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<meta name="description" content="There are conflicting effects of TENS on pain outcomes in patients with RA. AL-TENS is beneficial for reducing pain intensity and improving muscle power scores over placebo while, conversely, C-TENS resulted in no clinical benefit on pain intensity compared with placebo. However C-TENS resulted in a …"><meta name="keywords" content="pmid:12918009, PMC8826159, doi:10.1002/14651858.CD004377, Review, Systematic Review, L Brosseau, M G Judd, K Yonge, Arthritis, Rheumatoid / therapy*, Hand*, Humans, Randomized Controlled Trials as Topic, Transcutaneous Electric Nerve Stimulation*, PubMed Abstract, NIH, NLM, NCBI, National Institutes of Health, National Center for Biotechnology Information, National Library of Medicine, MEDLINE"><meta name="robots" content="index,nofollow,noarchive"><meta property="og:title" content="Transcutaneous electrical nerve stimulation (TENS) for the treatment of rheumatoid arthritis in the hand - PubMed"><meta property="og:url" content="https://pubmed.ncbi.nlm.nih.gov/12918009/"><meta property="og:description" content="There are conflicting effects of TENS on pain outcomes in patients with RA. AL-TENS is beneficial for reducing pain intensity and improving muscle power scores over placebo while, conversely, C-TENS resulted in no clinical benefit on pain intensity compared with placebo. However C-TENS resulted in a …"><meta property="og:image" content="https://cdn.ncbi.nlm.nih.gov/pubmed/persistent/pubmed-meta-image-v2.jpg"><meta property="og:image:secure_url" content="https://cdn.ncbi.nlm.nih.gov/pubmed/persistent/pubmed-meta-image-v2.jpg"><meta property="og:type" content="website"><meta property="og:site_name" content="PubMed"><meta name="twitter:domain" content="pubmed.ncbi.nlm.nih.gov"><meta name="twitter:card" content="summary_large_image"><meta name="twitter:title" content="Transcutaneous electrical nerve stimulation (TENS) for the treatment of rheumatoid arthritis in the hand - PubMed"><meta name="twitter:url" content="https://pubmed.ncbi.nlm.nih.gov/12918009/"><meta name="twitter:description" content="There are conflicting effects of TENS on pain outcomes in patients with RA. AL-TENS is beneficial for reducing pain intensity and improving muscle power scores over placebo while, conversely, C-TENS resulted in no clinical benefit on pain intensity compared with placebo. However C-TENS resulted in a …"><meta name="twitter:image" content="https://cdn.ncbi.nlm.nih.gov/pubmed/persistent/pubmed-meta-image-v2.jpg">
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<option value="abstract-text">Abstract (text)</option>
</select>
</div>
<div class="include-supplemental-container">
<input type="checkbox" aria-label="Include MeSH and other data" name="include-supplemental" id="email-include-supplemental" class="email-include-supplemental">
<label for="email-include-supplemental" class="email-include-supplemental-label">MeSH and other data</label>
</div>
<div class="form-field recaptcha ">
<div class="g-recaptcha" id="id-recaptcha" data-sitekey="6LfsWHMdAAAAAClKbtOpjQ2pMjgsGxvv7NdZW9uI"></div>
</div>
<div id="captcha-error-message" class="usa-input-error-message captcha-validation-message" role="alert"></div>
<div class="action-panel-actions">
<button class="action-panel-submit"
type="submit"
data-loading-label="Sending..."
data-ga-category="save_share"
data-ga-action="email"
data-ga-label="send">
Send email
</button>
<button class="action-panel-cancel"
aria-label="Close 'Email citations' panel"
ref="linksrc=close_email_panel"
aria-controls="email-action-panel"
aria-expanded="false"
data-ga-category="save_share"
data-ga-action="email"
data-ga-label="cancel">
Cancel
</button>
</div>
<input type="hidden" name="email-search-details" value="" />
<input type="hidden" name="email-search-details-hash" value="0e42663a6c3bd85498fcb88798998fed7bfdc45d457db35281e41afe13cc0524" />
</form>
</div>
</div>
<div id="collections-action-panel"
class="collections-action-panel action-panel in-progress-dots-panel"
aria-hidden="true"
data-collections-open-panel-enabled="false"
data-collections-open-panel-url-hash="#open-collections-panel">
<div class="inner-wrap">
<h3 class="action-panel-heading">
Add to Collections
</h3>
<form id="collections-action-panel-form"
class="collections-action-panel-form action-panel-content action-form action-panel-smaller-selectors"
data-existing-collections-url="/list-existing-collections/"
data-add-to-existing-collection-url="/add-to-existing-collection/"
data-create-and-add-to-new-collection-url="/create-and-add-to-new-collection/"
data-get-article-ids-by-search-url="/get-article-ids-by-search/"
data-myncbi-max-collection-name-length="100"
data-add-to-collection-max-amount="1000"
data-collections-root-url="https://www.ncbi.nlm.nih.gov/myncbi/collections/">
<input type="hidden" name="csrfmiddlewaretoken" value="vvMefHZT3PgqoRofUfrwXQRzQDOsZ6I4MiwjSxsfDq3Uiiu5xy4yrYndoHwESHgo">
<div class="choice-group" role="radiogroup">
<ul class="radio-group-items">
<li>
<input type="radio"
id="collections-action-panel-new"
class="collections-new"
name="collections"
value="new"
data-ga-category="save_share"
data-ga-action="collections"
data-ga-label="collections_radio_new">
<label for="collections-action-panel-new">Create a new collection</label>
</li>
<li>
<input type="radio"
id="collections-action-panel-existing"
class="collections-existing"
name="collections"
value="existing"
checked="true"
data-ga-category="save_share"
data-ga-action="collections"
data-ga-label="collections_radio_existing">
<label for="collections-action-panel-existing">Add to an existing collection</label>
