Speakers
Leslie J. Crofford, MD
Wilson Family Chair in Medicine
Professor of Medicine and Pathology, Microbiology & Immunology
Vanderbilt University Medical Center
Dana Dailey, PT, PhD
Assistant Research Scientist
Physical Therapy and Rehabilitation Science
University of Iowa
Kathleen Sluka, PT, PhD, FAPTA
Professor
University of Iowa
Keywords
Fibromyalgia; Pain; Physical Therapy; Rural Population
Key Points
- Fibromyalgia (FM) is widespread pain across four quadrants of the body, exacerbated by movement. The neuropsychiatric symptoms include fatigue, cognitive effects, and syndromes like depression, headache, and abdominal pain. Clinical trial data demonstrate modest effect sizes for all drug classes.
- Transcutaneous electrical nerve stimulation (TENS) works by activating central inhibition and reducing central excitability. It has been shown to reduce movement pain safely and effectively. The FM-TIPS pragmatic trial sought to test the feasibility and effectiveness of adding TENS to standard physical therapy care.
- The study team found that applying TENS at an optimal dose is clinically effective for reduction of movement-evoked pain in a real-world setting. They concluded that TENS is a safe, inexpensive, and readily available treatment for FM. They shared several tips regarding selection, design, implementation, and maintaining a network and engagement.
Discussion Themes
While TENS was highly effective at modulating pain and fatigue, it resulted in only small, non-clinically relevant changes in physical function. It can be added to an existing FM treatment plan to help manage the pain flares often caused by exercise.
There was a 99% enrollment rate among rural participants who passed screening, which the team attributed to strong, trusted relationships between patients and their local providers in smaller communities.
Dr. Sluka noted her surprise that the PT-only group did not show significant improvement, underscoring the specific efficacy of TENS in this pragmatic setting.
Team cohesion, maintaining relationships with clinical sites, and remaining open to help and new ideas (i.e., bringing in specialists mid-study) were all essential to the study’s success.