Transcutaneous electrical nerve stimulation (TENS) as an adjunct for pain management in perioperative settings: a critical review.

INTRODUCTION: Surgical procedures are ever more complex. Day-case surgical loads are increasing and the length of hospital stays are reducing. Management of pain in perioperative settings remains a challenge. Expert panels recommend a multimodal approach which is often interpreted by medical practitioners as polypharmacy. There is variability in non-pharmacological interventions offered to patients, although transcutaneous electrical nerve stimulation (TENS) has been used since the 1970s. Recommendations from expert panels are inconsistent about the use of TENS in perioperative pain settings. Areas covered: This critical review outlines the challenges of managing pain in perioperative settings and uses a narrative synthesis to evaluate the findings of systematic reviews on the clinical efficacy of TENS for pain in perioperative settings. Expert commentary: Moderate evidence from systematic reviews suggests that TENS is superior to placebo (no current) TENS for reducing analgesic consumption and improving pain, pulmonary function, and nausea and vomiting. Therefore, it seems reasonable to offer TENS as an adjunct to core treatment for surgical pain, especially because it is inexpensive and has a favorable safety profile compared with long-term medication. Practical considerations for the integration of TENS into service delivery are discussed.