</li>
</ul>
</div>
<div class="controls-wrapper">
<div class="action-panel-control-wrap new-collections-controls">
<label for="collections-action-panel-add-to-new" class="action-panel-label required-field-asterisk">
Name your collection:
</label>
<input
type="text"
name="add-to-new-collection"
id="collections-action-panel-add-to-new"
class="collections-action-add-to-new"
pattern="[^&quot;&amp;=&lt;&gt;\/]*" title="The following characters are not allowed in the Name field: &quot;&amp;=&lt;&gt;/"
maxlength="100"
data-ga-category="save_share"
data-ga-action="create_collection"
data-ga-label="non_favorties_collection">
<div class="collections-new-name-too-long usa-input-error-message selection-validation-message">
Name must be less than 100 characters
</div>
</div>
<div class="action-panel-control-wrap existing-collections-controls">
<label for="collections-action-panel-add-to-existing" class="action-panel-label">
Choose a collection:
</label>
<select id="collections-action-panel-add-to-existing"
class="action-panel-selector collections-action-add-to-existing"
data-ga-category="save_share"
data-ga-action="select_collection"
data-ga-label="($('#collections-action-add-to-existing').val() === 'Favorites') ? 'Favorites' : 'non_favorites_collection'">
</select>
<div class="collections-retry-load-on-error usa-input-error-message selection-validation-message">
Unable to load your collection due to an error<br>
<a href="#">Please try again</a>
</div>
</div>
</div>
<div class="action-panel-actions">
<button class="action-panel-submit"
type="submit"
data-loading-label="Adding..."
data-pinger-ignore
data-ga-category="save_share"
data-ga-action="collections"
data-ga-label="add">
Add
</button>
<button class="action-panel-cancel"
aria-label="Close 'Add to Collections' panel"
ref="linksrc=close_collections_panel"
aria-controls="collections-action-panel"
aria-expanded="false"
data-ga-category="save_share"
data-ga-action="collections"
data-ga-label="cancel">
Cancel
</button>
</div>
</form>
</div>
</div>
<div id="bibliography-action-panel"
class="bibliography-action-panel action-panel in-progress-dots-panel"
aria-hidden="true"
data-bibliography-open-panel-enabled="false"
data-bibliography-open-panel-url-hash="#open-bibliography-panel">
<div class="inner-wrap">
<h3 class="action-panel-heading">
Add to My Bibliography
</h3>
<form id="bibliography-action-panel-form"
class="bibliography-action-panel-form action-panel-content action-form action-panel-smaller-selectors"
data-add-to-bibliography-max-amount="100"
data-add-to-bibliography-batch-size="10"
data-bibliography-delegates-url="/list-bibliography-delegates/"
data-add-to-bibliography-url="/add-to-bibliography/"
data-get-article-ids-by-search-url="/get-article-ids-by-search/"
data-mybib-root-url="https://www.ncbi.nlm.nih.gov/myncbi/collections/mybibliography/">
<input type="hidden" name="csrfmiddlewaretoken" value="vvMefHZT3PgqoRofUfrwXQRzQDOsZ6I4MiwjSxsfDq3Uiiu5xy4yrYndoHwESHgo">
<div class="action-panel-control-wrap bibliographies-controls">
<div class="choice-group">
<ul class="bibliographies-action-add radio-group-items">
<li>
<input name="bibliography" id="my-bibliography" class="my-bibliography" type="radio" checked/>
<label for="my-bibliography">My Bibliography</label>
</li>
</ul>
</div>
</div>
<div class="bibliographies-retry-load-on-error usa-input-error-message selection-validation-message">
Unable to load your delegates due to an error<br>
<a href="#">Please try again</a>
</div>
<div class="action-panel-actions">
<button class="action-panel-submit"
type="submit"
data-loading-label="Adding..."
data-pinger-ignore>
Add
</button>
<button class="action-panel-cancel"
aria-label="Close 'Add to bibliography' panel"
ref="linksrc=close_bibliography_panel"
aria-controls="bibliography-action-panel"
aria-expanded="false"
data-ga-category="save_share"
data-ga-action="mybib"
data-ga-label="cancel">
Cancel
</button>
</div>
</form>
</div>
</div>
<div id="saved-search-action-panel" class="saved-search-action-panel action-panel " aria-hidden="true"
data-saved-search-open-panel-enabled="false"
data-saved-search-open-panel-url-hash="#open-saved-search-panel">
<div class="inner-wrap">
<h2 class="action-panel-heading">
Your saved search
</h2>
<form id="saved-search-action-panel-form"
class="saved-search-action-panel-form action-panel-content action-form"
data-create-saved-search-url="/create-saved-search/"
data-try-search-terms-url="/try-search-term/"
data-saved-search-root-url="https://www.ncbi.nlm.nih.gov/myncbi/searches/">
<input type="hidden" name="csrfmiddlewaretoken" value="vvMefHZT3PgqoRofUfrwXQRzQDOsZ6I4MiwjSxsfDq3Uiiu5xy4yrYndoHwESHgo">
<div class="action-panel-control-wrap">
<label for="saved-search-name" class="action-panel-label saved-search-name-label required-field-asterisk">
Name of saved search:
</label>
<input maxlength="200"
type="text"
name="saved-search-name"
id="saved-search-name"
class="saved-search-name"
value=""
required
pattern="[^&quot;&amp;=&lt;&gt;\/]*" title="The following characters are not allowed in the Name field: &quot;&amp;=&lt;&gt;/">
</div>
<div class="action-panel-control-wrap">
<label for="saved-search-term" class="action-panel-label required-field-asterisk">
Search terms:
</label>
<textarea name="saved-search-term" id="saved-search-term" class="saved-search-term" required></textarea>
</div>
<div class="test-search-term-wrap">
<a href="#" class="try-search-term">Test search terms</a>
</div>
<div class="choice-group action-panel-extra-margin-top">
<span class="action-panel-label" id="fieldset-label">
Would you like email updates of new search results?
