Transcutaneous Electrical Nerve Stimulation (TENS)
Transcutaneous electrical nerve stimulation (TENS) is a technique using small amounts of electricity to relieve pain. This form of electrical therapy is sometimes used to treat conditions including nerve pain, migraines, arthritis, osteoporosis and some forms of back pain , shoulder pain and pelvic pain.
TENS is available in healthcare settings such as physical therapy. Patients are typically instructed in how to perform the treatment at home for acute pain or chronic pain. A small device called a TENS unit delivers electrical pulses through pads placed on the skin to the nerves below. The patient controls the current level, duration of electrical stimulation and the number of treatments, under guidance of a healthcare professional.
Scientists are not certain how TENS works. Many researchers and patients have reported it to be useful in easing pain, but, as with all forms of treatment for pain, it does not help everyone who tries it.
TENS should not be used on certain parts of the neck or without a physician's approval, especially on pregnant women or people who have medical implants such as pacemakers.
Transcutaneous electrical nerve stimulation (TENS) is a drug-free pain management technique that applies small amounts of electricity to nerve endings beneath the skin. It is sometimes used to treat a wide range of conditions, including pelvic pain, neuropathy, shoulder pain and other types of joint pain, muscle pain and post-surgical pain.
Scientists are unsure how TENS may relieve pain. One theory is that the device blocks pain impulses. Pain results from an interaction between several components of the nervous system, including the peripheral nerves, spinal cord and brain. Pain in a particular part of the body is sensed by the peripheral nerves and transported to the brain through the spinal cord. It is believed that certain signals facilitate the transmission and others inhibit it. When TENS unit is used appropriately, the stimulus it provides inhibits pain transmission to the brain. However, when the intensity of the TENS stimulation is too strong it can facilitate transmission of the pain signals and result in pain.
Other theories suggest that the electrical impulses delivered to brain during TENS treatment may increase levels of chemicals in the brain that relieve pain, such as endorphins. Still other theories suggest that electrical stimulation such as that delivered by
TENS may : -
- Inhibit overactive nerves
- Restore disturbed neuronal pathways
- Improve blood flow
- Strengthen muscles
- Numb the painful area
Research on the effectiveness of TENS is continuing. Some studies have shown no benefit, but others have found it to be a useful part of pain management. Many individuals report success with TENS, but for some it has little or no effect. In some cases, it may be used as an alternative or adjunct to the use of powerful pain medications such as opioids because TENS has few side effects and is not addictive. When TENS does help an individual, improvement may be apparent immediately or within three or four months of use, according to the National Institutes of Health.
TENS may be used in outpatient settings such as rehabilitation centers, healthcare clinics or medical offices. It is usually applied by a physician, physical therapist, chiropractor or other healthcare professional who has had special training, such as an occupational therapist.
Patients who respond to TENS in therapy can be trained to use it at home. Patients can rent or buy the device. The purchase price varies widely, but the unit usually costs several hundred dollars. If a physician has prescribed TENS, insurance may pay for the device. The only parts that need to be replaced regularly are the electrodes that attach to the skin.
A typical TENS unit is usually smaller than a cell phone and has a clip so the unit can be worn on a belt. The device consists of a power module, generally powered by a 9-volt battery and attached by wires to self-adhesive cloth or foam pads called electrodes.
The electrodes are placed on the skin to supply current to the nerves just below the surface of the skin. The wires are usually run under the patient's clothes so they are not noticeable. Controls on the power unit allow adjustments to the electrical stimulation. There are also smaller wireless devices that weigh less than half an ounce and attach directly to the electrodes.
The TENS unit can be adjusted according to : -
- Intensity (amplitude). Strength of the electrical current.
- Frequency (pulse rate). The number of waves per second. Types include continuous flow and bursts of current.
- Duration (pulse width). Given in microseconds.
Trial and error is often the best way to determine how TENS works best for an individual. The patient may experiment with various frequencies, intensities and electrode locations, within guidelines set by a physician or other healthcare provider.
The length of a session can vary widely but typically is 45 minutes. Maximum benefits seem to be related to frequent use of the TENS with the unit being turned off for about 30 minutes between sessions. TENS can not only relieve pain once it is present but can also prevent pain or reduce its severity.
