Abstract Details

Title Transcutaneous Electrical Nerve Stimulation (TENS) for Reducing Procedural Pain During Injection-based Headache Treatments: A Preliminary Case Series

Topic Headache

Presentation(s) P1 - Poster Session 1 (8:00 AM-9:00 AM)

Poster/Presentation
Number 15-012

Objective To assess whether transcutaneous electrical nerve stimulation (TENS), applied during injection-based procedures, reduces procedural pain compared with prior injections without TENS in patients with headache disorders.

Background Procedural pain during peripheral nerve blocks and botulinum toxin injections can limit patient adherence to repeated treatments. Current strategies, such as topical anesthetics, provide limited relief. Non-invasive neuromodulation, including TENS, activates endogenous analgesic pathways and may reduce procedural discomfort. Prior work with remote electrical stimulation suggests potential benefit for injection pain, but TENS has not been evaluated in this context.

Design/Methods Seven patients undergoing routine headache interventions (nerve blocks: n=4; botulinum toxin injections: n=3) received TENS using either HeadaTerm2 or TENS7000 devices applied to the upper arm immediately before and during injections. We used moderate, non-panful stimulation intensity. Patients reported prior procedural pain (without TENS) and current pain (with TENS) using a 0–10 Numerical Rating Scale (NRS) for average and maximum injection pain.

Results Mean prior average pain was 6.5±0.76 and maximum pain was 7.3±0.76. With TENS, mean average pain decreased to 4.7±1.25 and maximum pain to 5.6±1.35, corresponding to reductions of 1.8 and 1.7 points, respectively. Six of seven patients rated the procedure as “less painful” than previous experiences; one reported “same pain.” No adverse effects occurred.

Conclusions TENS applied during injection-based headache procedures was associated with reductions in procedural pain and high patient-reported tolerability. These preliminary findings support TENS as a non-pharmacologic adjunct to improve comfort and acceptance of repeated therapeutic injections. Controlled trials are warranted to confirm efficacy and optimize stimulation parameters.

Authors/Disclosures
Brendan Parr, DO PRESENTER	Dr. Parr has nothing to disclose.
Chai Ching Ng, MBBS, MRCP (Neurology Department, Tan Tock Seng Hospital)	The institution of Dr. Ng has received personal compensation in the range of $500-$4,999 for serving as a Consultant for AbbVie. Dr. Ng has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Abbvie and Lundbeck.
Hsiangkuo Yuan, MD, PhD (Jefferson Headache Center)	An immediate family member of Dr. Yuan has received personal compensation for serving as an employee of Merck. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Pfizer. Dr. Yuan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Pfizer. Dr. Yuan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Salvia. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cerenovous. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Regional Anesthesia and Pain Medicine. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Current Headache and Pain Reports. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for MedLink Neurology. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Cephalalgia. The institution of Dr. Yuan has received research support from NIH. The institution of Dr. Yuan has received research support from American Headache Society. The institution of Dr. Yuan has received research support from Pfizer. Dr. Yuan has received publishing royalties from a publication relating to health care. Dr. Yuan has received publishing royalties from a publication relating to health care. Dr. Yuan has received personal compensation in the range of $500-$4,999 for serving as a Grant reviewer with NIH. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving as a Invited speaker with Chinese Stroke Association.
Nicole M. Spare, DO (Jefferson Headache Center)	Dr. Spare has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for AbbVie.
Michael J. Marmura, MD, FAAN (Thomas Jefferson University)	Dr. Marmura has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Lundbeck. Dr. Marmura has received personal compensation in the range of $500-$4,999 for serving as a Consultant for AbbVie. The institution of Dr. Marmura has received research support from Teva. The institution of Dr. Marmura has received research support from AbbVie. The institution of Dr. Marmura has received research support from Axsome. The institution of Dr. Marmura has received research support from Pfizer. Dr. Marmura has received publishing royalties from a publication relating to health care. Dr. Marmura has received publishing royalties from a publication relating to health care. Dr. Marmura has received publishing royalties from a publication relating to health care.

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