Transcutaneous Electrical Nerve Stimulation (TENS) for Pain Control During First Trimester Abortion

Sponsor
Stanford University (Other)
Overall Status
Completed
CT.gov ID
NCT03187002
Collaborator
(none)
109
1
2
21.4
5.1

Study Details

Study Description

Brief Summary

High-frequency, high-intensity transcutaneous electrical nerve-stimulation (TENS) is an inexpensive and non-invasive pain control approach. TENS, pulsating electrical currents that activate underlying nerves, does not have drug interactions or risk of overdose. Cochrane review of TENS for acute pain found inconclusive evidence. One previous abortion trial comparing TENS to IV sedation only looked at pain control in the recovery room. The investigators propose a randomized controlled trial comparing TENS to IV sedation (in conjunction with local anesthesia) among women presenting for first-trimester surgical abortion. Primary outcome will be perceived pain by Visual Analogue Scale (VAS) during aspiration.

Condition or Disease Intervention/Treatment Phase
  • Device: Transcutaneous electrical nerve stimulation (TENS)
  • Drug: Moderate IV Sedation
  • Other: SHAM: Transcutaneous electrical nerve stimulation (TENS)
  • Other: SHAM: Moderate IV Sedation
N/A

Study Design

Study Type:
Interventional
Actual Enrollment :
109 participants
Allocation:
Randomized
Intervention Model:
Parallel Assignment
Masking:
Triple (Participant, Investigator, Outcomes Assessor)
Primary Purpose:
Treatment
Official Title:
Transcutaneous Electrical Nerve Stimulation (TENS) for Pain Control During First Trimester Abortion: A Blinded Randomized Controlled Trial
Actual Study Start Date :
Jan 18, 2018
Actual Primary Completion Date :
Oct 31, 2019
Actual Study Completion Date :
Oct 31, 2019

Arms and Interventions

Arm Intervention/Treatment
Experimental: Transcutaneous electrical nerve stimulation (TENS)

Transcutaneous electrical nerve stimulation (TENS)

Device: Transcutaneous electrical nerve stimulation (TENS)
Transcutaneous electrical nerve-stimulation (TENS) is a nonpharmacologic means of pain control that delivers electrical currents through the skin. These pulses of electrical current reduce pain by peripheral and central mechanisms, TENS actives descending inhibitory systems in the central nervous system to reduce sensitivity to pain (hypoalgesia). Assessment of previous TENS research identifies intensity as a critical factor in efficacy-documenting high intensity as the best means of pain control, as the higher pulse allows for deeper tissue afferents to be activated. TENS has been researched in a number of settings as pain control, including cancer pain, lower back pain, labor, and a range of gynecologic procedures and disorders.

Other: SHAM: Moderate IV Sedation
Sham IV to ensure blinding

Active Comparator: Moderate IV Sedation

Fentanyl, versed

Drug: Moderate IV Sedation
IV sedation with fentanyl and versed

Other: SHAM: Transcutaneous electrical nerve stimulation (TENS)
Sham Transcutaneous electrical nerve stimulation (TENS) to ensure blinding

Outcome Measures

Primary Outcome Measures

  1. Aspiration Pain [Intraoperative, collected during procedure at the time of aspiration (up to 30 seconds)]

    Pain with aspiration, assessed by visual analogue scale (VAS, 0-100mm; 0 being "no pain" and 100 being "worst pain imaginable")

Secondary Outcome Measures

  1. Speculum Placement Pain [Intraoperative, collected during procedure (up to 30 seconds)]

    Pain with speculum placement, assessed by visual analog scale (VAS, 0-100mm; 0 being "no pain" and 100 being "worst pain imaginable")

  2. Tenaculum Placement Pain [Intraoperative, collected during procedure (up to 30 seconds)]

    Pain at time of tenaculum placement, assessed by visual analog scale (VAS, 0-100mm; 0 being "no pain" and 100 being "worst pain imaginable")

  3. Paracervical Block Pain [Intraoperative, collected during procedure (up to 30 seconds)]

    Pain with paracervical block, assessed by visual analog scale (VAS, 0-100mm; 0 being "no pain" and 100 being "worst pain imaginable")

