N Engl J Med 2023;389:158-64.
DOI: 10.1056/NEJMra2110098

Chronic pain, defined as pain that persists for more than 3 months, is a major global health problem and affects as many as 100 million adults in the United States alone. Besides the suffering, chronic pain costs the nation up to $894 billion each year in medical treatment and lost productivity.1 Many common pharmacologic pain treatments do not always man- age chronic pain effectively (especially neuropathic pain, which is caused by a lesion or disease of the somatosensory nervous system),2 and their use may increase the risk of drug-related adverse outcomes such as addiction (e.g., opioid addiction) and polypharmacy.

Contemporary clinical guidelines recommend nonpharmacologic therapies.3 One such approach is electroanalgesia, which has been used since Greco-Roman times, when Pliny, Aristotle, and Plutarch recommended that patients with chron- ic pain stand in a pool of water containing electric rays in order to receive analge- sia from electrical currents.4 Today, common forms of cutaneous electroanalgesia include transcutaneous electrical nerve stimulation (TENS) and scrambler therapy. This focused review provides an overview of the physiological effects of each ap- proach; details the technology and safety of these two forms of cutaneous electro- analgesia; reviews clinical results of randomized trials evaluating electroanalgesia for pain related to cancer, pain due to other diseases, and neuropathic pain; and discusses limitations of the data.

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