluated the effect on heart rate. A statistically significant reduction in SBP (−3.00mmHg; 95% confidence interval [CI], −5.02 to −0.98; P=.004) was found using low-frequency TENS. A statistically significant reduction in DBP (−1.04mmHg; 95% CI, −2.77 to −0.03; I2=61%; P=.04) and in heart rate (−2.55beats/min; 95% CI, −4.31 to −0.78; I2=86%; P=.005]) was found using both frequencies. The median value on the PEDro scale was 7 (range, 4–8).

      Conclusions

      TENS seems to promote a discrete reduction in SBP, DBP, and heart rate in apparently healthy individuals.

      Keywords

      List of abbreviations:

      CI (confidence interval), DBP (diastolic blood pressure), RCT (randomized controlled trial), SBP (systolic blood pressure), TENS (transcutaneous electrical nerve stimulation)
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      References

        • Sluka K.A.
        • Walsh D.
        Transcutaneous electrical nerve stimulation: basic science mechanisms and clinical effectiveness.
        J Pain. 2003; 4: 109-121
        • Nnoaham K.E.
        • Kumbang J.
        Transcutaneous electrical nerve stimulation (TENS) for chronic pain.
        Cochrane Database Syst Rev. 2008; : CD003222
        • Wolf S.L.
        Perspectives on central nervous system responsiveness to transcutaneous electrical nerve stimulation.
        Phys Ther. 1978; 58: 1443-1449
        • Malow R.M.
        • Dougher M.J.
        A signal detection analysis of the effects of transcutaneous stimulation on pain.
        Psychosom Med. 1979; 41: 101-108
        • Hughes G.S.
        • Lichstein P.R.
        • Whitlock D.
        • Harker C.
        Response of plasma beta-endorphins to transcutaneous electrical nerve stimulation in healthy subjects.
        Phys Ther. 1984; 64: 1062-1066
        • Kaada B.
        • Eielsen O.
        In search of mediators of skin vasodilation induced by transcutaneous nerve stimulation: I. Failure to block the response by antagonists of endogenous vasodilators.
        Gen Pharmacol. 1983; 14: 623-633
        • Wong R.A.
        • Jette D.U.
        Changes in sympathetic tone associated with different forms of transcutaneous electrical nerve stimulation in healthy subjects.
        Phys Ther. 1984; 64: 478-482
        • Bajada S.
        • Touraine A.
        Transcutaneous sympathetic stimulation: effects of autonomic nervous function.
        Clin Exp Neurol. 1981; 17: 139-145
        • Sanderson J.E.
        • Tomlinson B.
        • Lau M.S.
        • et al.
        The effect of transcutaneous electrical nerve stimulation (TENS) on autonomic cardiovascular reflexes.
        Clin Auton Res. 1995; 5: 81-84
        • Sherry J.E.
        • Oehrlein K.M.
        • Hegge K.S.
        • Morgan B.J.
        Effect of burst-mode transcutaneous electrical nerve stimulation on peripheral vascular resistance.
        Phys Ther. 2001; 81: 1183-1191
        • Vieira P.J.
        • Ribeiro J.P.
        • Cipriano Jr., G.
        • et al.
        Effect of transcutaneous electrical nerve stimulation on muscle metaboreflex in healthy young and older subjects.
        Eur J Appl Physiol. 2012; 112: 1327-1334
        • Mannheimer C.
        • Carlsson C.A.
        • Vedin A.
        • Wilhelmsson C.
        Transcutaneous electrical nerve stimulation (TENS) in angina pectoris.
        Pain. 1986; 26: 291-300
        • Mannheimer C.
        • Carlsson C.A.
        • Ericson K.
        • Vedin A.
        • Wilhelmsson C.
        Transcutaneous electrical nerve stimulation in severe angina pectoris.
        Eur Heart J. 1982; 3: 297-302
        • Hollman J.E.
        • Morgan B.J.
        Effect of transcutaneous electrical nerve stimulation on the pressor response to static handgrip exercise.
        Phys Ther. 1997; 77: 28-36
        • Mannheimer C.
        • Emanuelsson H.
        • Waagstein F.
        The effect of transcutaneous electrical nerve stimulation (TENS) on catecholamine metabolism during pacing-induced angina pectoris and the influence of naloxone.
        Pain. 1990; 41: 27-34
        • Dickersin K.
        • Scherer R.
        • Lefebvre C.
        Identifying relevant studies for systematic reviews.
        BMJ. 1994; 309: 1286-1291
        • Verhagen A.P.
        • de Vet H.C.
        • de Bie R.A.
        • et al.
        The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus.
        J Clin Epidemiol. 1998; 51: 1235-1241
        • Lundh A.
        • Gotzsche P.C.
        Recommendations by Cochrane Review Groups for assessment of the risk of bias in studies.
        BMC Med Res Methodol. 2008; 8: 22
        • Campbell T.S.
        • Ditto B.
        Exaggeration of blood pressure-related hypoalgesia and reduction of blood pressure with low frequency transcutaneous electrical nerve stimulation.
