Transcutaneous Electrical Nerve Stimulation for Acute Pain Management in Obstetrics & Gynecology: Applicability for IUD Insertion

 

Background:

• Transcutaneous electrical nerve stimulation (TENS)

therapy: a modality for pain control that utilizes

electrical currents to target nerve stimulation

within a specific area of the body.

• Electrical currents (frequency—dependent)

stimulate mechanoreceptors on the skin, neurons

of the dorsal column medial lemniscus (DCML)

pathway, and inhibitory interneurons in the

substantia gelatinosa (SG) which ultimately inhibit

pain signals. Other theories suggest TENS utilizes a

descending inhibitory pathway and increases

endogenous opioids.

• In OBGYN, TENS has been shown to be effective at

providing pain relief in patients with dysmenorrhea

and chronic pelvic pain, as well as during vaginal

delivery and C-sections.

 

Purpose:

• Despite the efficacy, durability, and reversible

nature of intrauterine devices (IUDs), many sexually

active women are deterred from this form of birth

control due the painful insertion process.

Discussion:

• High-intensity TENS likely has better applicability for

acute pain management since it activates gate

control by stimulating Aβ fibers.

• No studies available for systematic review. However,

recently published systematic review: Efficacy of

Transcutaneous Electrical Nerve Stimulation (TENS)

for Management of Pain Associated With

Hysteroscopy showed that TENS is effective in

reducing subjective pain perceptions in patients

undergoing hysteroscopy.

 

Conclusion: 

 • Currently, there is an ongoing clinical trial at the

Icahn School of Medicine at Mount Sinai using

high frequency TENS (TENS for IUD Insertion

Pain).

• Additional RCTs and meta-analyses needed to

explore the potential of TENS therapy in the

realm of IUD insertion, as well as pain

management in other minimally invasive

procedures.