  4. Manual Cervical Dilation Pain [Intraoperative, collected during procedure (up to 30 seconds)]

    Pain with manual cervical dilation, assessed by visual analog scale (VAS, 0-100mm; 0 being "no pain" and 100 being "worst pain imaginable")

  5. Speculum Removal Pain [Intraoperative, collected during procedure (up to 30 seconds)]

    Pain with speculum removal, assessed by visual analog scale (VAS, 0-100mm; 0 being "no pain" and 100 being "worst pain imaginable")

  6. Total Procedure Time [Intraoperative, collected during procedure (up to 20 minutes)]

    Time from speculum placement to speculum removal, measured in minutes

Eligibility Criteria

Criteria

Ages Eligible for Study:
18 Years and Older
Sexes Eligible for Study:
Female
Accepts Healthy Volunteers:
No
Inclusion criteria:
  • Presenting for surgical abortion

  • Gestational age <12 weeks

  • < 18 years of age

  • Agrees to be randomized

Exclusion criteria:
  • Allergy to study medications (lidocaine, fentanyl, midazolam)

  • 18 years of age

  • Fetal demise

  • Pre-procedure use of misoprostol

  • No means of transportation following procedure

Contacts and Locations

Locations

Site City State Country Postal Code
1 Planned Parenthood Mar Monte San Jose California United States 95126

Sponsors and Collaborators

  • Stanford University

Investigators

  • Principal Investigator: Principal Investigator, MD, Stanford University

Study Documents (Full-Text)

More Information

Publications

None provided.
Responsible Party:
Stanford University
ClinicalTrials.gov Identifier:
NCT03187002
Other Study ID Numbers:
  • IRB-41589
First Posted:
Jun 14, 2017
Last Update Posted:
Nov 2, 2020
Last Verified:
Oct 1, 2020
Studies a U.S. FDA-regulated Drug Product:
No
Studies a U.S. FDA-regulated Device Product:
Yes
Product Manufactured in and Exported from the U.S.:
Yes

Study Results

Participant Flow

Recruitment Details All recruitment occurred at the Planned Parenthood site.
Pre-assignment Detail
Arm/Group Title Transcutaneous Electrical Nerve Stimulation (TENS) Moderate IV Sedation
Arm/Group Description Transcutaneous electrical nerve stimulation (TENS) Transcutaneous electrical nerve stimulation (TENS): Transcutaneous electrical nerve-stimulation (TENS) is a nonpharmacologic means of pain control that delivers electrical currents through the skin. These pulses of electrical current reduce pain by peripheral and central mechanisms, TENS actives descending inhibitory systems in the central nervous system to reduce sensitivity to pain (hypoalgesia). Assessment of previous TENS research identifies intensity as a critical factor in efficacy-documenting high intensity as the best means of pain control, as the higher pulse allows for deeper tissue afferents to be activated. TENS has been researched in a number of settings as pain control, including cancer pain, lower back pain, labor, and a range of gynecologic procedures and disorders. SHAM: Moderate IV Sedation: Sham IV to ensure blinding Fentanyl, versed Moderate IV Sedation: IV sedation with fentanyl and versed SHAM: Transcutaneous electrical nerve stimulation (TENS): Sham Transcutaneous electrical nerve stimulation (TENS) to ensure blinding
Period Title: Overall Study
STARTED 55 54
COMPLETED 55 54
NOT COMPLETED 0 0

