TENS Helps Reduce Pain Associated With Carboxytherapy

Patients in the active TENS group reported more mild pain intensity compared with those in the placebo and control groups.

The use of transcutaneous electrical nerve stimulation (TENS) is effective in reducing the intensity of pain experienced by patients undergoing carboxytherapy for the treatment of cellulite in the gluteal region, according to the results of a 3-arm, randomized, placebo-controlled trial (ClinicalTrials.gov identifier: NCT02743403) published in the Journal of Cosmetic Dermatology.

A total of 84 women between 18 and 44 years of age with moderate cellulite in the gluteal region, as measured by the Cellulite Severity Scale, who had never before received carboxytherapy were randomly assigned in a 1:1:1 ratio to 1 of 3 treatment groups: (1) active TENS group, (2) placebo TENS group, and (3) control group. Each study group included a total of 28 participants. In the placebo TENS group, 1 patient withdrew because she was unable to bear the pain associated with carboxytherapy.

For the intervention, skin depressions with cellulite were outlined, and the gluteal area targeted to be treated was identified. The active TENS group underwent carboxytherapy with TENS, the placebo TENS group underwent carboxytherapy with placebo TENS, and the control group received carboxytherapy only. The application of placebo TENS was performed using a device that appeared identical to the device used in the active TENS group and that was designed specifically for use in this study. The placebo TENS device remained active only during the initial 30 seconds of the application.

The investigators used the visual numeric pain rating scale (0 corresponding to no pain and 10 representing the worst pain imaginable) to assess the pain intensity experienced by the participants.

According to visual numeric pain rating scale scores, the active TENS group reported significantly lower pain intensity compared with the placebo TENS (95% CI, 1.555-3.95; P <.0001) and the control (95% CI, 1.515-3.888; P <.0001) groups.

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A secondary analysis of pain intensity was conducted as well, with pain categorized as mild (0 to 3), moderate (4 to 7), or severe (8 to 10). Based on this rating, 7% of patients in the active TENS group reported mild pain intensity, whereas 81% of those in the placebo TENS group and 67% of those in the control group reported moderate pain.

The investigators concluded that additional research on the use of TENS for the amelioration of pain during certain dermatologic and aesthetic procedures, including microneedling, intense pulsed light, and laser hair removal, is warranted to evaluate the effectiveness of this treatment.


Sadala AY, Machado AFP, Liebano RE. Effects of transcutaneous electrical nerve stimulation on pain intensity during application of carboxytherapy in patients with cellulite: a randomized placebo-controlled trial [published online January 16, 2018]. J Cosmet Dermatol. doi: 10.1111/jocd.12489