</span>
<fieldset id="saved-search-alert" aria-describedby="fieldset-label">
<legend class="usa-sr-only">Saved Search Alert Radio Buttons</legend>
<ul class="radio-group-items">
<li>
<input type="radio" id="saved-search-alert-yes" class="saved-search-alert-yes" name="saved-search-alert" value="yes" checked>
<label for="saved-search-alert-yes" class="action-panel-label">Yes</label>
</li>
<li>
<input aria-label="No radio input" type="radio" id="saved-search-alert-no" class="saved-search-alert-no" name="saved-search-alert" value="no">
<label for="saved-search-alert-no" class="action-panel-label">No</label>
</li>
</ul>
</fieldset>
</div>
<div class="alert-schedule-wrap">
<div class="action-panel-control-wrap">
<label class="action-panel-label">
Email:
</label>
<span aria-label="Email address" id="saved-search-email" class="action-panel-label"><span class="action-panel-label-bold"></span> (<a class="myncbi-account-settings" href="https://www.ncbi.nlm.nih.gov/account/settings/">change</a>)</span>
</div>
<div class="action-panel-control-wrap action-panel-extra-margin-top">
<label for="saved-search-frequency" class="action-panel-label">
Frequency:
</label>
<select id="saved-search-frequency" class="no-border-panel-selector saved-search-frequency">
<option value="monthly">Monthly</option>
<option value="weekly">Weekly</option>
<option value="daily">Daily</option>
</select>
</div>
<div class="action-panel-control-wrap saved-search-monthly-additional">
<label for="saved-search-monthly-on-day" class="action-panel-label">
Which day?
</label>
<select id="saved-search-monthly-on-day" class="no-border-panel-selector">
<option value="Sunday">The first Sunday</option>
<option value="Monday">The first Monday</option>
<option value="Tuesday">The first Tuesday</option>
<option value="Wednesday">The first Wednesday</option>
<option value="Thursday">The first Thursday</option>
<option value="Friday">The first Friday</option>
<option value="Saturday">The first Saturday</option>
<option value="day">The first day</option>
<option value="weekday">The first weekday</option>
</select>
</div>
<div class="action-panel-control-wrap saved-search-weekly-additional">
<label for="saved-search-weekly-on-day" class="action-panel-label">
Which day?
</label>
<select id="saved-search-weekly-on-day" class="no-border-panel-selector saved-search-weekly-on-day">
<option value="Sunday">Sunday</option>
<option value="Monday">Monday</option>
<option value="Tuesday">Tuesday</option>
<option value="Wednesday">Wednesday</option>
<option value="Thursday">Thursday</option>
<option value="Friday">Friday</option>
<option value="Saturday">Saturday</option>
</select>
</div>
<div class="action-panel-control-wrap">
<label for="saved-search-report" class="action-panel-label">
Report format:
</label>
<select id="saved-search-report" class="no-border-panel-selector saved-search-report">
<option value="DocSum">Summary</option>
<option value="DocSumText">Summary (text)</option>
<option value="Abstract">Abstract</option>
<option value="AbstractText">Abstract (text)</option>
<option value="MEDLINE">PubMed</option>
</select>
</div>
<div class="action-panel-control-wrap">
<label for="saved-search-amount" class="action-panel-label">
Send at most:
</label>
<select id="saved-search-amount" class="no-border-panel-selector saved-search-amount">
<option value="1">1 item</option>
<option value="5" selected>5 items</option>
<option value="10">10 items</option>
<option value="20">20 items</option>
<option value="50">50 items</option>
<option value="100">100 items</option>
<option value="200">200 items</option>
</select>
</div>
<div>
<input type="checkbox" id="saved-search-send-if-no-result" class="saved-search-send-if-no-result" name="saved-search-send-if-no-result">
<label for="saved-search-send-if-no-result" class="action-panel-label smaller-checkbox">
Send even when there aren't any new results
</label>
</div>
<div class="action-panel-control-wrap option-text-in-email-wrap">
<label for="saved-search-email-text" class="action-panel-label">
Optional text in email:
</label>
<textarea name="saved-search-email-text"
id="saved-search-email-text"
class="saved-search-email-text"></textarea>
</div>
</div>
<div class="action-panel-actions">
<button class="action-panel-submit"
type="submit"
data-loading-label="Saving..."
