{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T05:45:47Z","timestamp":1784958347517,"version":"3.55.0"},"reference-count":41,"publisher":"Oxford University Press (OUP)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,11,1]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>There is no consensus regarding the effectiveness of transcutaneous electrical nerve stimulation (TENS) for management of chronic musculoskeletal pain or chronic low back pain. A recent review of previous trial methodology identified significant problems with low treatment fidelity. There is little information available to guide selection of patient-reported outcome measures appropriate for TENS evaluation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>The purpose of this study was to explore the experiences of patients at a secondary care pain clinic who successfully used TENS to help manage chronic musculoskeletal pain. These key informants were selected because they had the potential to generate knowledge that could inform research design and clinical practice.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>A qualitative method using individual semistructured interviews with open questions was selected for its capacity to generate rich data.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A mini focus group informed the development of a discussion guide for semistructured interviews with 9 patients (6 women, 3 men). Thematic analysis was used as the primary data analysis method, and this analysis was enhanced by a case-level analysis of the context and processes of TENS use of each individual.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Data analysis indicated that distraction from pain and a reduction in the sensations associated with muscle tension or spasm should be considered as separate outcomes from pain relief. These direct benefits led to a wide range of indirect benefits dependent on patient decision making, including medication reduction, enhanced function, psychological benefits, and enhanced ability to rest.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The findings indicate that evaluating TENS using a unidimensional pain scale is likely to overlook potential benefits. The complex pattern of TENS usage, as well as multiple direct and indirect outcomes, indicates that TENS could be considered as a complex intervention.<\/jats:p>\n               <\/jats:sec>","DOI":"10.2522\/ptj.20140120","type":"journal-article","created":{"date-parts":[[2015,4,30]],"date-time":"2015-04-30T21:22:43Z","timestamp":1430428963000},"page":"1518-1528","source":"Crossref","is-referenced-by-count":26,"title":["Direct and Indirect Benefits Reported by Users of Transcutaneous Electrical Nerve Stimulation for Chronic Musculoskeletal Pain: Qualitative Exploration Using Patient Interviews"],"prefix":"10.1093","volume":"95","author":[{"given":"Peter William","family":"Gladwell","sequence":"first","affiliation":[{"name":"P.W. Gladwell, PhD, MCSP, BScHons, Pain Management Service, North Bristol NHS Trust, Southmead Hospital, Southmead Road, Bristol, United Kingdom BS10 5NB."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Badlan","sequence":"additional","affiliation":[{"name":"K. Badlan, MPhil, CertEdFE, MCSP, Faculty of Health and Life Sciences, University of the West of England, Bristol, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiona","family":"Cramp","sequence":"additional","affiliation":[{"name":"F. Cramp, PhD, FCSP, BScHons, Allied Health Professions, University of the West of England."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shea","family":"Palmer","sequence":"additional","affiliation":[{"name":"S. Palmer, PhD, MCSP, FHEA, BScHons, Allied Health Professions, University of the West of England."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","reference":[{"key":"2019123007574891500_B1","first-page":"CD003222","article-title":"Transcutaneous electrical nerve stimulation (TENS) for chronic pain","volume":"3","author":"Nnoaham","year":"2008","journal-title":"Cochrane Database Syst Rev"},{"key":"2019123007574891500_B2","first-page":"CD003008","article-title":"Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain","volume":"4","author":"Khadilkar","year":"2008","journal-title":"Cochrane Database Syst Rev"},{"key":"2019123007574891500_B3","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1016\/j.pain.2010.12.009","article-title":"Methodological quality in randomised controlled trials of transcutaneous electric nerve stimulation for pain: low fidelity may explain negative findings","volume":"152","author":"Bennett","year":"2011","journal-title":"Pain"},{"key":"2019123007574891500_B4","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/1748-5908-2-40","article-title":"A conceptual framework for implementation fidelity","volume":"2","author":"Carroll","year":"2007","journal-title":"Implement Sci"},{"key":"2019123007574891500_B5","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1002\/j.1532-2149.2011.00061.x","article-title":"Value of TENS for relief of chronic low back pain with or without radicular pain","volume":"16","author":"Buchmuller","year":"2012","journal-title":"Eur J Pain"},{"key":"2019123007574891500_B6","doi-asserted-by":"crossref","first-page":"f5160","DOI":"10.1136\/bmj.f5160","article-title":"Transcutaneous electrical nerve stimulation as adjunct to primary care management for tennis elbow: pragmatic randomised controlled trial (TATE trial)","volume":"347","author":"Chesterton","year":"2013","journal-title":"BMJ"},{"key":"2019123007574891500_B7","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/0304-3959(91)90089-G","article-title":"An in-depth study of long-term users of transcutaneous electrical nerve stimulation (TENS): implications for clinical use of TENS","volume":"44","author":"Johnson","year":"1991","journal-title":"Pain"},{"key":"2019123007574891500_B8","doi-asserted-by":"crossref","first-page":"i","DOI":"10.3310\/hta2140","article-title":"Evaluating patient-based outcome measures for use in clinical trials","volume":"2","author":"Fitzpatrick","year":"1998","journal-title":"Health Technol Assess"},{"key":"2019123007574891500_B9","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.pain.2004.09.012","article-title":"Core outcome measures for chronic pain clinical trials: IMMPACT recommendations","volume":"113","author":"Dworkin","year":"2005","journal-title":"Pain"},{"key":"2019123007574891500_B10","first-page":"129","article-title":"Pain assessment: global use of the Brief Pain Inventory","volume":"23","author":"Cleeland","year":"1994","journal-title":"Ann Acad Med Singapore"},{"key":"2019123007574891500_B11","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/0304-3959(85)90004-1","article-title":"The West Haven-Yale Multidimensional Pain Inventory (WHYMPI)","volume":"23","author":"Kerns","year":"1985","journal-title":"Pain"},{"key":"2019123007574891500_B12","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1097\/00005650-199206000-00002","article-title":"The MOS 36-item short-form health survey (SF-36), I: conceptual framework and item selection","volume":"30","author":"Ware","year":"1992","journal-title":"Med Care"},{"key":"2019123007574891500_B13","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1097\/00007632-198303000-00004","article-title":"A study of the natural history of back pain, part I: development of a reliable and sensitive measure of disability in low back pain","volume":"8","author":"Roland","year":"1983","journal-title":"Spine (Phila Pa 1976)"},{"key":"2019123007574891500_B14","article-title":"TENS effectiveness: have we been barking up the wrong RCT?","author":"Gladwell"},{"key":"2019123007574891500_B15","unstructured":"Gladwell\n              PW\n            \n          . 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