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Papers: 12 Mar 2022 - 18 Mar 2022

2022 Mar 12

J Pain

The Influence of Opioids on Transcutaneous Electrical Nerve Stimulation Effects in Women with Fibromyalgia.


Dailey DL, Vance CGT, Chimenti R, Rakel BA, Zimmerman BM, Williams JM, Sluka KA, Crofford LJ
J Pain. 2022 Mar 12.
PMID: 35292378.


Transcutaneous electrical nerve stimulation (TENS) uses endogenous opioids to produce analgesia, and effectiveness can be reduced in opioid-tolerant individuals. We examined TENS effectiveness (primary aim), and differences in fibromyalgia symptoms (secondary aim), in women with fibromyalgia regularly taking opioid (RTO) medications compared with women not- regularly taking opioids (not-RTO). Women (RTO n=79; not-RTO not-n=222) with fibromyalgia with daily pain levels ≥4 were enrolled and categorized into RTO (taking opioids at least 5 of 7 days in last 30 days) or not-RTO groups. For the RTO group, participants were categorized into tramadol n=52 (65.8%) and other opioids n=27 (34.2%). Participants were phenotyped across multiple domains including demographics, fibromyalgia characteristics pain, fatigue, sleep, psychosocial factors, and activity. Participants were randomized to active TENS (n=101), placebo TENS (n=99), or no TENS (n=99) for 1-month with randomization stratified by opioid use. Active TENS was equally effective in movement-evoked pain in those in the RTO and not-RTO groups. Women with fibromyalgia in the RTO group were older (p=0.002), lower income (p=0.035), more likely to smoke (p=0.014), and more likely to report depression (p=0.013), hypertension (p=0.005) or osteoarthritis (p=0.027). The RTO group demonstrated greater bodily pain on SF-36 (p=0.005), lower quality of life on the physical health component of the SF-36 (p=0.040), and greater fatigue (MAF-ADL p=0.047; fatigue with sit to stand test (p=0.047) These differences were small of and unclear clinical significance. In summary, regular use of opioid analgesics does not interfere with effectiveness of TENS for movement-evoked pain. Clinical Trial Registration Number: NCT01888640 Perspective: Individuals treated with mixed frequency TENS at strong but comfortable intensity that were taking prescription opioid analgesics showed a significant reduction in movement-evoked pain and fatigue. These data support the use of TENS, using appropriate parameters of stimulation, as an intervention for individuals with fibromyalgia taking opioid analgesics.