data-ga-category="save_share"
data-ga-action="alert"
data-ga-label="save">
Save
</button>
<button class="action-panel-cancel"
aria-label="Close 'Your saved search' panel"
ref="linksrc=close_saved_search_panel"
aria-controls="saved-search-action-panel"
aria-expanded="false"
data-ga-category="save_share"
data-ga-action="alert"
data-ga-label="cancel">
Cancel
</button>
</div>
</form>
</div>
</div>
<div id="citation-manager-action-panel" class="citation-manager-action-panel action-panel" aria-hidden="true">
<div class="inner-wrap">
<h2 class="action-panel-heading">
Create a file for external citation management software
</h2>
<form id="citation-manager-action-panel-form"
class="action-panel-content action-form"
action="/results-export-ids/"
data-by-search-action="/results-export-search-data/"
data-by-ids-action="/results-export-ids/"
method="post"
data-by-search-method="post"
data-by-ids-method="post">
<input type="hidden" name="csrfmiddlewaretoken" value="vvMefHZT3PgqoRofUfrwXQRzQDOsZ6I4MiwjSxsfDq3Uiiu5xy4yrYndoHwESHgo">
<input name="results-format" type="hidden" value="pubmed"/>
<div class="action-panel-actions">
<button class="action-panel-submit"
type="submit"
data-loading-label="Sending..."
data-ga-category="save_share"
data-ga-action="citation_manager"
data-ga-label="save">
Create file
</button>
<button class="action-panel-cancel"
aria-label="Close 'Send citations to citation manager' panel"
ref="linksrc=close_citation_manager_panel"
aria-controls="citation-manager-action-panel"
aria-expanded="false"
data-ga-category="save_share"
data-ga-action="citation_manager"
data-ga-label="cancel">
Cancel
</button>
</div>
</form>
</div>
</div>
<div id="rss-action-panel" class="rss-action-panel action-panel " aria-hidden="true">
<div class="inner-wrap">
<h2 class="action-panel-heading">
Your RSS Feed
</h2>
<form id="rss-action-panel-form"
class="rss-action-panel-form action-panel-content action-form"
data-create-rss-feed-url="/create-rss-feed-url/"
data-search-form-term-value="">
<input type="hidden" name="csrfmiddlewaretoken" value="vvMefHZT3PgqoRofUfrwXQRzQDOsZ6I4MiwjSxsfDq3Uiiu5xy4yrYndoHwESHgo">
<div class="action-panel-control-wrap">
<label for="rss-name" class="action-panel-label required-field-asterisk">
Name of RSS Feed:
</label>
<input maxlength="200"
placeholder="Name"
type="text"
name="rss-name"
id="rss-name"
class="rss-name"
value=''
required
pattern="[^&quot;&amp;=&lt;&gt;\/]*" title="The following characters are not allowed in the Name field: &quot;&amp;=&lt;&gt;/">
</div>
<div class="rss-limit-wrap">
<div class="action-panel-control-wrap action-panel-extra-margin-top">
<label for="rss-limit" class="action-panel-label">
Number of items displayed:
</label>
<select id="rss-limit" class="no-border-panel-selector rss-limit">
<option value="5">5</option>
<option value="10">10</option>
<option value="15" selected="selected">15</option>
<option value="20">20</option>
<option value="50">50</option>
<option value="100">100</option>
</select>
</div>
</div>
<div class="action-panel-actions">
<button class="action-panel-submit"
type="submit"
data-loading-label="Creating..."
data-ga-category="save_share"
data-ga-action="alert"
data-ga-label="save">
Create RSS
</button>
<button class="action-panel-cancel"
aria-label="Close 'Your RSS' panel"
ref="linksrc=close_rss_panel"
aria-controls="rss-action-panel"
aria-expanded="false"
data-ga-category="save_share"
data-ga-action="alert"
data-ga-label="cancel">
Cancel
</button>
</div>
<div class="action-panel-control-wrap rss-link-copy-wrap">
<label for="rss-link" class="usa-sr-only">RSS Link</label>
<input placeholder="Your RSS Feed Link" type="text" name="rss-link" id="rss-link" class="rss-link" title="RSS Link">
<button
type="button"
disabled
class="rss-link-copy-button disabled"
data-ga-category="save_share"
data-ga-action="rss"
data-ga-label="copy">
Copy
</button>
</div>
</form>
</div>
</div>
</div>
</div>
<div class="article-page" id="article-page" data-article-pmid="12918009">
<aside class="page-sidebar">
<div class="inner-wrap">
<div class="full-text-links">
<div class="full-view">
<h3 class="title">
Full text links
</h3>
<div class="full-text-links-list">
<a class="link-item
dialog-focus"
href="https://doi.org/10.1002/14651858.CD004377"
target="_blank"
rel="noopener"
ref="linksrc=fulltextorjournal_fulltext&amp;is_pmc=False&amp;PrId=3058&amp;itool=Abstract-def&amp;log$=linkouticon&amp;uid=12918009&amp;db=pubmed&amp;nlmid=100909747"
title="See full text options at Wiley"
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data-ga-action="Wiley"
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><img src="https://cdn.ncbi.nlm.nih.gov/corehtml/query/egifs/http:--media.wiley.com-assets-7331-42-Cochrane_Library_Logo_RGB_120x30.jpg" alt="Wiley full text link"><span class="text">
Wiley
</span></a><a class="link-item
pmc
"
href="https://pmc.ncbi.nlm.nih.gov/articles/pmid/12918009/"
target="_blank"
rel="noopener"
ref="linksrc=fulltextorjournal_fulltext&amp;is_pmc=True&amp;PrId=3494&amp;itool=Abstract-def&amp;log$=linkouticon&amp;uid=12918009&amp;db=pubmed&amp;nlmid=100909747"
title="Free full text at PubMed Central"
data-ga-category="full_text"
data-ga-action="PMC"
data-ga-label="12918009"
><span class="text">
Free PMC article
</span></a>
</div>
</div>
<div class="short-view">
<a href="#" class="full-text-links-button full-text-links-dialog-trigger">
Full text links
</a>
</div>
</div>
<div class="actions-buttons sidebar"><h3 class="title">Actions</h3><div class="inner-wrap"><button class="citation-button citation-dialog-trigger"
aria-label="Open dialog with citation text in different styles"
data-ga-category="save_share"
data-ga-action="cite"
data-ga-label="open"
data-all-citations-url="/12918009/citations/"
data-citation-style="nlm"
data-pubmed-format-link="/12918009/export/"><span class="button-label">Cite</span></button><link type="text/css" href="ncbi-overlay-block/src/overlay-block.css"><div class="collections-button-container" data-article-id="12918009" data-article-db="pubmed"><button class="collections-button collections-dialog-trigger"
aria-label="Save article in MyNCBI collections."
