An investigation of the development of analgesic tolerance to TENS in humans

Richard E. Liebano, Barbara Rakel, Carol G.T. Vance, Deirdre M. Walsh, Kathleen A. Sluka

    Research output: Contribution to journalArticle

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    Abstract

    Transcutaneous electrical nerve stimulation (TENS) is a noninvasive modality used to control pain. Animal models show that repeated TENS application produces analgesic tolerance and cross-tolerance at spinal opioid receptors. The aim of the present investigation was to examine whether repeated application of TENS produces analgesic tolerance in humans. One hundred healthy subjects were randomly assigned to 1 of 4 groups: control, placebo, low-frequency (4 Hz) or high-frequency (100 Hz) TENS. TENS was applied daily for 5 days to the nondominant upper limb; pressure-pain threshold (PPT) measurements were recorded before and after TENS. Temporal summation to mechanical stimulation was recorded on days 1 and 5, before and after TENS. Diffuse noxious inhibitory control (DNIC) was tested on day 5 using the cold pressor test and PPT measurements. There was an initial increase in PPTs in both low- and high-frequency TENS groups when compared with placebo or control groups. However, by day 5this TENS-induced increase in PPT did not occur, and there was no difference between active TENS and placebo or control groups. High-frequency TENS decreased temporal summation on day 1 when compared with day 5. DNIC increased the PPT similarly in all groups. These data suggest that repeated daily application of TENS results in a decrease in its hypoalgesic effect by the fifth day and that the tolerance like effect to repeated TENS results from tolerance at centrally located opioid receptors. The lack of change in DNIC response suggests that TENS and DNIC utilize separate pathways to produce analgesia.
    LanguageEnglish
    Pages335-342
    JournalPain
    Volume152
    Issue number2
    DOIs
    Publication statusPublished - 2011

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    Transcutaneous Electric Nerve Stimulation
    Analgesics
    Diffuse Noxious Inhibitory Control
    Pain Threshold
    Pressure
    Placebos
    Opioid Receptors
    Pain Measurement
    Control Groups
    Upper Extremity
    Analgesia

    Cite this

    Liebano, R. E., Rakel, B., Vance, C. G. T., Walsh, D. M., & Sluka, K. A. (2011). An investigation of the development of analgesic tolerance to TENS in humans. Pain, 152(2), 335-342. https://doi.org/10.1016/j.pain.2010.10.040
    Liebano, Richard E. ; Rakel, Barbara ; Vance, Carol G.T. ; Walsh, Deirdre M. ; Sluka, Kathleen A. / An investigation of the development of analgesic tolerance to TENS in humans. In: Pain. 2011 ; Vol. 152, No. 2. pp. 335-342.
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    abstract = "Transcutaneous electrical nerve stimulation (TENS) is a noninvasive modality used to control pain. Animal models show that repeated TENS application produces analgesic tolerance and cross-tolerance at spinal opioid receptors. The aim of the present investigation was to examine whether repeated application of TENS produces analgesic tolerance in humans. One hundred healthy subjects were randomly assigned to 1 of 4 groups: control, placebo, low-frequency (4 Hz) or high-frequency (100 Hz) TENS. TENS was applied daily for 5 days to the nondominant upper limb; pressure-pain threshold (PPT) measurements were recorded before and after TENS. Temporal summation to mechanical stimulation was recorded on days 1 and 5, before and after TENS. Diffuse noxious inhibitory control (DNIC) was tested on day 5 using the cold pressor test and PPT measurements. There was an initial increase in PPTs in both low- and high-frequency TENS groups when compared with placebo or control groups. However, by day 5this TENS-induced increase in PPT did not occur, and there was no difference between active TENS and placebo or control groups. High-frequency TENS decreased temporal summation on day 1 when compared with day 5. DNIC increased the PPT similarly in all groups. These data suggest that repeated daily application of TENS results in a decrease in its hypoalgesic effect by the fifth day and that the tolerance like effect to repeated TENS results from tolerance at centrally located opioid receptors. The lack of change in DNIC response suggests that TENS and DNIC utilize separate pathways to produce analgesia.",
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    Liebano, RE, Rakel, B, Vance, CGT, Walsh, DM & Sluka, KA 2011, 'An investigation of the development of analgesic tolerance to TENS in humans', Pain, vol. 152, no. 2, pp. 335-342. https://doi.org/10.1016/j.pain.2010.10.040

    An investigation of the development of analgesic tolerance to TENS in humans. / Liebano, Richard E.; Rakel, Barbara; Vance, Carol G.T.; Walsh, Deirdre M.; Sluka, Kathleen A.

    In: Pain, Vol. 152, No. 2, 2011, p. 335-342.

    Research output: Contribution to journalArticle

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    AU - Liebano, Richard E.

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