Comparison of diadynamic current, interferential current and transcutaneous electrical nerve stimulation therapies in patients with chronic low back pain

IntroductionLow back pain (LBP) is defined as muscle spasms and pain in the region between the lower border of the 12th rib and the lower gluteal fold.Chronic low back pain (CLBP) is a health problem in all age groups and creates significant financial burdens on health systems.Up to 90% of the adult population will suffer from LBP at some point in their lives (1).LBP is classified according to duration as acute, subacute, and chronic (<6 weeks, 6-12 weeks, > 12 weeks).CLBP constitutes 2% to 7% of LBP (2).While pain is self-limiting in 6 weeks or less in the majority of patients, it may last six weeks or longer in 10-40% of patients (3).Acute LBP can be triggered by physical, psychosocial, or both factors.LBP is primarily due to non-specific causes.According to a study, it was shown that approximately 4% of patients with LBP in primary health care facilities had compression fractures, 3% had spinal stenosis, 2% had visceral disease, 0.7% had tumor or metastasis, and 0.01% had an infection (1, 4).Patient education and pharmacological and non-pharmacological approaches constitute the basis of treatment.Pharmacological treatments are essential in the treatment of both acute and chronic LBP.Acetaminophen and NSAIDs are effective in the short-term control of pain.In addition, muscle relaxants, tramadol, some types of antidepressants, and antiepileptics have also been useful in treating LBP.Nonpharmacological treatment approaches aim to reduce the patient's pain and increase their functionality, and they can be combined with pharmacological treatments.These methods include exercise, heat application, back schools, manual therapy, massage, acupuncture, spinal manipulation, EMG biofeedback, back support, and cognitive behavioral therapy.Epidural steroid injections and local injections can also be used for treatment (3,5).TENS is a non-pharmacological treatment modality widely used in the management of LBP.It is a safe, non-invasive, and easy-to-use form of treatment.TENS units provide electrical stimulation to the underlying peripheral nerves through electrodes placed on the intact skin surface near the maximum source of pain.The gate control theory explains the pain relief