179: Reducing Movement-Evoked Pain to Enable Exercise: TENS During Exercise for Musculoskeletal Pain

Topic: Clinical Science
Subtopic: Non-specific to any diagnosis, Non-pharmacological treatments, Physiotherapy (e.g. exercise, rehab), Treatment/management

Background and Aims: Many people experience musculoskeletal (MSK) pain that impedes movement, although exercise is a cornerstone of MSK pain management (1). Movement-evoked pain can limit participation, reduce adherence, and hinder active rehabilitation (2). Transcutaneous electrical nerve stimulation (TENS) is an easy-to-use, safe, non-invasive technique that provides analgesia and may reduce movement-evoked pain, making exercise easier when applied concurrently (3). This quadruple-blind pilot randomized controlled trial aims to assess the feasibility and acceptability of a 3-week exercise program delivered with active versus sham TENS, and to explore preliminary effects on IMMPACT-recommended pain domains (4) and complementary outcomes (e.g., kinesiophobia, compensatory movement strategies).

Methods: Twenty-four adults with musculoskeletal (MSK) pain are enrolled in a quadruple-blind pilot randomized controlled trial. Participants are randomized to active high-frequency or sham TENS applied during an individualized 3-week exercise program completed across home and clinic sessions (seven 30-min sessions/week). Feasibility outcomes include recruitment, retention, adherence, and adverse events. Acceptability is evaluated using ratings of ease of use, perceived usefulness, perceived safety, and satisfaction. Preliminary outcomes cover multiple IMMPACT-recommended pain domains assessed pre/post intervention, and pain intensity is also recorded pre/post exercise. Complementary outcomes include kinesiophobia and biomechanical analysis of compensatory movement strategies during functional tasks.

Results: Eighteen participants have completed the protocol to date. The intervention appears safe and well tolerated, with no adverse events reported. Acceptability ratings indicate that using TENS during exercise is feasible in practice and generally perceived as useful. Recruitment has been slower than anticipated, largely because some potential participants were unable to commit to a daily program over 3 weeks. Among completers, 2/18 did not complete all study procedures and 2/18 missed at least one session, most often during home-based sessions. Data collection is ongoing, and final analyses will be reported at the conference.

Conclusions: These interim findings suggest that delivering TENS concurrently with exercise is safe, acceptable, and feasible, while highlighting adherence as a key implementation challenge, particularly for home-based sessions. Final results will clarify preliminary signals across IMMPACT-aligned pain domains and movement-evoked pain. If this approach reduces pain during movement and makes exercise easier to perform, it could address key barriers to rehabilitation, including fear of movement and poor adherence. This may support sustained engagement in physical activity, ultimately leading to reduced pain and improved function in people with MSK pain. This pilot study will inform the design of a larger efficacy trial

References: (1) Lin I, Wiles L, Waller R, et al. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med. 2020;54(2):79-86. doi:10.1136/bjsports-2018-099878
(2) Gilanyi YL, Shah B, Cashin AG, et al. Barriers and enablers to exercise adherence in people with nonspecific chronic low back pain: a systematic review of qualitative evidence. Pain. 2024;165(10):2200-2214. doi:10.1097/j.pain.0000000000003234
(3) Dailey DL, Vance CGT, Rakel BA, et al. Transcutaneous Electrical Nerve Stimulation Reduces Movement-Evoked Pain and Fatigue: A Randomized, Controlled Trial. Arthritis Rheumatol. 2020;72(5):824-836. doi:10.1002/art.41170
(4) Dworkin RH, Turk DC, Farrar JT, et al. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain. 2005;113(1-2):9-19. doi:10.1016/j.pain.2004.09.012

Presenting Author: Adrien Nourry
Submitting Author: Adrien Nourry

Senior Author: Guillaume Léonard

IASP 2026 Global Year theme of Neuropathic Pain: No

• Adrien Nourry - Faculty of Medicine and Health Sciences, Sherbrooke QC, Canada
• Megan Casoli - School of Rehabilitation, Sherbrooke QC, Canada
• Thierry Lelard: phD - UFR STAPS, Amiens, France
• Guillaume Léonard: phD - School of Rehabilitation, Sherbrooke QC, Canada