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Is Transcutaneous Electrical Nerve Stimulation (TENS) effective as a modality to reduce pain and pruritus in patients with burn injuries

Prepared by:

Candice Osborne, OTR

Date:

April 2013

Review Date:

April 2015

Clinical Question:

Does Transcutaneous Electrical Nerve Stimulation (TENS) reduce pain and/or pruritus in adults who have sustained severe burn injury?

Clinical Scenario:

Pain and/or pruritus at the burn site are common side effects following serious burn injuries, and make it difficult for the patient to focus on therapeutic tasks secondary to pain and/or itching. The mechanism of pruritus secondary to burn injury is not fully understood. Both pruritus and pain are believed to travel along small C afferent fibres to the spinal cord.  In accordance with the gate control theory, the thalamus discriminates the neuronal discharge patterns and is able to decipher between pain and itch. Investigators propose that transcutaneous electrical nerve stimulation (TENS) stimulates the rapid conduction of A fibres. These impulses block or “close the gate to” the transmission of noxious stimuli transported by the slower conducting C fibres (Steinhoff, 2006).

Although TENS is hypothesized to reduce pain and/or pruritus, it is not used consistently in clinical practice.  The purpose of this CAT is t determine whether there is evidence to support the use of TENS to reduce discomfort following major burn injury

Clinical Bottom Line:

Studies suggest that both conventional TENS (high frequency/low intensity at site of discomfort) and auricular acupuncture-like TENS (lower frequency/higher intensity applied to ear) may be used as a modality to reduce pain and/or pruritus secondary to burn injury. 

It appears that TENS may be a safe, non-invasive, non-habit forming option for managing pain and/or pruritus in patients with burn wounds in the remodelling stage of healing as well as other unspecified stages in the wound healing process.  

Full Document:

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