Comparison of Mesotherapy and Transcutaneous Electrical Nerve Stimulation (TENS) in the Management of Chronic Non-Specific Low Back Pain: A Randomized Clinical Trial

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Published Jan 2, 2025
https://doi.org/10.62438/tunismed.v103i1.5187
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Vol. 103 No. 1 (2025): Tunis Med Jan 2025

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Najla Mouhli
Department of Physical Medicine and rehabilitation , Military hospital of Tunis. Faculty of Medicine of Tunis, University of Tunis El Manar,Tunisia
Soumaya Belghith
Department of Physical Medicine and rehabilitation , Military hospital of Tunis, Tunisia
Souad Karoui
Department of Physical Medicine and rehabilitation , Military hospital of Tunis, Tunisia
Maroua Slouma
Department of Rhumatology, Military hospital of Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
Rim Dhahri
Department of Rhumatology, Military hospital of Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
Faida Ajili
Unit Research Systemic Diseases (UR) 17DN02, Tunisia
Rim Maaoui
Department of Physical Medicine and rehabilitation , Military hospital of Tunis. Faculty of Medicine of Tunis, University of Tunis El Manar,Tunisia
Hajer Rahali
Department of Physical Medicine and rehabilitation , Military hospital of Tunis. Faculty of Medicine of Tunis, University of Tunis El Manar,Tunisia

Abstract

Introduction-Aim: Chronic low back pain affects 80% of individuals at some point in their lives and has significant socioeconomic impacts. This study aims to compare the efficacy of mesotherapy with transcutaneous electrical nerve stimulation (TENS) in treating chronic low back pain.


Methods: A randomized bicentric study was conducted at the Military Hospital of Tunis and the Multidisciplinary Military Polyclinic of Mefeteh Saadallah between August 2023 and June 2024. Sixty patients (40 men and 20 women) with chronic low back pain were included. Group 1 (TENS) received 6 sessions of neurostimulation twice a week for 3 weeks. Group 2 (mesotherapy) received 3 sessions of mesotherapy. Measurements included pain, analgesic consumption, physical examination, Oswestry Disability Index, Hospital Anxiety and Depression (HAD) score, and patient satisfaction.


Results: Out of 293 patients consulted, 60 were included and randomized. Both groups showed significant pain improvement (p<0.001) with no notable difference between them (p=0.05). Analgesic consumption decreased more significantly with mesotherapy (p<0.001). Improvements in physical examination, Oswestry score, and HAD score were significant in both groups without significant differences between them. Patient satisfaction was high in both groups with an average score of 88/100 for TENS and 77/100 for mesotherapy (p=0.154).


Discussion: Mesotherapy and TENS are effective in treating chronic low back pain, reducing pain and improving functional and psycho-emotional scores with no significant difference between them. Mesotherapy reduces analgesic consumption more. Further studies are needed to confirm these results.

Keywords:

Chronic low back pain, Mesotherapy, Transcutaneous electrical nerve stimulation (TENS), Rehabilitation Centers