data-ga-category="collections_button"
data-ga-action="click"
data-ga-label="collections_button"
data-collections-open-dialog-enabled="false"
data-collections-open-dialog-url="https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F12918009%2F%23open-collections-dialog"
data-in-collections="false"><span class="button-label">Collections</span></button><div class="overlay" role="dialog"><div id="collections-action-dialog"
class="dialog collections-dialog"
aria-hidden="true"><div class="title">Add to Collections</div><div class="collections-action-panel action-panel"><form id="collections-action-dialog-form"
class="collections-action-panel-form action-panel-content action-form action-panel-smaller-selectors"
data-existing-collections-url="/list-existing-collections/"
data-add-to-existing-collection-url="/add-to-existing-collection/"
data-create-and-add-to-new-collection-url="/create-and-add-to-new-collection/"
data-myncbi-max-collection-name-length="100"
data-collections-root-url="https://www.ncbi.nlm.nih.gov/myncbi/collections/"><input type="hidden" name="csrfmiddlewaretoken" value="vvMefHZT3PgqoRofUfrwXQRzQDOsZ6I4MiwjSxsfDq3Uiiu5xy4yrYndoHwESHgo"><div class="choice-group" role="radiogroup"><ul class="radio-group-items"><li><input type="radio"
id="collections-action-dialog-new"
class="collections-new"
name="collections"
value="new"
data-ga-category="collections_button"
data-ga-action="click"
data-ga-label="collections_radio_new"><label for="collections-action-dialog-new">Create a new collection</label></li><li><input type="radio"
id="collections-action-dialog-existing"
class="collections-existing"
name="collections"
value="existing"
checked="true"
data-ga-category="collections_button"
data-ga-action="click"
data-ga-label="collections_radio_existing"><label for="collections-action-dialog-existing">Add to an existing collection</label></li></ul></div><div class="controls-wrapper"><div class="action-panel-control-wrap new-collections-controls"><label for="collections-action-dialog-add-to-new" class="action-panel-label required-field-asterisk">
Name your collection:
</label><input
type="text"
name="add-to-new-collection"
id="collections-action-dialog-add-to-new"
class="collections-action-add-to-new"
pattern="[^&quot;&amp;=&lt;&gt;\/]*" title="The following characters are not allowed in the Name field: &quot;&amp;=&lt;&gt;/"
maxlength="100"
data-ga-category="collections_button"
data-ga-action="create_collection"
data-ga-label="non_favorties_collection"><div class="collections-new-name-too-long usa-input-error-message selection-validation-message">
Name must be less than 100 characters
</div></div><div class="action-panel-control-wrap existing-collections-controls"><label for="collections-action-dialog-add-to-existing" class="action-panel-label">
Choose a collection:
</label><select id="collections-action-dialog-add-to-existing"
class="action-panel-selector collections-action-add-to-existing"
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Abstract
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<div class="abstract-content selected"
id="eng-abstract">
<p>
<strong class="sub-title">
Background:
</strong>
Rheumatoid arthritis (RA) is a chronic, inflammatory, system disease. It commonly affects the small peripheral joints (such as fingers and wrist). The main goals of intervention for RA are preventing joint deformity, preserving joint function, and reducing inflammation and pain. Transelectrical nerve stimulation (TENS) is a form of electrotherapy and is thought to produce analgesia according to the gate control theory.
</p>
<p>
<strong class="sub-title">
Objectives:
</strong>
To determine the efficacy and safety of TENS in the treatment of RA of the hand. The primary outcomes of interest were relief of grip pain and resting pain intensity, relief of joint tenderness, number of tender joints and patient assessment of disease. The secondary objective was to determine the most effective mode of TENS application in pain control.
</p>
<p>
<strong class="sub-title">
Search strategy:
</strong>
We searched for relevant studies, in English, in the Cochrane field of physical and related therapies, the Cochrane Controlled Trials Register, MEDLINE, EMBASE, HEALTHSTAR, Sports Discus, CINAHL, Current Contents, and the PEDro database, up to October 2002.
