Reduced analgesic effect of acupuncture-like TENS but not conventional TENS in opioid treated patients

Abstract

Abstract : Evidence from recent animal studies indicates that the analgesic effect of low frequency TENS is reduced in opioid tolerant animals. The aim of the present study was to compare the analgesic effect of conventional (high frequency) and acupuncture-like (low frequency) TENS between a group of opioid treated patients and a group of opioid-naive patients in order to determine if this cross-tolerance effect is also present in humans. Twenty-three chronic pain patients (11 who took opioids and 12 who did not) participated in the study. Participants were assigned in a randomized cross-over design to receive alternately conventional and acupuncture-like TENS. There was a significant reduction in pain during and after conventional TENS when compared to baseline for both the opioid and non-opioid group (p<.01). For acupuncture-like TENS however, the analgesic effect of TENS was only observed in the non-opioid group (p<.01), with opioid treated patients showing no change in pain scores during and after TENS when compared to baseline (p>.09). The reduced analgesic effect of acupuncture-like TENS in opioid treated patients is coherent with previous animal studies and suggests that conventional TENS should be preferred in patients taking opioids on a regular basis.

Perspective: This study shows that patients taking opioids on a regular basis are less susceptible to benefit from acupuncture-like TENS. This phenomenon is probably attributable to the fact that the analgesia induced by acupuncture-like TENS and opioids are mediated by the same receptors (i.e. μ opioid receptors).