Sickle cell disease: TENS had no clear effect on painful crises.

Clinical bottom line (level 1b-)

  1. In patients with sickle cell disease, transcutaneous electrical nerve stimulation had no clear effect on improvement in pain ratings or need for analgesia.
Wang et al: Acta Haematologica 1988; 80: 99-102
Expires June 2003

The study

Double-blinded concealed randomised cross-over trial without intention-to-treat
Setting: university hospital, USA

22 patients (aged range 12 to 27 years; mean 17.5, 55% female) sickle cell disease with painful crisis. 60 episodes occurred in the 22 patients
Note:
  • Patients were stratified according to severity of painful crisis.
  • Pain ratings were determined at study entry:
    • grade 1- mild pain- relieved with drugs
    • grade 2- moderate pain- relieved with drugs
    • grade 3- severe pain-relieved with drugs
    • grade 4- severe pain- not relieved with drugs


    • Control Group: (n = 30, 30 analysed): placebo
    Experimental Group: (n = 30, 30 analysed): transcutaneous electrical nerve stimulation (TENS) - 100 Hz pulse rate and 30 µ s pulse width

    100% followed for ?

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    no improvement in pain ratings unknown 16
    (53.3%)    		 12
    (48.0%)    		 10%
    (-53% to 47%)    		 5.33%
    (-21.2% to 31.8%)    		 19
    (NNT = 3 to infinity;
    NNH = 5 to infinity)
    required analgesia within 4 hours unknown 20
    (66.7%)    		 18
    (60.0%)    		 10%
    (-32% to 39%)    		 6.67%
    (-17.7% to 31.0%)    		 15
    (NNT = 3 to infinity;
    NNH = 6 to infinity)

  • Only 25 patients were analysed for improvement in pain rating.

    • Comments

    1. Results may be misleading as the number of episodes were used to compare the treatments, not the number of patients.

    Citation

    1. Wang WC, George SL, Wilimas JA: transcutaneous electrical nerve stimulation treatment of sickle cell pain crises. Acta Haematologica 1988; 80: 99-102
    Contributor: Clare Wotton and Musab Hayatli, June 2000
    Reviewer:

    Clinical Question.
    Patient sickle cell painful crises
    Intervention or Exposure transcutaneous electrica nerve stimulation
    Comparison placebo
    Outcome pain rating and analgesic requirement