Sensory Complaints of the Upper Extremities in Multiple Sclerosis: Relative Efficacy of Nortriptyline and Transcutaneous Electrical Nerve Stimulation

Objective: The aim of this study was to evaluate the relative efficacy of nortriptyline and self-applied transcutaneous electrical nerve stimulation (TENS) in the treatment of pain and/or sensory complaints of the upper extremities in people with multiple sclerosis (MS). Methods: A randomized clinical trial conducted from September 2005 to September 2006. Fifty-nine people with clinically definite MS aged 15 to 50 years were randomly allocated to receive an 8 week treatment course of either nortriptyline (10 mg daily increment over 1 week to 50 mg) or self-applied TENS. Response to treatment was assessed at 2, 4, and 8 weeks after commencement of the intervention. Results: TENS seemed to be equivalent in efficacy to nortriptyline. A significant decrease in visual analog scale scores of pain and/or sensory complaints of the upper extremities occurred in both groups. Of the 29 people treated with TENS, the mean (SD) intensity of pain and/or sensory complaints decreased from 5.3 (1.6) at baseline to 2.8 (1.5) at 8 weeks follow-up (P < 0.001). Correspondingly in the 30 people treated with nortriptyline, the mean (SD) intensity of pain and/or sensory complaints decreased from 4.9 (1.9) to 3.3 (2.1) (P<0.001). The mean difference in visual analog scale score at 8 weeks follow-up was not significant between the 2 groups (mean difference -0.5; 95% confidence interval, - 1.5-0.5). Discussion: This study demonstrates that both nortriptyline and TENS can be effective in reducing the intensity of pain and/or sensory complaints in the upper extremities of people with MS. However given the side-effect profile of nortriptyline, TENS may have some benefits over nortriptyline. This modest reduction in the intensity of pain and/or sensory complaints Suggests that physicians should carefully weigh the risk and benefits of nortriptyline and TENS in people with MS with pain and/or sensory complaints.