August 2025 Pick of the Month

Real Change is Rare

In this month's POTM, we examine the treatment of one of the most common complaints seen in emergency care: lower back pain. It has been said that if you have a back, you will have pain in it at some point in your life. Indeed, more than half of Americans seek medical assistance for back pain at some point in their life. Most get better with time, but many suffer weeks of disability. That context highlights the importance of the work by Otterness and colleagues, "Use of TENS for the treatment of back pain in the emergency department: a randomized controlled trial." The investigators conducted a randomized, controlled trial in which they used sham transcutaneous electrical nerve stimulation (TENS) or real TENS and measured pain perception at 30 minutes. This time frame is relevant to real emergency medicine. Please read the article to see the exact data, but I will summarize the key points here: the improvement in pain reduction with the active comparator was sufficient for me as a practicing emergency clinician to conclude that if I could have a nurse or technician place a TENS, I would do it every time for willing patients with low back pain. These data suggest that TENS beats narcotics, methocarbamol, lidocaine patches, and other non-evidence-based ways we treat back pain. I believe this work marks the beginning of a change in practice for a common malady in emergency care.

Jeffrey A. Kline, MD
Wayne State University School of Medicine
Editor-in-Chief