Functional Magnetic Resonance Imaging of the Effects of Low-frequency Transcutaneous Electrical Nerve Stimulation on Central Pain Modulation

Objectives: Transcutaneous electrical nerve stimulation (TENS) is an analgesic current that is used in many acute and chronic painful states. The aim of this study was to investigate central pain modulation by low-frequency TENS. Methods: Twenty patients diagnosed with subacromial impingement syndrome of the shoulder were enrolled in the study. Patients were randomized into 2 groups: low-frequency TENS and sham TENS. Painful stimuli were delivered during which functional magnetic resonance imaging scans were performed, both before and after treatment. Ten central regions of interest that were reported to have a role in pain perception were chosen and analyzed bilaterally on functional magnetic resonance images. Perceived pain intensity during painful stimuli was evaluated using visual analog scale (VAS). Results: In the low-frequency TENS group, there was a statistically significant decrease in the perceived pain intensity and pain-specific activation of the contralateral primary sensory cortex, bilateral caudal anterior cingulate cortex, and of the ipsilateral supplementary motor area. There was a statistically significant correlation between the change of VAS value and the change of activity in the contralateral thalamus, prefrontal cortex, and the ipsilateral posterior parietal cortex. In the sham TENS group, there was no significant change in VAS value and activity of regions of interest. Discussion: We suggest that a 1-session low-frequency TENS may induce analgesic effect through modulation of discriminative, affective, and motor aspects of central pain perception.