Intervention Review

Transcutaneous electrical nerve stimulation for primary dysmenorrhoea

  1. Michelle Proctor2,
  2. Cindy Farquhar3,
  3. Will Stones4,
  4. Lin He5,
  5. Xiaoshu Zhu1,*,
  6. Julie Brown3

Editorial Group: Cochrane Menstrual Disorders and Subfertility Group

Published Online: 21 JAN 2002

Assessed as up-to-date: 2 MAY 2009

DOI: 10.1002/14651858.CD002123


How to Cite

Proctor M, Farquhar C, Stones W, He L, Zhu X, Brown J. Transcutaneous electrical nerve stimulation for primary dysmenorrhoea. Cochrane Database of Systematic Reviews 2002, Issue 1. Art. No.: CD002123. DOI: 10.1002/14651858.CD002123.

Author Information

  1. 1

    School of Biomedical and Health Science, University of Western Sydney, Center for Complementary Medicine Research, Sydney, New South Wales, Australia

  2. 2

    Department of Corrections, Psychological Service, Auckland, New Zealand

  3. 3

    University of Auckland, Obstetrics and Gynaecology, Auckland, New Zealand

  4. 4

    The Aga Khan University, Department of Obstetrics & Gynaecology, Nairobi, Kenya

  5. 5

    West China Hospital, Sichuan University, Books & Information Centre, Chengdu, Sichuan, China

*Xiaoshu Zhu, Center for Complementary Medicine Research, School of Biomedical and Health Science, University of Western Sydney, Building 24, Campbelltown Campus, Locked Bag 1797, Penrith South DC, Sydney, New South Wales, 1797, Australia. x.zhu@uws.edu.au. mszhuxiaoshu@yahoo.com.

Publication History

  1. Publication Status: Stable (no update expected for reasons given in 'What's new')
  2. Published Online: 21 JAN 2002

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Medical therapy for dysmenorrhoea (painful menstrual cramps of the uterus) such as non-steroidal anti-inflammatory drugs or the oral contraceptive pill work by reducing myometrial (uterine muscle) activity. Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological intervention shown to be effective for pain relief in a variety of conditions. TENS may be able to alter the body's ability to receive and perceive pain signals rather than having a direct effect on uterine contractions.

Objectives

To determine the effectiveness of high and low-frequency TENS when compared to placebo, no treatment, or medical treatment for primary dysmenorrhoea.

Search methods

Electronic searches of the Cochrane Menstrual Disorders and Subfertility Group Register of controlled trials, The Cochrane Library (Issue 1, 2009), MEDLINE, EMBASE, CINAHL, and AMED were performed (updated April 2009) to identify relevant randomised controlled trials. The Cochrane Complementary Medicine Field Register of controlled trials (CISCOM) was also searched. Attempts were also made to identify trials from the UK National Research Register, the Clinical Trial Register, and the citation lists of review articles and included trials.

Selection criteria

The inclusion criteria were: randomised controlled trials (RCTs) of TENS compared to placebo, no treatment, or medical treatment for primary dysmenorrhoea. Exclusion criteria were: mild, infrequent, or secondary dysmenorrhoea and dysmenorrhoea associated with an intrauterine device (IUD).

Data collection and analysis

Seven RCTs were identified that fulfilled the inclusion criteria for this review. No new studies were identified in the update. Quality assessment and data extraction were performed independently by two review authors. Data unsuitable for meta-analysis were reported as descriptive data and were included for discussion. The outcome measures were pain relief (dichotomous, visual analogue scale, descriptive), adverse effects, use of analgesics additional to treatment, and absence from work or school.

Main results

Overall, high-frequency TENS was shown to be more effective for pain relief than placebo TENS (OR 7.2, 95% CI 3.1 to 16.5). Low-frequency TENS was found to be no more effective in reducing pain than placebo TENS (OR 1.48, 95% CI 0.43 to 5.08). There were conflicting results regarding whether high-frequency TENS was more effective than low-frequency TENS.

Authors' conclusions

High-frequency TENS was found to be effective for the treatment of dysmenorrhoea by a number of small trials. The minor adverse effects reported in one trial require further investigation. There is insufficient evidence to determine the effectiveness of low-frequency TENS in reducing dysmenorrhoea.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Transcutaneous electrical nerve stimulation for primary dysmenorrhoea

High-frequency nerve stimulation may help relieve painful menstrual cramps. Dysmenorrhoea is a very common complaint that refers to painful menstrual cramps in the uterus. Transcutaneous electrical nerve stimulation (TENS) involves the sending of an electric current by placing electrodes on the skin to stimulate the nerves and reduce pain. It is thought to alter the body's ability to receive and understand pain signals rather than by having a direct effect on the uterine contractions. The review of trials found that high-frequency TENS may help but there is not enough evidence to assess the effect of low-frequency TENS. More research is needed.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