Baseline Characteristics

Arm/Group Title Transcutaneous Electrical Nerve Stimulation (TENS) Moderate IV Sedation Total
Arm/Group Description Transcutaneous electrical nerve stimulation (TENS) Transcutaneous electrical nerve stimulation (TENS): Transcutaneous electrical nerve-stimulation (TENS) is a nonpharmacologic means of pain control that delivers electrical currents through the skin. These pulses of electrical current reduce pain by peripheral and central mechanisms, TENS actives descending inhibitory systems in the central nervous system to reduce sensitivity to pain (hypoalgesia). Assessment of previous TENS research identifies intensity as a critical factor in efficacy-documenting high intensity as the best means of pain control, as the higher pulse allows for deeper tissue afferents to be activated. TENS has been researched in a number of settings as pain control, including cancer pain, lower back pain, labor, and a range of gynecologic procedures and disorders. SHAM: Moderate IV Sedation: Sham IV to ensure blinding Fentanyl, versed Moderate IV Sedation: IV sedation with fentanyl and versed SHAM: Transcutaneous electrical nerve stimulation (TENS): Sham Transcutaneous electrical nerve stimulation (TENS) to ensure blinding Total of all reporting groups
Overall Participants 55 54 109
Age (years) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [years]
26
(5.5)
28
(6)
27
(6)
Sex: Female, Male (Count of Participants)
Female
55
100%
54
100%
109
100%
Male
0
0%
0
0%
0
0%
Ethnicity (NIH/OMB) (Count of Participants)
Hispanic or Latino
21
38.2%
26
48.1%
47
43.1%
Not Hispanic or Latino
32
58.2%
25
46.3%
57
52.3%
Unknown or Not Reported
2
3.6%
3
5.6%
5
4.6%
Race (NIH/OMB) (Count of Participants)
American Indian or Alaska Native
0
0%
1
1.9%
1
0.9%
Asian
12
21.8%
10
18.5%
22
20.2%
Native Hawaiian or Other Pacific Islander
1
1.8%
2
3.7%
3
2.8%
Black or African American
4
7.3%
4
7.4%
8
7.3%
White
21
38.2%
17
31.5%
38
34.9%
More than one race
3
5.5%
5
9.3%
8
7.3%
Unknown or Not Reported
14
25.5%
15
27.8%
29
26.6%
Region of Enrollment (participants) [Number]
United States
55
100%
54
100%
109
100%
Gestational Age (days) [Median (Full Range) ]
Median (Full Range) [days]
53
58
55

Outcome Measures

1. Primary Outcome
Title Aspiration Pain
Description Pain with aspiration, assessed by visual analogue scale (VAS, 0-100mm; 0 being "no pain" and 100 being "worst pain imaginable")
Time Frame Intraoperative, collected during procedure at the time of aspiration (up to 30 seconds)

Outcome Measure Data

Analysis Population Description
9 participants required rescue medication (IV sedation with fentanyl and versed) during the procedure in the TENS group and were excluded from per-protocol analysis.
Arm/Group Title Transcutaneous Electrical Nerve Stimulation (TENS) Moderate IV Sedation
Arm/Group Description Transcutaneous electrical nerve stimulation (TENS) Transcutaneous electrical nerve stimulation (TENS): Transcutaneous electrical nerve-stimulation (TENS) is a nonpharmacologic means of pain control that delivers electrical currents through the skin. These pulses of electrical current reduce pain by peripheral and central mechanisms, TENS actives descending inhibitory systems in the central nervous system to reduce sensitivity to pain (hypoalgesia). Assessment of previous TENS research identifies intensity as a critical factor in efficacy-documenting high intensity as the best means of pain control, as the higher pulse allows for deeper tissue afferents to be activated. TENS has been researched in a number of settings as pain control, including cancer pain, lower back pain, labor, and a range of gynecologic procedures and disorders. SHAM: Moderate IV Sedation: Sham IV to ensure blinding Fentanyl, versed Moderate IV Sedation: IV sedation with fentanyl and versed SHAM: Transcutaneous electrical nerve stimulation (TENS): Sham Transcutaneous electrical nerve stimulation (TENS) to ensure blinding
Measure Participants 46 54
Median (Full Range) [units on a scale]
73
66
2. Secondary Outcome
Title Speculum Placement Pain
Description Pain with speculum placement, assessed by visual analog scale (VAS, 0-100mm; 0 being "no pain" and 100 being "worst pain imaginable")
Time Frame Intraoperative, collected during procedure (up to 30 seconds)

