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CompletedNCT04683042Updated Oct 29, 2025

Fibromyalgia TENS in Physical Therapy Study (TIPS): an Embedded Pragmatic Clinical Trial

A Phase 3 interventional study of Transcutaneous Electrical Nerve Stimulation (TENS) with PT and PT only in Fibromyalgia, sponsored by Kathleen Sluka. Completed at 6 sites in United States. Open to participants aged 18 Years to 99 Years. Per ClinicalTrials.gov, last updated 2025-10-29.

Sponsored by Kathleen Sluka · Phase 3, Interventional, and Treatment

From the registry’s dates

  • Primary completion was Mar 2025, 1 year 6 months ago, and no results have been posted to the registry.
Phase
Phase 3
Study type
Interventional
Enrollment
459
Allocation
Randomized
Ages
18 Years to 99 Years
Sex
All
01

Study summary

The purpose of this study is to determine if addition of Transcutaneous Electrical Nerve Stimulation (TENS) to routine physical therapy improves movement-evoked pain in patients with fibromyalgia (FM).

The study will also determine if addition of TENS to routine physical therapy (PT) improves disease activity and symptoms, increases adherence to physical therapy, increases the likelihood of meeting patient specific functional goals, and reduces medication use.

Read the detailed description

This study is a pragmatic clinical trial in outpatient PT practices utilizing cluster randomization by healthcare system and facility size. Sites will be randomized to enroll all eligible and consented participants with FM to TENS with PT, or PT only (no TENS). We are identifying 25-35 clinics across 6 healthcare systems in both rural and urban settings. We will enroll 450 patients that self report a clinician diagnosis of FM. At each site, TENS (or no TENS) will be applied during each visit along with individualized PT treatment specified by the physical therapist. Participants randomized to TENS intervention sites will receive TENS units and electrodes at baseline to be applied to the cervical and lumbar regions. Participants will take the units home and bring the units back to their PT clinic visits with instructions for use at home while active and during their exercises. The physical therapist at each clinic will complete routine documentation of treatment. In addition to the primary and secondary outcomes, Electronic Health Record data variables will be collected as exploratory outcomes. Variables including adherence to treatment will be extracted from each site's Electronic Health Record. Patient-reported assessments will be obtained from the participant's at home the day of their second PT visit (Baseline) and at 30, 60 (primary outcome), 90, and 180 days following enrollment. The primary and secondary outcome assessments will be comparing TENS and no TENS groups in terms of changes from baseline to 60 days.

Participants will be identified after they are referred for PT for treatment of primary fibromyalgia (FM) or chronic pain (pain lasting more than three months). At their first (intake) physical therapy visit, they will be provided information about the study that can be accessed on paper or on-line. They will perform an electronic screening form on the first visit if interested in participating. Participants will provide e-consent after eligibility is confirmed at the initial PT visit. At the second PT visit after e-consent is signed, participants will be provided instructions on logging onto REDCap for data capture and accessing the case report forms. Participants enrolled at a TENS site will then be instructed in use of TENS and the TENS unit with electrodes will be provided. Those participants enrolled at a no TENS site will skip the instruction in use of TENS but will then receive instructions along with the TENS units at day 65. Participants will be instructed to capture all baseline assessments at home before their next PT visit before and following their first TENS treatment (or no TENS) at home (day 1). At 30, 60, 90, and 180 days following enrollment, participants will complete the same assessments at home including pain ratings at rest and with movement along with questionnaires. The primary and secondary outcome assessments will be comparing TENS and no TENS groups in terms of changes from baseline to 60 days.

02

Conditions studied

  • Fibromyalgia

Keywords

  • Transcutaneous Electrical Nerve Stimulation (TENS)
  • chronic pain
  • fibromyalgia
  • movement pain
03

In context

Fibromyalgia

1,336 studies on the registry are indexed under Fibromyalgia; 266 are open to participants now.

This study's enrollment of 459 is above the median of 60 across 1,035 interventional studies indexed under Fibromyalgia.

