PS18 - Transcutaneous Electrical Nerve Stimulation and Mindfulness-Based Stress Reduction for Primary Care Patients with Chronic Pain
Poster Video

Poster Presenter:
Michelle Reddin, University of Wisconsin-Oshkosh, Madison, Wisconsin
[email protected]

Additional Poster Presenters:
Paula McNiel, DNP, RN, PHNA-BC, Associate Professor, University of Wisconsin-Oshkosh College of Nursing
[email protected]










•    Increase knowledge of TENS and MBSR as therapies for chronic pain
•    Decrease provider frustration and stress with patients with chronic pain
•    Decrease the likelihood of providers prescribing opioids for chronic pain

A pre-implementation survey included validated questions adapted with author permission from the “Pain Medication in Primary Care”
questionnaire. This questionnaire was developed for the Royal National Hospital in England by Shoenfeld et al. (2017) to assess providers’ current practices, feelings, and beliefs about the treatment of chronic pain. The survey also included questions regarding the providers’ beliefs of efficacy, confidence in teaching, and comfort recommending TENS and MBSR to patients with face and content validity reviewed by the project mentor and project supervisor.
During implementation, providers were to be taught a one minute “elevator speech” on TENS and MBSR to give to non-pregnant adult patients with chronic pain. Two “healing boxes” containing a TENS unit for demonstration and trial in-clinic, a TENS handout for patients, and an MBSR handout including local MBSR resources were to be available in clinic.
On the day of pre-implementation teaching, UWFFM was unexpectedly closed due to COVID-19 and all subsequent chronic pain visits were changed to video visits. Therefore, the pre-implementation survey was taken in May 2020 by four providers, while the “elevator speech” for providers and TENS demonstration were conducted in pre-recorded videos by the author. TENS unit trials by patients in-clinic were no longer feasible.
During the two-week implementation period, when providers identified an eligible chronic pain patient, they sent an Epic dotphrase containing handouts on MBSR and TENS and the link for the TENS demonstration video to the patient’s electronic health record. The providers kept track of how many patients were provided with this material.
In June 2020, after the two-week implementation period, UWFMM providers again completed the survey. Survey data analysis was conducted in August 2020.
It is intended that after COVID restrictions are lifted, TENS units purchased will still be given to UWFMM for demonstration and trial purposes.

Three family medicine doctors and one nurse practitioner completed the pre and post survey. Only the NP had any specialty training in chronic pain or pain management. The providers were asked what percent of patients in their practice suffer from chronic pain and the replies ranged from 10 to 33 percent. The providers responded that they prescribe opioids for five to 25 percent of these chronic pain patients. During the two-week implementation period, providers sent materials on TENS and MBSR to 22 patients. A paired sample t-test was conducted to compare survey results before and after implementation. There was no paired t-test that produced statistically significant (p< .05) results. It is possible that the significance of these findings was affected by the small sample size available to this project.
A Pearson correlation coefficient was then calculated to explore the degree to which the intervention affected providers’ responses to the survey. Although none of the results were statistically significant, several questions from the survey demonstrated some effect. The table below illustrates questions which showed medium (.3 to .5 or -.0.3 to -0.5) or large (.5 to 1.0 or -0.5 to 1.0) associations.
With money left over from the project budget, one TENS unit was purchased for a patient that would otherwise have been unable to afford it.

With 22 uses over a two-week period, this project demonstrates a demand for TENS and MBSR resources in primary care. Although providers did not report stress and frustration reduction, results suggest increased knowledge of and confidence in using TENS, an evidenced-based treatment for chronic pain. In addition, these resources may have had a modest impact on prescribing practices. This approach should be investigated further for its potential to combat the current opioid crisis and align practices with CDC recommendations and Joint Commission requirements for alternative interventions for pain. Since these results were likely affected by small sample size and kurtosis, repeating this study with a larger sample size and longer implementation period would be helpful to confirm these findings.
As noted above, the original goal of allowing patients to test a TENS unit in-clinic was not able to be completed due to the COVID-19 pandemic. When providers return to conducting inperson visits for chronic pain, it would be beneficial to implement the original study design with in-clinic TENS unit instruction. As COVID-19 has precipitated a move to virtual and electronic health care, however, the electronic resources developed for the revised project should be used in conjunction with in-person TENS unit instruction.

Faculty Chair: Paula McNiel, DNP, RN, PHNA-BC
UW Health Fitchburg Family medicine providers, especially Dr. Rachel Bennett, MD, the in-clinic mentor for this project
The University of Wisconsin Oshkosh College of Nursing Center for Nursing Research
Dr. Laura Smolinski, who sponsored the project in memory of a family member who died of an opioid overdose.

Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016.
MMWR Recomm Rep 2016;65(No. RR-1):1–49. DOI:
Schoenfeld, A. J., Jiang, W., Chaudhary, M. A., Scully, R. E., Koehlmoos, T., & Haider, A. H. (2017). Sustained prescription opioid use among previously opioid-naive patients insured through TRICARE (2006-2014). JAMA surgery, 152(12), 1175-1176