Outcome Measure Data

Analysis Population Description
9 participants required rescue medication (IV sedation with fentanyl and versed) during the procedure in the TENS group and were excluded from per-protocol analysis.
Arm/Group Title Transcutaneous Electrical Nerve Stimulation (TENS) Moderate IV Sedation
Arm/Group Description Transcutaneous electrical nerve stimulation (TENS) Transcutaneous electrical nerve stimulation (TENS): Transcutaneous electrical nerve-stimulation (TENS) is a nonpharmacologic means of pain control that delivers electrical currents through the skin. These pulses of electrical current reduce pain by peripheral and central mechanisms, TENS actives descending inhibitory systems in the central nervous system to reduce sensitivity to pain (hypoalgesia). Assessment of previous TENS research identifies intensity as a critical factor in efficacy-documenting high intensity as the best means of pain control, as the higher pulse allows for deeper tissue afferents to be activated. TENS has been researched in a number of settings as pain control, including cancer pain, lower back pain, labor, and a range of gynecologic procedures and disorders. SHAM: Moderate IV Sedation: Sham IV to ensure blinding Fentanyl, versed Moderate IV Sedation: IV sedation with fentanyl and versed SHAM: Transcutaneous electrical nerve stimulation (TENS): Sham Transcutaneous electrical nerve stimulation (TENS) to ensure blinding
Measure Participants 46 54
Median (Full Range) [units on a scale]
27
17.5
3. Secondary Outcome
Title Tenaculum Placement Pain
Description Pain at time of tenaculum placement, assessed by visual analog scale (VAS, 0-100mm; 0 being "no pain" and 100 being "worst pain imaginable")
Time Frame Intraoperative, collected during procedure (up to 30 seconds)

Outcome Measure Data

Analysis Population Description
9 participants required rescue medication (IV sedation with fentanyl and versed) during the procedure in the TENS group and were excluded from per-protocol analysis.
Arm/Group Title Transcutaneous Electrical Nerve Stimulation (TENS) Moderate IV Sedation
Arm/Group Description Transcutaneous electrical nerve stimulation (TENS) Transcutaneous electrical nerve stimulation (TENS): Transcutaneous electrical nerve-stimulation (TENS) is a nonpharmacologic means of pain control that delivers electrical currents through the skin. These pulses of electrical current reduce pain by peripheral and central mechanisms, TENS actives descending inhibitory systems in the central nervous system to reduce sensitivity to pain (hypoalgesia). Assessment of previous TENS research identifies intensity as a critical factor in efficacy-documenting high intensity as the best means of pain control, as the higher pulse allows for deeper tissue afferents to be activated. TENS has been researched in a number of settings as pain control, including cancer pain, lower back pain, labor, and a range of gynecologic procedures and disorders. SHAM: Moderate IV Sedation: Sham IV to ensure blinding Fentanyl, versed Moderate IV Sedation: IV sedation with fentanyl and versed SHAM: Transcutaneous electrical nerve stimulation (TENS): Sham Transcutaneous electrical nerve stimulation (TENS) to ensure blinding
Measure Participants 46 54
Median (Full Range) [units on a scale]
34.5
23.5
4. Secondary Outcome
Title Paracervical Block Pain
Description Pain with paracervical block, assessed by visual analog scale (VAS, 0-100mm; 0 being "no pain" and 100 being "worst pain imaginable")
Time Frame Intraoperative, collected during procedure (up to 30 seconds)

