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Article analysis:

The article is a systematic review and meta-analysis of 381 studies investigating the efficacy and safety of transcutaneous electrical nerve stimulation (TENS) for relief of pain in adults. The authors conducted a thorough search for relevant studies, using multiple databases such as Medline, Cochrane Central, Embase, etc., from inception to July 2019 and updated on 17 May 2020. The study selection criteria included randomised controlled trials comparing strong non-painful TENS at or close to the site of pain versus placebo or other treatments in adults with pain, irrespective of diagnosis.

The results showed that pain intensity was lower during or immediately after TENS compared with placebo (moderate-certainty evidence), as well as pharmacological and non-pharmacological treatments used as part of standard of care (low-certainty evidence). Adverse events were generally mild and not different to comparators; however data was limited for other outcomes including adverse events which were poorly reported.

The article is overall reliable and trustworthy due to its thorough search process for relevant studies, use of randomised controlled trials, use of Grading and Recommendations Assessment Development Evaluation criteria to judge the impact on certainty estimates, use of subgroup analyses to explore statistical heterogeneity, use of trim and fill method to explore publication bias, etc. However there are some potential biases that should be noted such as small sample sizes contributing to imprecision in magnitude estimates which led to downgrading levels of evidence; this could lead to an overestimation or underestimation in the effects observed depending on the directionality bias present in the study samples. Additionally there may be some missing points such as unexplored counterarguments or missing evidence for claims made which could affect the reliability and trustworthiness of the article if not addressed properly.