</p>
<p>
<strong class="sub-title">
Selection criteria:
</strong>
Two independent reviewers selected the trials that met predetermined inclusion criteria.
</p>
<p>
<strong class="sub-title">
Data collection and analysis:
</strong>
Study results were extracted by two independent reviewers. Continuous outcomes were analyzed by weighted mean difference (WMD) using a fixed effects model.
</p>
<p>
<strong class="sub-title">
Main results:
</strong>
Three RCTs, involving 78 people, were included in this review. AL-TENS and C-TENS were compared to placebo and to each other. Administration of 15 minutes of AL-TENS a week, for 3 weeks, resulted in a significant decrease in rest pain (67% relative benefit, 45 points absolute benefit on 100 mm VAS scale) but not in grip pain compared to placebo. AL-TENS did result in a clinical beneficial improvement in muscle power scores with a relative difference of 55%, and an absolute benefit of 0.98, compared to placebo. No significant difference was found between one 20-minute treatment duration of C-TENS versus AL-TENS, or C-TENS versus placebo on decrease in mean scores for rest pain or grip pain, or on the number of tender joints. Results showed a statistically significant reduction in joint tenderness, but no clinical benefit from C-TENS over placebo in relief of joint tenderness. No statistically significant difference was shown between 15 days of treatment with C-TENS or AL-TENS in relief of joint pain, although there was a clinically important benefit of C-TENS over AL-TENS on patient assessment of change in disease (risk difference 21%, NNT 5).
</p>
<p>
<strong class="sub-title">
Reviewer&#x27;s conclusions:
</strong>
There are conflicting effects of TENS on pain outcomes in patients with RA. AL-TENS is beneficial for reducing pain intensity and improving muscle power scores over placebo while, conversely, C-TENS resulted in no clinical benefit on pain intensity compared with placebo. However C-TENS resulted in a clinical benefit on patient assessment of change in disease over AL-TENS. More well designed studies with a standardized protocol and adequate number of subjects are needed to fully conclude the effect of C-TENS and AL-TENS in the treatment of RA of the hand.
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Conflict of interest statement
</h2>
<div class="statement">
<p xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:p1="http://pubmed.gov/pub-one">This review was initially conducted as part of a guidelines development project that received financial support of The Arthritis Society (Canada). This final review was completed with the support of a research grant obtained from the Ontario Ministry of Health and LongTerm Care (Canada) and the Ministry of Human Resources (Canada) for the development of EvidenceBased Clinical Practice Guidelines for physical rehabilitation interventions in the treatment of RA.</p>
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Figures
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<p> 1.1. Analysis </p>
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<div class="figure-caption-contents"><p> Comparison 1 Placebo vs Treatment… </p></div>
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<p> 1.1. Analysis </p>
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<div class="figure-caption-contents"><p> Comparison 1 Placebo vs Treatment (end of treatment 3 weeks), Outcome 1 Resting… </p></div>
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1.1. Analysis
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<div class="figure-caption-contents">Comparison 1 Placebo vs Treatment (end of treatment 3 weeks), Outcome 1 Resting Pain VAS 100mm.</div>
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<p> 1.2. Analysis </p>
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<div class="figure-caption-contents"><p> Comparison 1 Placebo vs Treatment… </p></div>
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<div class="figure-caption-medium figure-caption-text" aria-hidden="true">
<strong class="figure-label">
<p> 1.2. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 1 Placebo vs Treatment (end of treatment 3 weeks), Outcome 2 Grip… </p></div>
</div>
<figcaption id="figure-caption-1" class="figure-caption-full figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="description">
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1.2. Analysis
</strong>
<div class="figure-caption-contents">Comparison 1 Placebo vs Treatment (end of treatment 3 weeks), Outcome 2 Grip pain Vas100mm.</div>
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id="article-image-2"
src="https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3b06/8826159/7bd70021bf56/nCD004377-CMP-001-03.gif"
alt="1.3" />
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<p> 1.3. Analysis </p>
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<div class="figure-caption-contents"><p> Comparison 1 Placebo vs Treatment… </p></div>
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<div class="figure-caption-medium figure-caption-text" aria-hidden="true">
<strong class="figure-label">
<p> 1.3. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 1 Placebo vs Treatment (end of treatment 3 weeks), Outcome 3 Power… </p></div>
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<figcaption id="figure-caption-2" class="figure-caption-full figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="description">
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1.3. Analysis
</strong>
<div class="figure-caption-contents">Comparison 1 Placebo vs Treatment (end of treatment 3 weeks), Outcome 3 Power Score (Watts).</div>
</figcaption>
</figure>
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id="article-image-3"
src="https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3b06/8826159/7999dd7bb5ba/nCD004377-CMP-001-04.gif"
alt="1.4" />
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<p> 1.4. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 1 Placebo vs Treatment… </p></div>
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<div class="figure-caption-medium figure-caption-text" aria-hidden="true">
<strong class="figure-label">
<p> 1.4. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 1 Placebo vs Treatment (end of treatment 3 weeks), Outcome 4 Work… </p></div>
</div>
<figcaption id="figure-caption-3" class="figure-caption-full figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="description">
<strong class="figure-label">
1.4. Analysis
</strong>
<div class="figure-caption-contents">Comparison 1 Placebo vs Treatment (end of treatment 3 weeks), Outcome 4 Work Score (Joules).</div>