針對原發性經痛而使用的經皮神經電刺激法以及針灸

經痛是子宮在經期發生痙攣的疼痛。對於經痛所用的醫學療法,通常包含了非類固醇類的抗發炎藥物,或是口服的避孕藥物,而這二者都是透過降低肌肉層(子宮的肌肉)的活性來發揮作用。然而,這些治療方法都會帶來一些的副作用,使得有效治療經痛的非藥物療法有其潛在的價值。經皮神經電刺激法(TENS)已經被證實在各種不同狀況下可以有效地緩解疼痛的一種治療,有效地紓解疼痛。我們會將電極放在皮膚上,然後使用不同脈衝速率(頻率)與強度下所產生的電流來刺激這些區域,藉以達到紓解疼痛的功效。在發生經痛的時候,人們認為經皮神經電刺激法會藉由改變身體接受或感受疼痛訊號之能力,而不是直接影響子宮的收縮來達到治療效果。針對治療經痛而言,針灸也可能是一種有用的、非藥物型的方式。人們認為針灸可以激化受器或是神經纖維,並且在透過跟血清素(serotonin)與腦內啡(endorphins)等調控物質之間所產生的某種複雜作用之後,它就可以阻檔疼痛的脈衝。典型的針灸包含了以細小的、堅硬的金屬針尖來穿透皮膚,並以手動或電刺激來操作。

目標

對於原發性經痛的治療,以高及低頻率經皮神經電刺激及針灸間之相互比較,並與安慰劑、不採取治療,或是藥物治療做比較,以確認高與低頻率的經皮神經電刺激法以及針灸的有效性。

搜尋策略

2001年8月以電腦搜尋Cochrane Menstrual Disorders以及Subfertility Group Register of controlled trials、CCTR (Cochrane Library Issue 3, 2001) 、MEDLINE、EMBASE、CINAHL、Bio extracts、PsycLIT以及SPORTDiscus以找出相關的隨機對照試驗 (RCTs) 。並搜尋Cochrane Complementary Medicine Field's Register of controlled trials (CISCOM) 。嘗試透過 UK National Research Register、the Clinical Trial Register 以及回顧性文章與所納入的研究的參考文章清單。並聯絡多數試驗的第一作者或通訊作者以取得額外的資訊。

選擇標準

收集的標準為經皮神經電刺激法與針灸的隨機對照試驗,而這些試驗中必須在這些治療方法之間進行相互比較,或是將它們與安慰劑、不採取治療,或是針對原發性經痛的藥物治療方法之間進行比較。排除的標準為:輕微的、不常出現的,或是續發性的經痛,以及使用了某種子宮內避孕器的經痛狀況。

資料收集與分析

當中共確認了9個符合本回顧收集標準的隨機對照試驗,有7個包含了經皮神經電刺激法,有一個為針灸,而有一個則是將這2種治療方法都包含在內。有二位審稿者獨立地完成了品質評估與資料擷取的工作。進行統合分析的時候,我們針對二元化的結果使用了勝算比,對連續性的結果使用了加權平均差。不適合用於統合分析的資料,都會被當作描述性的資料來報告。關於結果的測量方式為疼痛的紓解程度(二元性、視覺化類比量尺、描述性)、不良的影響、在治療之外再多加使用止痛劑,以及在工作或學校當中缺席。

主要結論

整體而言,跟安慰劑型的經皮神經電刺激法比較起來,高頻率的經皮神經電刺激法顯然可以更有效地紓解疼痛。跟安慰劑型的經皮神經電刺激法比較起來,在減少疼痛感方面,低頻率的經皮神經電刺激法顯然不會帶來更大的功效。當比較到高頻率的經皮神經電刺激法是否會比低頻率的經皮神經電刺激法有效時結果是相互矛盾的。在一份小型的試驗中顯示,跟安慰組的針灸與2個不採取治療的對照組比較起來,針灸明顯地可以更有功效地緩解疼痛。

作者結論

在一些小型試驗當中顯示,對於治療經痛而言,高頻率的經皮神經電刺激法是有效的。在一個試驗當中,報告過的輕微副作用,還需要有更深入的探討。在減輕經痛方面,要確認低頻率的經皮神經電刺激法之有效性尚缺乏足夠的證據。在減輕經痛方面,要確認針灸的功效,也沒有足夠的證據,然而,有一個小型但方法上又具備合理性的試驗,認為針灸是有優點的。

翻譯人

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

高頻率的神經刺激法或許能夠幫助紓解疼痛的月經性痙攣。經痛是一種常見的因子宮在經期發生疼痛性痙攣的主訴。經皮神經電刺激法(TENS)包含了在皮膚上放置電極,然後送出電流刺激神經,以減輕疼痛。一般認為,這樣可以改變身體接受與領會疼痛訊號的能力,而不是直接對於子宮的收縮方面產生某種影響。人們也會使用針灸的方法。本篇試驗的回顧發現,高頻率的經皮神經電刺激法或許會有幫助,但是並沒有足夠的證據可以評估針灸或是低頻率的經皮神經電刺激法之效果。還需要有更多的研究。