Acupuncture-like transcutaneous electrical nerve stimulation (AL-TENS) in the management of pain

Conventional transcutaneous electrical nerve stimulation (TENS) is a simple, non-invasive analgesic technique which is delivered using high frequency (10–250 Hz) currents to produce a 'strong but comfortable' paraesthesia within the site of pain. Acupuncture-like TENS (AL-TENS) is a variant of conventional TENS and is defined in this article as the induction of forceful but non-painful phasic muscle contractions using low frequency (1–10 Hz) electrical currents. The purpose of this paper is to discuss the analgesic effects and clinical effectiveness of AL-TENS. There is insufficient evidence to support or refute claims that there are differences in the analgesic profiles of conventional TENS and AL-TENS. Despite a large literature on TENS, it is not possible to perform an objective review of the clinical effectiveness of AL-TENS due to inconsistency in the method of application and insufficient detail on TENS treatment interventions in written reports. The use of banner terms, such as AL-TENS, to describe electrotherapeutic treatment modalities is seriously questioned.