</figcaption>
</figure>
<figure class="figure-item "
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id="article-image-4"
src="https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3b06/8826159/febca86e6e76/nCD004377-CMP-002-01.gif"
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<strong class="figure-label">
<p> 2.1. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 2 CTENS vs Placebo… </p></div>
</div>
</div>
<div class="figure-caption-medium figure-caption-text" aria-hidden="true">
<strong class="figure-label">
<p> 2.1. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 2 CTENS vs Placebo (end of treatment same day), Outcome 1 *Resting… </p></div>
</div>
<figcaption id="figure-caption-4" class="figure-caption-full figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="description">
<strong class="figure-label">
2.1. Analysis
</strong>
<div class="figure-caption-contents">Comparison 2 CTENS vs Placebo (end of treatment same day), Outcome 1 *Resting pain scores (VAS).</div>
</figcaption>
</figure>
<figure class="figure-item "
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<p> 2.2. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 2 CTENS vs Placebo… </p></div>
</div>
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<div class="figure-caption-medium figure-caption-text" aria-hidden="true">
<strong class="figure-label">
<p> 2.2. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 2 CTENS vs Placebo (end of treatment same day), Outcome 2 *Grip… </p></div>
</div>
<figcaption id="figure-caption-5" class="figure-caption-full figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="description">
<strong class="figure-label">
2.2. Analysis
</strong>
<div class="figure-caption-contents">Comparison 2 CTENS vs Placebo (end of treatment same day), Outcome 2 *Grip pain score (VAS).</div>
</figcaption>
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<p> 2.3. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 2 CTENS vs Placebo… </p></div>
</div>
</div>
<div class="figure-caption-medium figure-caption-text" aria-hidden="true">
<strong class="figure-label">
<p> 2.3. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 2 CTENS vs Placebo (end of treatment same day), Outcome 3 *Joint… </p></div>
</div>
<figcaption id="figure-caption-6" class="figure-caption-full figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="description">
<strong class="figure-label">
2.3. Analysis
</strong>
<div class="figure-caption-contents">Comparison 2 CTENS vs Placebo (end of treatment same day), Outcome 3 *Joint Tenderness score (22 pt scale).</div>
</figcaption>
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src="https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3b06/8826159/80ee49f29c04/nCD004377-CMP-002-04.gif"
alt="2.4" />
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<p> 2.4. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 2 CTENS vs Placebo… </p></div>
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<div class="figure-caption-medium figure-caption-text" aria-hidden="true">
<strong class="figure-label">
<p> 2.4. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 2 CTENS vs Placebo (end of treatment same day), Outcome 4 No.… </p></div>
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2.4. Analysis
</strong>
<div class="figure-caption-contents">Comparison 2 CTENS vs Placebo (end of treatment same day), Outcome 4 No. Tender joints (no tender joints / total joints assessed).</div>
</figcaption>
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data-figure-id="CD004377-fig-0009">
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src="https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3b06/8826159/c8010dc85f1a/nCD004377-CMP-003-01.gif"
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<p> 3.1. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 3 CTENS vs ALTENS… </p></div>
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<div class="figure-caption-medium figure-caption-text" aria-hidden="true">
<strong class="figure-label">
<p> 3.1. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 3 CTENS vs ALTENS (head to head end of treatment: 15 days),… </p></div>
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3.1. Analysis
</strong>
<div class="figure-caption-contents">Comparison 3 CTENS vs ALTENS (head to head end of treatment: 15 days), Outcome 1 Number of patients improved.</div>
</figcaption>
</figure>
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References
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<h4 class="refs-list-title">References to studies included in this review</h4>
<div class="refs-list">
<h5 class="refs-list-title">Abelson 1983 {published data only}</h5>
<ol id="top-references-list-2" class="references-list">
<li>
<ol class="references-and-notes-list">
<li
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Abelson K, Langley GB, Sheppeard H, Vlieg M, Wigley RD. Trascutaneous Electrical Nerve Stimulation in Rheumatoid Arthritis. New Zealand Medical Journal 1983;96:1568. [1EL]
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<h5 class="refs-list-title">Langley 1984 {published data only}</h5>
<ol id="top-references-list-3" class="references-list">
<li>
<ol class="references-and-notes-list">
<li
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Langley GB, Sheppeard H, Johnson M, Wigley RD. The Analgesic Effects of Transcutaneous Electrical Nerve Stimulation and Placebo in Chronic Pain Patients. Rheumatology International 1984;4:11923. [14EL]
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<div class="refs-list">
<h5 class="refs-list-title">Manheimer 1978 {published data only}</h5>
<ol id="top-references-list-4" class="references-list">
<li>
<ol class="references-and-notes-list">
<li
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Manheimer C, Lund S, Carlsson CA. The Effect of Transcutaneous Electrical Nerve Stimulation (TNS) on Joint Pain in Patients with RA. Scandinavian Journal of Rheumatology 1978;7:1316. [18EL]
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</div>
<div class="refs-list">
<h4 class="refs-list-title">References to studies excluded from this review</h4>
<div class="refs-list">
<h5 class="refs-list-title">Angulo 1990 {published data only}</h5>
<ol id="top-references-list-6" class="references-list">
<li>
<ol class="references-and-notes-list">
<li
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Angulo DL, Colwell CW. Use of Postoperative TENS and Continuous Passive Motion Following Total Knee Replacement. JOSPT 1990;11(12):599604.