Browse Fibromyalgia studies →

Lead sponsor

Kathleen Sluka is the lead sponsor of 3 studies on the registry; none are open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years to 99 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  1. Age 18 until 99.
  2. Clinician diagnosis of FM
  3. Referred for land-based PT
  4. Referred for treatment for FM or chronic pain (pain lasting more than 3 months)
  5. Able to provide informed consent.
  6. Fluent in reading English
  7. Willing to use TENS

Exclusion criteria

Exclusion Criteria:

  1. Contraindications to TENS use including:

    1. Pacemaker, defibrillator, implanted neurostimulator or implanted device
    2. Epilepsy
    3. Currently pregnant or plan to become pregnant in the next 6 months
    4. Allergic reaction to patches with gel
    5. Current treatment for cancer
  2. Currently enrolled in another pain control study
  3. Use of TENS within the last 30 days
  4. Clinically unstable medical or psychiatric issues
05

Study design

Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
459 participants (actual)

Study arms

  • Active comparator
    TENS with PT

    TENS with PT group: The TENS with PT group will receive usual PT care and following enrollment, during the second PT visit, participants will receive TENS units and instruction on use of the TENS units. TENS will be applied to the upper and lower back with butterfly electrodes using the following parameters: mixed frequency (2-125Hz), strong but comfortable intensity, variable pulse duration from 100-250 microseconds. TENS to be applied when the patient is active and doing exercises at home and during PT sessions for 30 minutes at least 2 hours per day. The TENS with PT group will complete TENS use to the end of the study at 6 months.

    Device: Transcutaneous Electrical Nerve Stimulation (TENS) with PT

  • Other
    No TENS with PT

    The No TENS group will receive usual PT care until the primary endpoint timeframe of 60 days. After completion of the research homework at 60 days, TENS units will be mailed to the participants and a study team member will complete virtual TENS instruction. The no TENS group will complete TENS to the end of the study at 6 months.

    Other: PT only

Interventions

  • DeviceTranscutaneous Electrical Nerve Stimulation (TENS) with PT

    Use of TENS units along with routine PT therapy

  • OtherPT only

    Routine PT therapy only

06

What researchers measure

Primary outcomes

  1. Reduction of movement-evoked pain (0-10 Low to High scale) during the Sit and Stand Test

    Numeric rating scale of 0-10 for reduction of movement-evoked pain measured by 11-point NRS from baseline to 60 days.

    Time frame: Research Homework before PT Visit 3 (Day 1), Day 60 +/- 5 days Home

Secondary outcomes

  1. Change in the resting pain score (0 - 10 Low to High scale)

    The severity of pain will be measured on a 0 to 10 numeric rating scale where 0 is no-pain and 10 is worst pain imaginable.

    Time frame: Research Homework before PT Visit 3 (Day 1), Day 60 +/- 5 days Home

  2. Pain interference (BPI) (0-10 Low to High Scale)

    11 items measuring pain severity and interference with daily activities on a 0-10 scale.

    Time frame: Research Homework before PT Visit 3 (Day 1), Day 60 +/- 5 days Home

  3. FM Disease activity (FIQR) (0-10 Low to High Scale)

    21 items used to evaluate function, overall impact, and symptoms in patients with fibromyalgia.

    Time frame: Research Homework before PT Visit 3 (Day 1), Day 60 +/- 5 days Home

  4. Resting fatigue (NRS) (0-10 Low to High Scale)

    The severity of fatigue will be measured with a 0 to 10 scale where 0 is no fatigue and 10 is worst fatigue imaginable.

    Time frame: Research Homework before PT Visit 3 (Day 1), Day 60 +/- 5 days Home

  5. Movement-evoked fatigue (NRS) (0-10 Low to High Scale)

    Fatigue during a five times sit and stand test will be measured with a 0 to 10 numeric rating scale with 0 as no fatigue and 10 as the worst fatigue imaginable.

    Time frame: Research Homework before PT Visit 3 (Day 1), Day 60 +/- 5 days Home

  6. Multidimensional assessment of fatigue (MAF) (0-10 Low to High Scale)

    16 items measuring fatigue according to four dimensions: degree and severity, distress that it causes, timing of fatigue, and impact on various activities of daily living.

    Time frame: Research Homework before PT Visit 3 (Day 1), Day 60 +/- 5 days Home

  7. Rapid assessment of physical activity (RAPA) (0-10 Low to High Scale)

    9 items evaluating current level of physical activity.

