Electrical Nerve Stimulation for Fibromyalgia
Fibromyalgia is characterized by ‘widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues.’ Patients with fibromyalgia often experience chronic widespread muscle pain and fatigue and many treatment options are aimed to provide symptomatic relief and increased ability to perform daily activities ultimately resulting in a better quality of life. When treating patients with fibromyalgia, the data and research provides conflicting results as to whether or not electrical stimulation offers pain relief.
During my Ambulatory Medicine rotation, I encountered a patient with fibromyalgia experiencing severe trigger point pain at her knee. The patient’s daughter inquired about a new treatment option they’d learned about – electric nerve stimulation to treat her pain. Given the other co-morbidities this patient experienced, she was looking at for options outside of pharmacological management and inquired with us to learn more. While we encouraged her to follow up with her Rheumatologist to discuss this best treatment plan (as we were seeing her in an Urgent Care setting), it was worthy of further inquiry to learn more about electric nerve stimulation effectiveness in treating fibromyalgic pain.
The article selected, a systematic review & meta-analysis of randomized controlled trials, evaluates the use of electric stimulation for pain relief in patients with fibromyalgia. The article reviewed published studies from reputable databases through April 2016 to formulate conclusions. Ultimately nine studies met the inclusion criteria and 301 patients were evaluated to determine the effectiveness of electric stimulation for pain relief in patients with fibromyalgia.
The authors conclude there is low-quality evidence for the effectiveness of ES for pain relief in patients with fibromyalgia, noting there is positive effect of ES treatment vs. control with a 95% confidence interval (-2.39 to -0.08). The authors also note there was no significant improvement on quality of life with this treatment but found electroacupunture (combined or not combined with other types of treatment) was found effective (with higher levels of evidence) for pain relief. In all of the studies reviewed, there seemed to be significant limitations that ultimately lead to my suggestion that further research and evaluation needs to be done with larger population sizes to ensure the data is transferrable to patients in the clinical setting.
That said, none of the studies reviewed showed any negative effects of using the electric stimulation. For my patient, I would, of course, discuss the risks and benefits of any treatment and share my belief that I feel more research needs to be done to fully understand the efficacy of treatment with TENS. If, at that point, my patient opted to move forward with the electric nerve stimulation, I would continue to encourage her to with her Rheumatologist to manage the treatment and discontinue treatment if she experienced any adverse side effects.
https://www.mayoclinic.org/diseases-conditions/fibromyalgia/symptoms-causes/syc-20354780
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