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British Journal of Anaesthesia, Vol 77, Issue 6 798-803, Copyright © 1996 by The Board of Management and Trustees of the British Journal of Anaesthesia

COMMENTARIES

Randomization is important in studies with pain outcomes: systematic review of transcutaneous electrical nerve stimulation in acute postoperative pain

D. Carroll, M. Tramer, H. McQuay, B. Nye and A. Moore
Pain Research Unit, Nuffield Department of Anaesthetics, University of Oxford, The Churchill, Oxford Radcliffe Hospital, Headington, Oxford OX3 7LJ

We set out to examine the evidence for the importance of randomization of transcutaneous electrical nerve stimulation (TENS) in acute postoperative pain. Controlled studies were sought; randomization and analgesic and adverse effect outcomes were summarized. Forty-six reports were identified by searching strategies. Seventeen reports with 786 patients could be regarded unequivocally as randomized controlled trials (RCT) in acute postoperative pain. No meta-analysis was possible. In 15 of 17 RCT, we judged there to be no benefit of TENS compared with placebo. Of the 29 excluded trials, 19 had pain outcomes but were not RCT; in 17 of these 19 TENS studies, the authors concluded that TENS had a positive analgesic effect. No adverse effects were reported. Non-randomized studies overestimated treatment effects.
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