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The Journal of Pain, Vol 12, No 5 (May), 2011: pp 581-590
Available online at www.sciencedirect.com

Adjusting Pulse Amplitude During Transcutaneous Electrical Nerve
Stimulation (TENS) Application Produces Greater Hypoalgesia
Manuela A. Pantale~o,* Marjorie F. Laurino,* Natalie L. G. Gallego,* a Cristina M. N. Cabral,* Barbara Rakel,y Carol Vance,z Kathleen A. Sluka,z
Deirdre M. Walsh,x and Richard E. Liebano*
* University of the City of Sao Paulo (UNICID), Physical Therapy Department, Sao Paulo, Brazil. y College of Nursing, Graduate Program in Physical Therapy & Rehabilitation Science, University of Iowa, Iowa City,
Iowa.
z
College of Medicine, Graduate Program in Physical Therapy & Rehabilitation Science, University of Iowa, Iowa City,
Iowa.
x
University of Ulster, Health and Rehabilitation Sciences Research Institute, Newtownabbey, Northern Ireland, UK.

Abstract: Transcutaneous electrical nerve stimulation (TENS) is a noninvasive technique used for pain modulation. During application of TENS there is a fading of current sensation. Textbooks of electrophysical agents recommend that pulse amplitude should be constantly adjusted. This seems to be accepted clinically despite the fact that there is no direct experimental evidence. The aim of the current study was to investigate the hypoalgesic effect of adjusting TENS pulse amplitude on pressure pain thresholds (PPTs) in healthy humans. Fifty-six healthy TENS na€ participants were recruited and ıve randomly assigned to 1 of 4 groups (n = 14 per group): control, placebo TENS, fixed pulse amplitude
TENS, and adjusted pulse amplitude TENS. Both active and placebo TENS were applied to the dominant forearm. PPTs were recorded from 2 points on the dominant forearm and hand before, during, and after 40 minutes of TENS. TENS increased the PPTs on the forearm (P = .003) and hand (P = .003) in the group that received the adjusted pulse amplitude when compared to all other groups. The mean final pulse amplitude for the adjusted