    Time frame: Research Homework before PT Visit 3 (Day 1), Day 60 +/- 5 days Home

  8. Patient global impression of change (PGIC) (0-6 Scale)

    Evaluates overall health status as perceived by the patient in a seven-point single-item scale ranging from 'very much worse' to 'very much improved'

    Time frame: Day 60 +/- 5 days Home

07

Study locations

6 sites
  • University of Illinois at Chicago
    Chicago, Illinois 60607, United States
  • Rock Valley Physical Therapy
    Moline, Illinois 61265, United States
  • Kepros Physical Therapy and Performance
    Cedar Rapids, Iowa 52404, United States
  • Genesis Physical Therapy
    Davenport, Iowa 52807, United States
  • Big Stone Therapies (BST)
    Big Stone City, South Dakota 57216, United States
  • Advanced Physical Therapy Sport Medicine
    Appleton, Wisconsin 54913, United States
08

References and documents

Publications

  • Dailey DL, Vance CGT, Van Gorp BJ, Johnson EM, Post AA, Chimenti RL, Vance KG, Franck C, Sault J, Yarasir E, Reisinger HS, Anderson A, Anderson J, Capelle R, Crouch A, Donatelle J, Kaster D, Kepros T, Nicklies E, Rein B, Worth R, Balinski M, Lafontant DE, Slade EJ, Jiang F, Ecklund D, Neill-Hudson T, Koepp M, Costigan M, Spencer M, Archer KR, Zimmerman BM, Bayman EO, Crofford LJ, Sluka KA; Clinician Group. Transcutaneous Electrical Nerve Stimulation and Pain With Movement in People With Fibromyalgia: A Cluster Randomized Clinical Trial. JAMA Netw Open. 2026 Mar 2;9(3):e262450. doi: 10.1001/jamanetworkopen.2026.2450. PubMed 41893844 ↗
  • Post AA, Dailey DL, Bayman EO, Chimenti RL, Costigan M, Franck C, Huff T, Johnson E, Koepp M, Lafontant DE, McCabe ME, Neill-Hudson T, Vance CGT, Van Gorp B, Zimmerman BM, Ecklund D, Crofford LJ, Sluka KA. The Fibromyalgia Transcutaneous Electrical Nerve Stimulation in Physical Therapy Study Protocol: A Multisite Embedded Pragmatic Trial. Phys Ther. 2022 Nov 6;102(11):pzac116. doi: 10.1093/ptj/pzac116. PubMed 36036838 ↗

Study documents

  • Study protocol · Aug 12, 2024
  • Statistical analysis plan · May 25, 2025
  • Informed consent form · Jul 15, 2024

Documents are hosted by the registry — open the source record to download them.

Individual participant data

Plan to share: Yes — The current study is expected to generate patient-reported outcomes for individuals with fibromyalgia across a broad spectrum of domains, pain, fatigue, function, psychological factors, and quality of life. We will also collect some data from the electronic health record about number of physical therapy visits, Current Protocol Terminology (CPT) codes for treatments, and the patient-specific functional scale. In addition, we will have TENS usage data downloaded from the TENS devices that will show the number of minutes of TENS use and the number of 30 minute sessions completed. Data will be collected prior to the intervention (baseline data) and 30, 60, 90 and 180 days after enrollment.

Supporting information: Study protocol, Sap, Icf, Csr

09

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Oct 29, 2025, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT04683042
Lead sponsor
Kathleen Sluka
Responsible party
Kathleen Sluka (Kathleen A. Sluka, PhD, PT, FAPTA, University of Iowa) — Sponsor-investigator
First posted
Dec 24, 2020
Start date
Jan 22, 2021
Primary completion
Mar 11, 2025
Completion
Mar 11, 2025
Last update
Oct 29, 2025

Study contacts

Kathleen Sluka, PhD, PT
principal investigator · University of Iowa
Leslie Crofford, MD
principal investigator · Vanderbilt University
Dana Dailey, PhD, PT
study director · University of Iowa

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
Yes
View the source record on ClinicalTrials.gov ↗

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