        Psychophysiology. 2002; 39: 473-481
        • Chu H.
        • Li M.-H.
        • Juan S.-H.
        • Chiou W.-Y.
        Effects of transcutaneous electrical nerve stimulation on motion sickness induced by rotary chair: a crossover study.
        J Altern Complement Med. 2012; 18: 494-500
        • Lazarou L.
        • Kitsios A.
        • Lazarou I.
        • Sikaras E.
        • Trampas A.
        Effects of intensity of transcutaneous electrical nerve stimulation (TENS) on pressure pain threshold and blood pressure in healthy humans: a randomized, double-blind, placebo-controlled trial.
        Clin J Pain. 2009; 25: 773-780
        • Gademan M.G.
        • Sun Y.
        • Han L.
        • et al.
        Rehabilitation: periodic somatosensory stimulation increases arterial baroreflex sensitivity in chronic heart failure patients.
        Int J Cardiol. 2011; 152: 237-241
        • Jessurun G.A.
        • Tio R.A.
        • De Jongste M.J.
        • Hautvast R.W.
        • Den Heijer P.
        • Crijns H.J.
        Coronary blood flow dynamics during transcutaneous electrical nerve stimulation for stable angina pectoris associated with severe narrowing of one major coronary artery.
        Am J Cardiol. 1998; 82: 921-926
        • Indergand H.J.
        • Morgan B.J.
        Effects of high-frequency transcutaneous electrical nerve stimulation on limb blood flow in healthy humans.
        Phys Ther. 1994; 74: 361-367
        • Stein C.
        • Dal P.
        • Barcellos J.
        • Rabello K.
        • Della R.
        • Plentz M.
        Autonomic neuroscience: basic and clinical transcutaneous electrical nerve stimulation at different frequencies on heart rate variability in healthy subjects.
        Auton Neurosci Basic Clin. 2011; 165: 205-208
        • Williams T.
        • Mueller K.
        • Cornwall M.W.
        • Mueller K.
        Effect of acupuncture-point stimulation on diastolic blood pressure in hypertensive subjects: a preliminary study.
        Phys Ther. 1991; 71: 523-529
        • Chauhan A.
        • Mullins P.A.
        • Thuraisingham S.I.
        • Taylor G.
        • Petch M.C.
        • Schofield P.M.
        Effect of transcutaneous electrical nerve stimulation on coronary blood flow.
        Circulation. 1994; 89: 694-702
        • Yu D.T.
        • Jones A.Y.
        Physiological changes associated with de qi during electroacupuncture to LI4 and LI11: a randomised, placebo-controlled trial.
        Acupunct Med. 2013; 31: 143-150
        • Ngai S.P.
        • Jones A.Y.
        Changes in skin impedance and heart rate variability with application of Acu-TENS to BL 13 (Feishu).
        J Altern Complement Med. 2013; 19: 558-563
        • Liu Y.L.
        • Jin Z.G.
        [Clinical observation of the impacts and safety of electroacupuncture at Sanyinjiao (SP 6) on labor] [Chinese].
        Zhongguo Zhen Jiu. 2012; 32: 409-412
        • Lee J.H.
        • Kim K.H.
        • Hong J.W.
        • Lee W.C.
        • Koo S.
        Comparison of electroacupuncture frequency-related effects on heart rate variability in healthy volunteers: a randomized clinical trial.
        J Acupunct Meridian Stud. 2011; 4: 107-115
        • Jones A.Y.
        • Kwan Y.L.
        • Leung N.T.
        • Yu R.P.
        • Wu C.M.
        • Warburton D.E.
        Electrical stimulation of acupuncture points and blood pressure responses to postural changes: a pilot study.
        Am J Crit Care. 2011; 20: e67-74
        • Ter Laan M.
        • van Dijk J.M.
        • Elting J.W.
        • Fidler V.
        • Staal M.J.
        The influence of transcutaneous electrical neurostimulation (TENS) on human cerebral blood flow velocities.
        Acta Neurochir (Wien). 2010; 152: 1367-1373
        • Hallén K.
        • Hrafnkelsdóttir T.
        • Jern S.
        • Biber B.
        • Mannheimer C.
        • DuttaRoy S.
        Transcutaneous electrical nerve stimulation induces vasodilation in healthy controls but not in refractory angina patients.
        J Pain Symptom Manage. 2010; 40: 95-101
        • Sandberg M.L.
        • Sandberg M.K.
        • Dahl J.
        Blood flow changes in the trapezius muscle and overlying skin following transcutaneous electrical nerve stimulation.
        Phys Ther. 2007; 87: 1047-1055
        • Hsu C.C.
        • Weng C.S.
        • Liu T.S.
        • Tsai Y.S.
        • Chang Y.H.
        Effects of electrical acupuncture on acupoint BL15 evaluated in terms of heart rate variability, pulse rate variability and skin conductance response.
        Am J Chin Med. 2006; 34: 23-36
        • Li P.
        • Ayannusi O.
        • Reid C.
        • Longhurst J.C.
        Inhibitory effect of electroacupuncture (EA) on the pressor response induced by exercise stress.
