Dokumentasjon

Problems, Solutions, and Strategies Reported by Users of TENS for Chronic Musculoskeletal Pain: A Qualitative Exploration Using Patient Interviews

Problems, Solutions, and Strategies Reported by Users of TENS for Chronic Musculoskeletal Pain: A Qualitative Exploration Using Patient Interviews

  1. Peter William Gladwell (Peter.Gladwell@nbt.nhs.uk),
  2. Kathryn Badlan,
  3. Fiona Cramp and
  4. Shea Palmer

+ Author Affiliations

  1. P.W. Gladwell, PhD, MCSP, BScHons, Pain Management Service, North Bristol NHS Trust, Southmead Hospital, Southmead Road, Bristol BS10 5NB, United Kingdom.
  2. K. Badlan, MPhil, CertEdFE, MCSP, Faculty of Health and Life Sciences, University of the West of England, Bristol, United Kingdom.
  3. F. Cramp, PhD, FCSP, BScHons, Faculty of Health and Life Sciences, University of the West of England.
  4. S. Palmer, PhD, MCSP, FHEA, BScHons, Allied Health Professions, University of the West of England, Glenside Campus Blackberry Hill, Bristol, United Kingdom.

Abstract

Background Transcutaneous Electrical Nerve Stimulation (TENS) could offer a non-drug form of pain relief, but there is no consensus regarding its effectiveness for chronic musculoskeletal pain or chronic low back pain. A recent review of previous trial methodology identified significant problems with low treatment fidelity. There is little information available to inform the development of a pragmatic implementation design for a TENS evaluation.

Objectives To explore the experiences of secondary care Pain Clinic patients with expertise in using TENS to manage chronic musculoskeletal pain. These key informants were selected as they had the potential to generate knowledge which could inform research design and clinical practice.

Design A qualitative method using individual semi-structured interviews with open questions was selected for its capacity to generate rich data.

Methods Semi-structured interviews were conducted with nine patients (6 women). Thematic analysis was used as the primary data analysis method, and this was enhanced by a case level analysis of the context and processes of TENS use of each individual.

Findings Data analysis indicated that patients learned to address a range of problems in order to optimise TENS use. Patients may need to personalise the positioning of electrodes, and the TENS settings, and to re-adjust these over time. Patients learned to use TENS in a strategic manner, and the outcomes of each strategy varied.

Conclusions The findings indicated that a pragmatic TENS evaluation may need to incorporate a learning phase to allow patients to optimise this complex pattern of TENS usage, and evaluation may need to be sensitive to the outcomes of strategic use. These findings also have implications for clinical practice.

  • Received May 11, 2015.
  • Accepted December 6, 2015.
  • © 2015 American Physical Therapy Association