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References

  1. Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014 Jun;73(6):968–74.
  2. Chou R, Huffman LH. Medications for Acute and Chronic Low Back Pain: A Review of the Evidence for an American Pain Society/American College of Physicians Clinical Practice Guideline. Ann Intern Med. 2007 Oct 2;147(7):505–14.
  3. Enthoven WT, Roelofs PD, Deyo RA, Van Tulder MW, Koes BW. Non-steroidal anti-inflammatory drugs for chronic low back pain. Cochrane Back and Neck Group, editor. Cochrane Database Syst Rev. 2016 Feb 10;2016(8).
  4. Qaseem A, Wilt TJ, McLean RM, Forciea MA, for the Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017 Apr 4;166(7):514–30.
  5. Aizuddin AN, Zamzuri M’Ammar IA, Mansor J, Nurumal SR, Yunus SZSA, Razak MAA, et al. Perception of integrating complementary and alternative medicine practice in patient’s treatment among the healthcare practitioners: a systematic review. Pan Afr Med J. 2022;43:19.
  6. Paolucci T, Bellomo R, Centra M, Giannandrea N, Pezzi L, Saggini R. Mesotherapy in the treatment of musculoskeletal pain in rehabilitation: the state of the art. J Pain Res. 2019 Jul;12:2391–401.
  7. Faetani L, Ghizzoni D, Ammendolia A, Costantino C. Safety and efficacy of mesotherapy in musculoskeletal disorders: A systematic review of randomized controlled trials with meta-analysis. J Rehabil Med. 2021;53(4):jrm00182.
  8. Ronconi G, Ferriero G, Nigito C, Foti C, Maccauro G, Ferrara PE. Efficacy of intradermal administration of diclofenac for the treatment of nonspecific chronic low back pain: results from a retrospective observational study. Eur J Phys Rehabil Med. 2019 Jul;55(4).
  9. Akbas I, Kocak AO, Kocak MB, Cakir Z. Comparison of intradermal mesotherapy with systemic therapy in the treatment of low back pain: A prospective randomized study. Am J Emerg Med. 2020 Jul;38(7):1431–5.
  10. Haute Autorité de Santé HAS. Appareils de neurostimulation électrique transcutanée (TENS). Saint-Denis La Plaine; 2019.
  11. Hayden JA, Ellis J, Ogilvie R, Malmivaara A, Van Tulder MW. Exercise therapy for chronic low back pain. Cochrane Back and Neck Group, editor. Cochrane Database Syst Rev. 2021 Sep 28;2021(10).
  12. Maaoui R, Ksibi I, Khezami A, Zrida S, Chiha N, Rahali H. Evaluation after two years of functionnal restoration for chronic low back pain: Tunisian experience. Tunis Med. 2018 Jan;96(1):36–41.
  13. Karoui S, Mouhli N, Yahyaoui A, Maaoui R, Rahali H, Ksibi I. Evaluation de la force musculaire chez le lombalgique chronique: Comparaison entre reeducation isocinetique et reeducation classique. Tunis Médicale. 2024 May 12;102(5).
  14. Melzack R, Wall PD. Pain Mechanisms: A New Theory. Science. 1965 Nov 19;150(3699):971–9.
  15. Gibson W, Wand BM, Meads C, Catley MJ, O’Connell NE. Transcutaneous electrical nerve stimulation (TENS) for chronic pain - an overview of Cochrane Reviews. Cochrane Pain, Palliative and Supportive Care Group, editor. Cochrane Database Syst Rev. 2019 Apr 3.
  16. Mammucari M, Gatti A, Maggiori S, Sabato AF. Role of Mesotherapy in Musculoskeletal Pain: Opinions from the Italian Society of Mesotherapy. Evid Based Complement Alternat Med. 2012;2012:1–12.
  17. Bonnet C, Laurens D, Perrin JJ. Guide Pratique De Mésothérapie. Medecine generale, medecine du sport, medecine esthetique, rhumatologie, pharmacopee. ELSEVIER-MASSON; 2011.
  18. Algarni AS, Ghorbel S, Jones JG, Guermazi M. Validation of an Arabic version of the Oswestry index in Saudi Arabia. Ann Phys Rehabil Med. 2014 Dec;57(9–10):653–63.
  19. Terkawi A, Tsang S, AlKahtani G, Al-Mousa S, Al Musaed S, AlZoraigi U, et al. Development and validation of Arabic version of the Hospital Anxiety and Depression Scale. Saudi J Anaesth. 2017;11(5):11.
  20. Fairbank JC, Couper J, Davies JB, O’Brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy. 1980 Aug;66(8):271–3.
  21. Herreros FOC, Moraes AM de, Velho PENF. Mesotherapy: a bibliographical review. An Bras Dermatol. 2011;86(1):96–101.
  22. Costantino C, Marangio E, Coruzzi G. Mesotherapy versus Systemic Therapy in the Treatment of Acute Low Back Pain: A Randomized Trial. Evid Based Complement Alternat Med. 2011;2011:1–6.
  23. Tekin E, Gur A, Bayraktar M, Ozlu I, Celik BK. The effectiveness of intradermal sterile water injection for low back pain in the emergency department: A prospective, randomized controlled study. Am J Emerg Med. 2021 Apr;42:103–9.
