Background & Aims

Chronic pain is a common symptom in endometriosis and negatively impacts physical activity, social functioning, and health-related quality of life. First-line treatments for pain relief are oral contraceptives and nonsteroidal anti-inflammatory drugs, but many patients also receive opioids, incurring serious side effects. Transcutaneous electrical nerve stimulation (TENS) is a self-administered method used in the treatment of acute and chronic pain. Swedish national guidelines recommend TENS and physical activity (PA) as complementary treatment strategies for endometriosis-related pain. However, some patients report challenges engaging in PA due to pain and energy deficiency. There is a lack of knowledge of whether TENS can be used as an effective tool to increase PA in daily life. This study aims to explore enablers and barriers to using TENS for endometriosis-related pain and patients’ experiences of TENS including the treatment effects on PA.

Methods

Nineteen individuals, who participated in a larger, ongoing randomized controlled trial (RCT), assessing TENS for endometriosis-related pain, were consecutively invited to participate in the present focus group interview study. The eligibility criteria for the current study were individuals aged 18 years or older, endometriosis verified by laparoscopy or ultrasound, endometriosis-related chronic pain, and completing the RCT intervention, including TENS demonstration and education, followed by daily use of TENS for 16 weeks. Fifteen participants accepted the invitation and to date 10 participants have been interviewed. Four semi-structured, focus group interviews were recorded between September 2022 – January 2024 (duration 52 min – 80 min; participants in each group n=2, n=2, n=3, n=3). The interviews were transcribed and analysed using qualitative content analysis. Data collection is ongoing, and two more interviews are planned for Spring 2024.

Results

Our preliminary analysis showed that participants consider the regular use of TENS as an effective method to relieve everyday pain and facilitate daily PA by improving their ability to perform daily routines, such as taking care of the household and children, going shopping, and exercising. Participants described having increased control over their own pain management and a greater sense of security. These factors enhanced flexibility in planning and the ability to engage in social activities, resulting in a greater sense of well-being. Participants also felt satisfaction in everyday living due to the reduced need for analgesics. However, during periods of high and intense pain, i.e., acute pain flare-ups, TENS treatment was perceived as insufficient. Factors promoting the use of TENS were education and thorough demonstration of the TENS device. Factors hindering the use of TENS was the length of the wires, which were perceived as too long.

Conclusions

Patients with endometriosis-related pain experienced satisfying pain relief from TENS treatment, leading to increased PA and improved everyday functioning and well-being. TENS is self-administered and, with sufficient patient education, can lead to greater confidence and enhanced control of pain management. Our preliminary findings are encouraging, but more data and additional studies are needed to explore patients´ experiences with TENS treatment and its effectiveness in terms of increasing PA in individuals with endometriosis-related pain.

References

1.Nnoaham KE, Hummelshoj L, Webster P, d’Hooghe T, Nardone FD, Nardone CD, et al. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril. 2011;96(2):366-U431.
2.Missmer SA, Tu FF, Agarwal SK, Chapron C, Soliman AM, Chiuve S, et al. Impact of Endometriosis on Life-Course Potential: A Narrative Review. Int J Gen Med. 2021;14:9-25.
3.Soliman AM, Surrey E, Bonafede M, Nelson JK, Castelli-Haley J. Real-World Evaluation of Direct and Indirect Economic Burden Among Endometriosis Patients in the United States. Adv Ther. 2018;35(3):408-23.
4.Brown J, Crawford TJ, Allen C, Hopewell S, Prentice A. Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis. Cochrane Database Syst Rev. 2017;1(1):Cd004753.
5.Becker CM, Gattrell WT, Gude K, Singh SS. Reevaluating response and failure of medical treatment of endometriosis: a systematic review. Fertil Steril. 2017;108(1):125-36.
6.Rush G, Misajon R. Examining subjective wellbeing and health-related quality of life in women with endometriosis. Health Care Women Int. 2018;39(3):303-21.
7.Johnson MI, Paley CA, Jones G, Mulvey MR, Wittkopf PG. Efficacy and safety of transcutaneous electrical nerve stimulation (TENS) for acute and chronic pain in adults: a systematic review and meta-analysis of 381 studies (the meta-TENS study). BMJ Open. 2022;12(2):e051073.
8.Socialstyrelsen. Nationella riktlinjer för vård vid endometrios 2018 [National Guidelines for Endometriosis Care 2018]. [2023-03-04]. Available from: https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/nationella-riktlinjer/2018-12-27.pdf.

Presenting Author

Josefin Larsson

Poster Authors

Josefin Larsson

RN

Sahlgrenska Universitetssjukhuset

Lead Author

Birgit Heckemann RN PhD. Associate professor

Institute of Health and Care Sciences, University of Gothenburg

Lead Author

Emma Varkey

Sahlgrenska Universitetsjukhuset/Östra

Lead Author

Axel Wolf

Institute of Health and Care Sciences, University of Gothenburg

Lead Author

Cecilia Ögren CRNA

PhD student

Institute of Clinical Sciences

Lead Author

Karin Sundfeldt MD PhD

Professor

Institute of Clinical Sciences, Gothenburg University

Lead Author

Jenny Vennberg Karlsson RMW

Department of Gynecology, Northern Älvsborg County Hospital

Lead Author

Paulin Andréll

Sahlgrenska University Hospital

Lead Author

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Abdominal and Pelvic Pain