TENS (transcutaneous nerve stimulation) for pain relief in labour

Dowswell T, Bedwell C, Lavender T, Neilson JP

Published Online:

September 7, 2011

TENS is a device that emits low-voltage currents and which has been used for pain relief in labour. The way that TENS works is not well understood. The electrical pulses are thought to stimulate nerve pathways in the spinal cord which block the transmission of pain. In labour the electrodes from the TENS machine are usually attached to the lower back (and women themselves control the electrical currents using a hand-held device) but TENS can also be applied to acupuncture points or directly to the head. The purpose of the review was to see whether TENS is effective in relieving pain in labour. The review includes results from 17 studies with a total of 1466 women. Thirteen studies examined TENS applied to the back, two to acupuncture points and two to the cranium (head). Results show that pain scores were similar in women using TENS and in control groups. There was some evidence that women using TENS were less likely to rate their pain as severe but results were not consistent. Many women said they would be willing to use TENS again in a future labour. TENS did not seem have an effect on the length of labour, interventions in labour, or the well-being of mothers and babies. It is not known whether TENS would help women to manage pain at home in early labour. Although it is not clear that it reduces pain, women should have the choice of using TENS in labour if they think it will be helpful.

Abstract (click to read)

Background:

Transcutaneous nerve stimulation (TENS) has been proposed as a means of reducing pain in labour. The TENS unit emits low-voltage electrical impulses which vary in frequency and intensity. During labour, TENS electrodes are generally placed on the lower back, although TENS may be used to stimulate acupuncture points or other parts of the body. The physiological mechanisms whereby TENS relieves pain are uncertain. TENS machines are frequently operated by women, which may increase a sense of control in labour.

Objectives:

To assess the effects of TENS on pain in labour.

Search strategy:

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 April 2011) and reference lists of retrieved papers.

Selection criteria:

Randomised controlled trials comparing women receiving TENS for pain management in labour versus routine care, alternative non-pharmacological methods of pain relief, or placebo devices. We included all types of TENS machines.

Data collection and analysis:

Two review authors assessed for inclusion all trials identified by the search strategy, carried out data extraction and assessed risk of bias. We have recorded reasons for excluding studies.

Main results:

Seventeen trials with 1466 women contribute data to the review. Thirteen examined TENS applied to the back, two to acupuncture points, and two to the cranium. Overall, there was little difference in pain ratings between TENS and control groups, although women receiving TENS to acupuncture points were less likely to report severe pain (average risk ratio 0.41, 95% confidence interval 0.31 to 0.54; measured in two studies). The majority of women using TENS said they would be willing to use it again in a future labour. Where TENS was used as an adjunct to epidural analgesia there was no evidence that it reduced pain. There was no consistent evidence that TENS had any impact on interventions and outcomes in labour. There was little information on outcomes for mothers and babies. No adverse events were reported.

Authors' conclusions:

There is only limited evidence that TENS reduces pain in labour and it does not seem to have any impact (either positive or negative) on other outcomes for mothers or babies. The use of TENS at home in early labour has not been evaluated. TENS is widely available in hospital settings and women should have the choice of using it in labour.

This record should be cited as:

Dowswell T, Bedwell C, Lavender T, Neilson JP. Transcutaneous electrical nerve stimulation (TENS) for pain management in labour. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD007214. DOI: 10.1002/14651858.CD007214.pub2

Assessed as up to date:

June 22, 2011

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Primary Review Group:

Pregnancy and Childbirth Group

PEARLS - Practical Evidence About Real Life Situations (click to read)

Clinical question:

How effective is transcutaneous electrical nerve stimulation (TENS) for pain relief in labour?

Bottom line:

Overall, there was little difference in pain ratings between TENS and control groups, although women receiving TENS to acupuncture points were less likely to report severe pain. The majority of women using TENS said they would be willing to use it again in a future labour. Where TENS was used as an adjunct to epidural analgesia, there was no evidence it reduced pain. There was no consistent evidence TENS had any impact on the length of labour, interventions in labour, or the wellbeing of mothers and babies.

Caveat:

The risk of bias in these studies was generally high. Few studies provided clear information about sequence generation or methods used to conceal group allocation. It is not known whether TENS would help women to manage pain at home in early labour.

Context:

TENS has been proposed as a means of reducing pain in labour. The TENS unit emits low-voltage electrical impulses which vary in frequency and intensity. During labour, TENS electrodes are generally placed on the lower back, although TENS may be used to stimulate acupuncture points or other parts of the body. The physiological mechanisms whereby TENS relieves pain are uncertain. The TENS unit is frequently operated by women, which may increase sense of control in labour.

Cochrane Systematic Review:

Dowswell T et al. Transcutaneous electrical nerve stimulation (TENS) for pain relief in labour. Cochrane Reviews 2009, Issue 2. Article No. CD007214. DOI: 10.1002/14651858. CD007214.pub2. This review contains 19 studies involving 1671 participants.

Authored by:

Brian R McAvoy

Cochrane Primary Health Care Field

Health topics:

Pregnancy & childbirth > Pain during labour > Non-pharmacological methods

Complementary & alternative medicine > Pregnancy & childbirth > Pain during labour

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

TENS (transcutaneous nerve stimulation) for pain relief in labour

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