        Clin Auton Res. 2004; 14: 182-188
        • Lin C.F.
        • Liao J.M.
        • Tsai S.J.
        • et al.
        Depressor effect on blood pressure and flow elicited by electroacupuncture in normal subjects.
        Auton Neurosci. 2003; 107: 60-64
        • Cramp F.L.
        • McCullough G.R.
        • Lowe A.S.
        • Walsh D.M.
        Transcutaneous electric nerve stimulation: the effect of intensity on local and distal cutaneous blood flow and skin temperature in healthy subjects.
        Arch Phys Med Rehabil. 2002; 83: 5-9
        • Cramp A.F.
        • Gilsenan C.
        • Lowe A.S.
        • Walsh D.M.
        The effect of high- and low-frequency transcutaneous electrical nerve stimulation upon cutaneous blood flow and skin temperature in healthy subjects.
        Clin Physiol. 2000; 20: 150-157
        • Whelton S.P.
        • Chin A.
        • Xin X.
        • He J.
        Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials.
        Ann Intern Med. 2002; 136: 493-503
        • Neal B.
        • MacMahon S.
        • Chapman N.
        • Blood Pressure Lowering Treatment Trialists’ Collaboration
        Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomized trials.
        Lancet. 2000; 356: 1955-1964
        • Lewington S.
        • Clarke R.
        • Qizilbash N.
        • Peto R.
        • Collins R.
        • Prospective Studies Collaboration
        Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies.
        Lancet. 2002; 360: 1903-1913
        • Law M.R.
        • Morris J.K.
        • Wald N.J.
        Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies.
        BMJ. 2009; 338: b1665
        • Palatini P.
        • Julius S.
        Elevated heart rate: a major risk factor for cardiovascular disease.
        Clin Exp Hypertens. 2004; 26: 637-644
        • Fox K.
        • Ford I.
        • Steg P.G.
        • Tendera M.
        • Robertson M.
        • Ferrari R.
        • BEAUTIFUL Investigators
        Heart rate as a prognostic risk factor in patients with coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a subgroup analysis of a randomized controlled trial.
        Lancet. 2008; 372: 817-821
        • Olyaei G.R.
        • Talebian S.
        • Hadian M.R.
        • Bagheri H.
        • Momadjed F.
        The effect of transcutaneous electrical nerve stimulation on sympathetic skin response.
        Electromyogr Clin Neurophysiol. 2004; 44: 23-28
        • Norrsell H.
        • Eliasson T.
        • Mannheimer C.
        • et al.
        Effects of pacing-induced myocardial stress and spinal cord stimulation on whole body and cardiac norepinephrine spillover.
        Eur Heart J. 1997; 18: 1890-1896
        • Kalra A.
        • Urban M.O.
        • Sluka K.A.
        Blockade of opioid receptors in rostral ventral medulla prevents antihyperalgesia produced by transcutaneous electrical nerve stimulation (TENS).
        J Pharmacol Exp Ther. 2001; 298: 257-263
        • Triposkiadis F.
        • Karayannis G.
        • Giamouzis G.
        • Skoularigis J.
        • Louridas G.
        • Butler J.
        The sympathetic nervous system in heart failure physiology, pathophysiology, and clinical implications.
        J Am Coll Cardiol. 2009; 54: 1747-1762
        • Kishi T.
        • Hirooka Y.
        Central mechanisms of abnormal sympathoexcitation in chronic heart failure.
        Cardiol Res Pract. 2012; 2012: 847172
        • Lymperopoulos A.
        • Rengo G.
        • Koch W.J.
        Adrenergic nervous system in heart failure: pathophysiology and therapy.
        Circ Res. 2013; 113: 739-753
        • de Macedo A.R.
        • da Nobrega A.C.
        • Machado J.C.
        • de Souza M.N.
        Assessment of characteristic of the vasomotor control dynamics based on plethysmographic blood flow measurement.
        Physiol Meas. 2008; 29: 205-215
        • La Rovere M.T.
        • Bersano C.
        • Gnemmi M.
        • Specchia G.
        • Schwartz P.J.
        Exercise-induced increase in baroreflex sensitivity predicts improved prognosis after myocardial infarction.
        Circulation. 2002; 106: 945-949
        • Joyner M.J.
        • Charkoudian N.
        • Wallin B.G.
        Sympathetic nervous system and blood pressure in humans: individualized patterns of regulation and their implications.
        Hypertension. 2010; 56: 10-16
        • Bacurau A.V.
        • Jardim M.A.
        • Ferreira J.C.
        • et al.
        Sympathetic hyperactivity differentially affects skeletal muscle mass in developing heart failure: role of exercise training.
        J Appl Physiol. 2009; 106: 1631-1640
        • Floras J.S.
        Sympathetic nervous system activation in human heart failure: clinical implications of an updated model.
        J Am Coll Cardiol. 2009; 54: 375-385