Transcutaneous Electrical Nerve Stimulation Improves Constipation Symptoms And Quality Of Lifein Patients With Slow Transit Constipation

BACKGROUND:Slow transit constipation (STC) is the most common of functional constipation and it causes intractable symptoms, not responsive to medical treatment. Transcutaneous Electrical Nerve stimulation(TENS) is a novel treatment of slow transit constipation (STC). The effect and mechanism of TENS have remained elusive.OBJECTIVE:To assessed whether TENS is efficacious in treating patient with slow transit constipation in a randomized controlled trial.METHODS: Thirty five patient(4male/31female; mean age,34years; range,18-49years) with STC diagnosed by Rome â…¢ were randomized to receive either true or sham TENS for a2-week period. After a2-week break, they all received2-week real therapy. True TENS was performed at ST36(Zusanli), and sham TENS at non-acupoint for30min twice daily. The parameters of stimulation were trains of short pulses with a train frequency of12cycles/min and duration of2s, a pulse frequency of25Hz and amplitude of2mA to10mA adjustable. Each treatment period the patients were asked to finish constipation symptom diary and Questionnaires, after cessation of each treatment period Colon Transit Time (CTT) were also tested.RESULTS:Thirty patients complete at least one period of therapy,15patients each group.17patients complete the second2-week period therapy,10in TENS group and7in sham group.(1)After the first2-week period therapy there was a significant increase in total episodes of spontaneous bowel movements and spontaneous, complete bowel movements per week in treatment group (p=0.001, p=0.002), the PAC-SYM scores also showed significant improvement (p<0.001), however there was no significant difference in control group (p=0.083,p=0.958,p=0.17).(2)Colonic transit time was significantly decreased in treatment group when compared to their pretreatment (p=0.001),the rate of barium strips discharge in48and72hour was also improved (p=0.003,p<0.001).By contrast, those patients who received sham therapy had no significant change (p=0.713,0.524,0.727).(3) The scores of PAC-QOL and SDS of TENS group were significantly lower than those before treatment (p=0.001,p=0.011). Before and after the sham treatment in the control group the score of SDS has improved (p=0.011), however, there were no significant differences in PAC-QOL scores (p=0.243).(4)After a2-week wash-out period the spontaneous bowelmovementper week, Colonic transit time, the rate of barium strips discharge in48and72hour, the scores of PAC-SYM and PAC-QOL were still improved than those before treatment in the TENS group (p=0.033,p=0.001,p=0.003, p<0.001,p=0.004,p=0.02).(5)The rate of barium strips discharge in72hour, the scores of SDS and PAC-QOL were significantly improved as compared with wash-out period of the control group in the second real-therapy period(p=0.02, p=0.029, p=0.012). There were no significant adverse effects of treatment.CONCLUSION:TENS therapy at ST-36is a capable therapy with stable and long-term curative effect for patients with STC that improves their constipation symptoms and self-perceived quality of life.