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The superiority of high‐intensity TENS compared with low‐frequency TENS, regardless of
frequency used, has been demonstrated in further clinical (Olsen et al, 2007 Level II) and
experimental (Aarskog et al, 2007 Level II; Claydon et al, 2008 Level II) pain studies.
Use of high‐intensity (strong but comfortable) TENS improved pain relief after inguinal
herniorrhaphy (DeSantana et al, 2008 Level II), laparoscopic tubal ligation (Desantana et al,
2009 Level II) and thoracotomy (Erdogan et al, 2005 Level II).
TENS was of value in the treatment of primary dysmenorrhoea (Proctor et al, 2002 Level I).
Overall, there appeared to be no good evidence for any analgesic effect of TENS during labour
although severe pain was less likely to be reported in women receiving TENS to acupuncture
points (Dowswell et al, 2009 Level I).

Key messages
1. Overall, there is no evidence that TENS is effective for the treatment of pain during labour
(N) (Level I [Cochrane Review]).
2. Certain stimulation patterns of TENS are effective in some acute pain settings (S) (Level I).

8.3 ACUPUNCTURE

Acupuncture compared with sham controls reduced postoperative pain (at 8 hours and
72 hours) and opioid consumption as well as nausea (not vomiting), sedation, pruritus and
urinary retention (Sun et al, 2008 Level I). There was wide variability in the types of surgery and
acupuncture regimens (including type of acupuncture, time of application, and type and
duration of stimulation) in the studies included in this review and the magnitude of benefit
was small. Another review looking specifically at auricular acupuncture for postoperative pain
control concluded that a meta‐analysis was not possible because of the heterogeneity of the
primary studies (Usichenko, Lehmann et al, 2008).
Reviews of the effectiveness of acupuncture in other acute pain settings suggest that it may be
useful for managing pain during childbirth (analgesic requirements were reduced) (Smith et al,
2006 Level I) and dental pain (Ernst & Pittler, 1998 Level I). CHAPTER 8
A meta‐analysis of trials comparing acupuncture (traditional‐ and electro‐acupuncture) with
placebo acupuncture for the treatment of pain in general concluded that it does result in a
small analgesic effect (4 mm on a 100 mm VAS), but that this seemed to lack clinical relevance
and could not clearly be distinguished from bias resulting from incomplete blinding (Madsen et
al, 2009 Level I).The analgesic effect of placebo acupuncture compared with placebo was
moderate but very variable, and considerable heterogeneity in the included trials was noted.
Acupressure
Acupressure is a technique derived from acupuncture, where physical pressure is applied to
acupuncture points.
Acupressure performed during prehospital transport using ‘true points’ led to better pain
relief than acupressure using ‘sham points’ (Kober et al, 2002 Level II; Barker et al, 2006 Level II;
Lang et al, 2007 Level II) or no acupressure (Kober et al, 2002 Level II).

Key messages
1. Acupuncture reduces postoperative pain as well as opioid‐related adverse effects (N)
(Level I).
2. Acupuncture may be effective in some other acute pain settings (U) (Level I).
Acute pain management: scientific evidence 227