Outcome Measure Data

Analysis Population Description
9 participants required rescue medication (IV sedation with fentanyl and versed) during the procedure in the TENS group and were excluded from per-protocol analysis.
Arm/Group Title Transcutaneous Electrical Nerve Stimulation (TENS) Moderate IV Sedation
Arm/Group Description Transcutaneous electrical nerve stimulation (TENS) Transcutaneous electrical nerve stimulation (TENS): Transcutaneous electrical nerve-stimulation (TENS) is a nonpharmacologic means of pain control that delivers electrical currents through the skin. These pulses of electrical current reduce pain by peripheral and central mechanisms, TENS actives descending inhibitory systems in the central nervous system to reduce sensitivity to pain (hypoalgesia). Assessment of previous TENS research identifies intensity as a critical factor in efficacy-documenting high intensity as the best means of pain control, as the higher pulse allows for deeper tissue afferents to be activated. TENS has been researched in a number of settings as pain control, including cancer pain, lower back pain, labor, and a range of gynecologic procedures and disorders. SHAM: Moderate IV Sedation: Sham IV to ensure blinding Fentanyl, versed Moderate IV Sedation: IV sedation with fentanyl and versed SHAM: Transcutaneous electrical nerve stimulation (TENS): Sham Transcutaneous electrical nerve stimulation (TENS) to ensure blinding
Measure Participants 46 54
Median (Full Range) [units on a scale]
48.5
34.5
5. Secondary Outcome
Title Manual Cervical Dilation Pain
Description Pain with manual cervical dilation, assessed by visual analog scale (VAS, 0-100mm; 0 being "no pain" and 100 being "worst pain imaginable")
Time Frame Intraoperative, collected during procedure (up to 30 seconds)

Outcome Measure Data

Analysis Population Description
9 participants required rescue medication (IV sedation with fentanyl and versed) during the procedure in the TENS group and were excluded from per-protocol analysis.
Arm/Group Title Transcutaneous Electrical Nerve Stimulation (TENS) Moderate IV Sedation
Arm/Group Description Transcutaneous electrical nerve stimulation (TENS) Transcutaneous electrical nerve stimulation (TENS): Transcutaneous electrical nerve-stimulation (TENS) is a nonpharmacologic means of pain control that delivers electrical currents through the skin. These pulses of electrical current reduce pain by peripheral and central mechanisms, TENS actives descending inhibitory systems in the central nervous system to reduce sensitivity to pain (hypoalgesia). Assessment of previous TENS research identifies intensity as a critical factor in efficacy-documenting high intensity as the best means of pain control, as the higher pulse allows for deeper tissue afferents to be activated. TENS has been researched in a number of settings as pain control, including cancer pain, lower back pain, labor, and a range of gynecologic procedures and disorders. SHAM: Moderate IV Sedation: Sham IV to ensure blinding Fentanyl, versed Moderate IV Sedation: IV sedation with fentanyl and versed SHAM: Transcutaneous electrical nerve stimulation (TENS): Sham Transcutaneous electrical nerve stimulation (TENS) to ensure blinding
Measure Participants 46 54
Median (Full Range) [units on a scale]
67
56
6. Secondary Outcome
Title Speculum Removal Pain
Description Pain with speculum removal, assessed by visual analog scale (VAS, 0-100mm; 0 being "no pain" and 100 being "worst pain imaginable")
Time Frame Intraoperative, collected during procedure (up to 30 seconds)

Outcome Measure Data

Analysis Population Description
9 participants required rescue medication (IV sedation with fentanyl and versed) during the procedure in the TENS group and were excluded from per-protocol analysis.
Arm/Group Title Transcutaneous Electrical Nerve Stimulation (TENS) Moderate IV Sedation
Arm/Group Description Transcutaneous electrical nerve stimulation (TENS) Transcutaneous electrical nerve stimulation (TENS): Transcutaneous electrical nerve-stimulation (TENS) is a nonpharmacologic means of pain control that delivers electrical currents through the skin. These pulses of electrical current reduce pain by peripheral and central mechanisms, TENS actives descending inhibitory systems in the central nervous system to reduce sensitivity to pain (hypoalgesia). Assessment of previous TENS research identifies intensity as a critical factor in efficacy-documenting high intensity as the best means of pain control, as the higher pulse allows for deeper tissue afferents to be activated. TENS has been researched in a number of settings as pain control, including cancer pain, lower back pain, labor, and a range of gynecologic procedures and disorders. SHAM: Moderate IV Sedation: Sham IV to ensure blinding Fentanyl, versed Moderate IV Sedation: IV sedation with fentanyl and versed SHAM: Transcutaneous electrical nerve stimulation (TENS): Sham Transcutaneous electrical nerve stimulation (TENS) to ensure blinding
Measure Participants 46 54
Median (Full Range) [units on a scale]
38.5
23
7. Secondary Outcome
Title Total Procedure Time
Description Time from speculum placement to speculum removal, measured in minutes
Time Frame Intraoperative, collected during procedure (up to 20 minutes)