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<div class="refs-list">
<h5 class="refs-list-title">Bruce 1988 {published data only}</h5>
<ol id="top-references-list-7" class="references-list">
<li>
<ol class="references-and-notes-list">
<li
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value="1">
Bruce JR, Riggin CS, Parker JC, Walker SE, Meyer AA, Wellman FE, Kunce J. Pain Management in Rheumatoid Arhtritis: Cognitive Behavior Modification and Transcutaneous Neural Stimulation. Arthritis Care and Research 1988;1(2):7884.
</li>
</ol>
</li>
</ol>
</div>
<div class="refs-list">
<h5 class="refs-list-title">HerreraLasso 1993 {published data only}</h5>
<ol id="top-references-list-8" class="references-list">
<li>
<ol class="references-and-notes-list">
<li
class="skip-numbering"
value="1">
HerreraLasso I, Mobarak L, FernandezDominguez L, Cardiel MH, AlarconSegovia D. Comparatice Effectiveness of Packages of Treatment Including Ultrasound or Transcutaneous Electrical Nerve Stimulation in Painful Shoulder Syndrome. Physiotherapy 1993;79(4):2513. [11EL]
</li>
</ol>
</li>
</ol>
</div>
<div class="refs-list">
<h5 class="refs-list-title">Kumar 1982 {published data only}</h5>
<ol id="top-references-list-9" class="references-list">
<li>
<ol class="references-and-notes-list">
<li
class="skip-numbering"
value="1">
Kumar VN, Redford JB. Trancutaneous Nerve Stimulation in Rheumatoid Arthritis. Archives of Physical Medicine and Rehabilitation 1982;63:5960. [29EL]
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<a
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<div class="refs-list">
<h5 class="refs-list-title">Levy 1987 {published data only}</h5>
<ol id="top-references-list-10" class="references-list">
<li>
<ol class="references-and-notes-list">
<li
class="skip-numbering"
value="1">
Levy A, Dalith M, Abramovici A, Pinkhas J, Weinberger A. Transcutaneous Electrical Nerve Stimulation in Experimental Acute Arthritis. Archives of Physical Medicine and Rehabilitation 1987;68:758. [5EL]
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<a
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</div>
<div class="refs-list">
<h5 class="refs-list-title">Moystad 1990 {published data only}</h5>
<ol id="top-references-list-11" class="references-list">
<li>
<ol class="references-and-notes-list">
<li
class="skip-numbering"
value="1">
Moystad A, Krogstad BS, Larheim TA, Odont. Transcutaneous Nerve Stimulation in a Group of Patients with Rheumatic Disease Involving the Temporomandibular Joint. The Journal of Prosthetic Dentistry 1990;64(5):596600. [32EL]
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<a
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</div>
<div class="refs-list">
<h4 class="refs-list-title">Additional references</h4>
<div class="refs-list">
<h5 class="refs-list-title">Albright 2001</h5>
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<li>
<ol class="references-and-notes-list">
<li
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value="1">
Albright, J. Allman, R, Bonfiglio, R.P, Conill, A, Dobkin, B, Guccione, A.A, Hasson, S, Russo, R, Shekelle, P, Susman, J.L, Wells, G.A, Tugwell, P, Brosseau, L, Robinson, V.A, Graham, I.D, Shea, B.J, McGowan, J. Philadelphia panel evidencebased clinical practice guidelines on selected rehabilitation interventions: Overview and methodology. Physical Therapy 2001;81(10):162940.
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PubMed
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</ol>
</li>
</ol>
</div>
<div class="refs-list">
<h5 class="refs-list-title">APTA 2001</h5>
<ol id="top-references-list-14" class="references-list">
<li>
<ol class="references-and-notes-list">
<li
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value="1">
American Physical Therapy Association. Guide to Physical Therapist Practice: Part One: A Description of Patient/Clinical Management. Alexandria VA: Springer Netherlands, 2001.
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</ol>
</li>
</ol>
</div>
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<h5 class="refs-list-title">ARA 1987</h5>
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<li>
<ol class="references-and-notes-list">
<li
class="skip-numbering"
value="1">
Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. Revised Criteria for Classification of Rheumatoid Arthritis.. Arthritis Rheumatology. Vol. 31, The American Rheumatism Association, 1987:31524.
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</div>
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<h5 class="refs-list-title">Belanger 2002</h5>
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<li>
<ol class="references-and-notes-list">
<li
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value="1">
Belanger AY. EvidenceBased Guide to Therapeutic Physical Agents. Philadelphia: Lippincott Williams &amp; Wilkins, 2002.
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<h5 class="refs-list-title">Cameron 1999</h5>
<ol id="top-references-list-17" class="references-list">
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<ol class="references-and-notes-list">
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Cameron MH. Physical Agents in Rehabilitation. From Research to Practice. Philadelphia: WB Saunders Company, 1999.
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<h5 class="refs-list-title">Carroll 2002</h5>
<ol id="top-references-list-18" class="references-list">
<li>
<ol class="references-and-notes-list">
<li
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value="1">
Carroll D, Moore RA, McQuay HJ, Fairman F, Tramer M, Leijon G. Transcutaneous electrical nerve stimulation (TENS) for chronic pain. Cochrane Database of Systematic Reviews 2002, Issue 4. [DOI: 10.1002/14651858.CD003222.pub2]
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DOI
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