  24. Saad EA, Nouby FHE, Fayomi GE, Fehr A, Fathy NA. Comparative Study between Mesotherapy and Conventional Systemic NSAIDs in the Treatment of Chronic Low Back Pain with Sciatica.
  25. Farpour HR, Sheybani E, Keshavarzi E. Comparative Effectiveness of Caudal Epidural Steroid Injection Versus Mesotherapy of Calcitonin on Pain Reduction and Improving Function in Patients with Lumbosacral Canal Stenosis: A Randomized Control Trial.
  26. Cui JZ, Geng ZS, Zhang YH, Feng JY, Zhu P, Zhang XB. Effects of intracutaneous injections of sterile water in patients with acute low back pain: a randomized, controlled, clinical trial. Braz J Med Biol Res. 2016 Mar;49(3).
  27. Ferrara PE, Ronconi G, Viscito R, Pascuzzo R, Rosulescu E, Ljoka C, et al. Efficacy of mesotherapy using drugs versus normal saline solution in chronic spinal pain: a retrospective study. Int J Rehabil Res. 2017 Jun;40(2):171–4.
  28. Tekin E, Gur A, Bayraktar M, Ozlu I, Celik BK. The effectiveness of intradermal sterile water injection for low back pain in the emergency department: A prospective, randomized controlled study. Am J Emerg Med. 2021 Apr;42:103–9.
  29. Masson E. Électrothérapie. Électrostimulation. EM-Consulte.
  30. American Physical Therapy Association. Guide to Physical Therapist Practice. Second Edition. Phys Ther. 2001 Jan;81(1):9–746.
  31. Pollez B, Thevenon A. Comment pratiquer l’électrothérapie excito-motrice ? Annales de Kinésithérapie. 1986;13(10):481–9.
  32. Santos CMF, Francischi JN, Lima-Paiva P, Sluka KA, Resende MA. Effect of transcutaneous electrical stimulation on nociception and edema induced by peripheral serotonin. Int J Neurosci. 2013 Jul;123(7):507–15.
  33. Wall PD, Sweet WH. Temporary abolition of pain in man. Science. 1967 Jan 6;155(3758):108–9.
  34. Sluka KA, Bjordal JM, Marchand S, Rakel BA. What makes transcutaneous electrical nerve stimulation work? Making sense of the mixed results in the clinical literature. Phys Ther. 2013 Oct;93(10):1397–402.
  35. Ezema CI, Onyeso OK, Nna EO, Awosoga OA, Odole AC, Kalu ME, et al. Transcutaneous electrical nerve stimulation effects on pain-intensity and endogenous opioids levels among chronic low-back pain patients: A randomised controlled trial. J Back Musculoskelet Rehabil. 2022;35(5):1053–64.
  36. Dailey DL, Rakel BA, Vance CGT, Liebano RE, Amrit AS, Bush HM, et al. Transcutaneous electrical nerve stimulation reduces pain, fatigue and hyperalgesia while restoring central inhibition in primary fibromyalgia. Pain. 2013 Nov;154(11):2554–62.
  37. Johnson MI, Paley CA, Jones G, Mulvey MR, Wittkopf PG. Efficacy and safety of transcutaneous electrical nerve stimulation (TENS) for acute and chronic pain in adults: a systematic review and meta-analysis of 381 studies (the meta-TENS study). BMJ Open. 2022 Feb;12(2):e051073.
  38. Healthcare Improvement Scotland. SIGN 136. Management of chronic pain. A national Guideline. Revised edition published August 2019.
  39. Haute Autorité de Santé. Appareils de neurostimulation électrique transcutanée (TENS).
  40. Wolfe D, Rosenstein B, Fortin M. The Effect of Transcutaneous Electrotherapy on Lumbar Range of Motion and Paraspinal Muscle Characteristics in Chronic Low Back Pain Patients: A Systematic Review and Meta-Analysis. J Clin Med. 2023 Jul 14;12(14):4680.
  41. Jalalvandi F, Ghasemi R, Mirzaei M, Shamsi M. Effects of back exercises versus transcutaneous electric nerve stimulation on relief of pain and disability in operating room nurses with chronic non-specific LBP: a randomized clinical trial. BMC Musculoskelet Disord. 2022;23.
  42. Florio A, Ceruti R, Sguazzini-Viscontini G, Cisari C. The sequelae of cervical whiplash injury. Eur Medicophysica. 1999;35(4).
  43. Serra JB, Ramos-Casals M, Munoz L, Moragas A, Garcia-Cruz A. Effects of extracorporeal shockwave therapy versus musculoskeletal mesotherapy for Achilles tendinopathy in athletes. Ann Rehabil Med. 2017;41(1):20–7.
  44. Serra JB, Ramos-Casals M, Munoz L, Moragas A, Garcia-Cruz A. Extracorporeal shockwave treatment vs. mesotherapy in the treatment of myofascial syndromes: A clinical trial. Clin Rehabil. 2018;32(2):180–8.
  45. Koszela K, Słupiński M, Woldańska-Okońska M. The Role of Rehabilitation after Spinal Mesotherapy in a Three-Stage Treatment Concept. J Clin Med. 2024 May 29;13(11):3195.