Outcome Measure Data

Analysis Population Description
9 participants required rescue medication (IV sedation with fentanyl and versed) during the procedure in the TENS group and were excluded from per-protocol analysis.
Arm/Group Title Transcutaneous Electrical Nerve Stimulation (TENS) Moderate IV Sedation
Arm/Group Description Transcutaneous electrical nerve stimulation (TENS) Transcutaneous electrical nerve stimulation (TENS): Transcutaneous electrical nerve-stimulation (TENS) is a nonpharmacologic means of pain control that delivers electrical currents through the skin. These pulses of electrical current reduce pain by peripheral and central mechanisms, TENS actives descending inhibitory systems in the central nervous system to reduce sensitivity to pain (hypoalgesia). Assessment of previous TENS research identifies intensity as a critical factor in efficacy-documenting high intensity as the best means of pain control, as the higher pulse allows for deeper tissue afferents to be activated. TENS has been researched in a number of settings as pain control, including cancer pain, lower back pain, labor, and a range of gynecologic procedures and disorders. SHAM: Moderate IV Sedation: Sham IV to ensure blinding Fentanyl, versed Moderate IV Sedation: IV sedation with fentanyl and versed SHAM: Transcutaneous electrical nerve stimulation (TENS): Sham Transcutaneous electrical nerve stimulation (TENS) to ensure blinding
Measure Participants 46 54
Median (Full Range) [minutes]
7
6.4

Adverse Events

Time Frame Up to 4 hours
Adverse Event Reporting Description
Arm/Group Title Transcutaneous Electrical Nerve Stimulation (TENS) Moderate IV Sedation
Arm/Group Description Transcutaneous electrical nerve stimulation (TENS) Transcutaneous electrical nerve stimulation (TENS): Transcutaneous electrical nerve-stimulation (TENS) is a nonpharmacologic means of pain control that delivers electrical currents through the skin. These pulses of electrical current reduce pain by peripheral and central mechanisms, TENS actives descending inhibitory systems in the central nervous system to reduce sensitivity to pain (hypoalgesia). Assessment of previous TENS research identifies intensity as a critical factor in efficacy-documenting high intensity as the best means of pain control, as the higher pulse allows for deeper tissue afferents to be activated. TENS has been researched in a number of settings as pain control, including cancer pain, lower back pain, labor, and a range of gynecologic procedures and disorders. SHAM: Moderate IV Sedation: Sham IV to ensure blinding Fentanyl, versed Moderate IV Sedation: IV sedation with fentanyl and versed SHAM: Transcutaneous electrical nerve stimulation (TENS): Sham Transcutaneous electrical nerve stimulation (TENS) to ensure blinding
All Cause Mortality
Transcutaneous Electrical Nerve Stimulation (TENS) Moderate IV Sedation
Affected / at Risk (%) # Events Affected / at Risk (%) # Events
Total 0/55 (0%) 0/54 (0%)
Serious Adverse Events
Transcutaneous Electrical Nerve Stimulation (TENS) Moderate IV Sedation
Affected / at Risk (%) # Events Affected / at Risk (%) # Events
Total 0/55 (0%) 0/54 (0%)
Other (Not Including Serious) Adverse Events
Transcutaneous Electrical Nerve Stimulation (TENS) Moderate IV Sedation
Affected / at Risk (%) # Events Affected / at Risk (%) # Events
Total 0/55 (0%) 0/54 (0%)

Limitations/Caveats

[Not Specified]

More Information

Certain Agreements

All Principal Investigators ARE employed by the organization sponsoring the study.

There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.

Results Point of Contact

Name/Title Research Manager
Organization Stanford University
Phone 6507211567
Email fpresearch@stanford.edu
Responsible Party:
Stanford University
ClinicalTrials.gov Identifier:
NCT03187002
Other Study ID Numbers:
  • IRB-41589
First Posted:
Jun 14, 2017
Last Update Posted:
Nov 2, 2020
Last Verified:
Oct 1, 2020