Effects of Transcutaneous Electrical Nerve Stimulation, Electrical Muscle Stimulation, Exercise and Heat on Back Pain—A Randomized Controlled Clinical Exploratory Trial

BACKGROUND: This randomized controlled study compared different forms of therapy for chronic back pain. METHODS: Seventy-nine patients with chronic back pain with a duration of symptoms of more than 6 months were included in the study and randomly assigned to one of four therapy groups (a) sports therapy with a focus on strength training (SG), (b) combined therapy with transcutaneous electrical nerve stimulation (TENS), electromyostimulation (EMS) and heat (TEH-G), (c) heat therapy only (HG) as well as a (d) control group receiving treatment as usual (CG). Treatment in groups a, b and c was twice a week for 3 months. All patients underwent questionnaire assessment, measurements of strength and mobility and a BIA and O2C measurement prior to and after treatment. Primary endpoint was the change in pain intensity, secondary endpoints were quality of life (QoL), motor function and sleep over the study period. RESULTS: Combined TENS/EMS/heat therapy and sports therapy showed the best results: TEH-G was able to reduce the average pain intensity and increase strength, muscle mass and self-assessed physical performance as well as positively influenced QoL. The SG showed improved sleep quality, motor skills and strength as well as increased muscle mass and condition. Heat therapy decreased pain, but did not affect other outcome measures. The CG group did not show any changes over 3 months. CONCLUSION: Strength training, TENS, EMS and heat can improve various symptoms associated with chronic pain. When choosing a certain therapy, patients' individual aspects such as pain characteristics and circumstances should be considered. SIGNIFICANCE: This RCT demostrates that chronic back pain patients benefit more from exercise therapy or combined Tens/heat/EMS therapy compared to heat therapy alone or standard care.