Conditions treated with TENS
Transcutaneous electrical nerve stimulation (TENS) may be recommended for a wide range of pain conditions. The effectiveness of TENS may vary from person to person. It is important to note that TENS is not believed to treat the underlying cause of most types of pain.
Conditions that may respond to TENS include : -
- Pelvic pain. TENS has been used to treat several sources of pelvic pain, including interstitial cystitis (also known as painful bladder syndrome), menstrual pain (dysmenorrhea) and prostatitis. With interstitial cystitis , TENS has been most effective in helping patients who have painful sores known as Hunner's ulcers, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). TENS might reduce pelvic pain and urinary frequency by increasing circulation to the bladder, strengthening pelvic muscles or causing the release of endorphins, according to the agency.
In some cases, TENS has been used to relieve labor pains. However, this use remains controversial because of the lack of research on how the fetus is affected by the electrical impulses. In general, pregnant women should avoid using TENS unless under the strict supervision of their physician.
- Back pain. TENS may relieve the severe pain and muscle spasms that sometimes develop after a vertebral fracture caused by osteoporosis, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). It has also been used for conditions including spinal cord trauma, spinal stenosis, sciatica and herniated discs.
- Shoulder pain. TENS has been used to reduce pain associated with conditions such as frozen shoulder (adhesive capsulitis) and rotator cuff injuries.
- Post-surgical pain. Some evidence suggests that TENS may be effective in treating post-operative pain, including in open-heart surgery patients. It may also help control mild to moderate acute pain after an operation such as arthroscopy or arthroplasty.
- Tendinitis and bursitis. TENS may help patients with these and similar inflammatory conditions, such as tennis elbow.
- Arthritis. Osteoarthritis, rheumatoid arthritis and other types of this disease have been treated with TENS.
- Other forms of joint pain. TENS may, for example, benefit patients with neck pain caused by whiplash.
- Complex regional pain syndrome (CRPS). TENS sometimes relieves the chronic pain of this condition.
- Peripheral neuropathic pain. TENS may be a treatment option for neuropathy caused by diabetes or other conditions, in which nerve sensation remains intact or sufficient. It may be possible to use TENS in cases of sensory neuropathy by delivering it through an intact nerve of the peripheral nervous system. For example, TENS applied on the thigh may relieve pain in a foot that has neuropathy. TENS may also be used in this way to avoid placing electrodes over areas with skin impairments such as a diabetic foot ulcer.
Types and differences of TENS
There are many variations of transcutaneous electrical nerve stimulation (TENS) and other forms of electrical therapy.
Types of TENS include : -
- Conventional TENS. High frequency but low intensity. Relief of pain is typically prompt but short-lasting.
- Acupuncture-like TENS. Low frequency but high intensity. Patients may find it difficult to tolerate, but it is sometimes effective when conventional TENS fails.
- Pulsed (burst) TENS. High-frequency bursts of low intensity. It is unclear if pulsed TENS has an advantage over conventional TENS.
TENS is not the only type of electrical stimulation therapy used to treat pain. Variations include : -
- Percutaneous neuromodulation therapy (also known as percutaneous electrical nerve stimulation, PENS or electroacupuncture). This combination of TENS and acupuncture uses needles instead of electrodes to deliver current through the skin.
- Transcutaneous electrical joint stimulation (TEJS). Electricity is delivered through electrodes worn for hours a day in an effort to ease osteoarthritis.
Before, during and after TENS
Transcutaneous electrical nerve stimulation (TENS) is typically offered as part of a pain management program that may include physical therapy, occupational therapy, manipulation therapy, exercise therapy, cognitive behavioral therapy, medication, acupuncture or biofeedback. Patients should receive training from a physician, therapist, chiropractor or other qualified health professional before using TENS on themselves.
Patients receiving instruction in home use of TENS should be able to : -
- Express understanding of the technique and precautions
- Demonstrate how to perform the procedure
- Demonstrate how to maintain the device
Before using TENS, the site where it will be applied is chosen. Usually this is over or near the painful area, but it may be over a nerve that serves the painful area or over a trigger point or acupuncture point.
The TENS unit is turned on at the recommended settings. For some cases of pelvic pain, TENS may involve use of a device inserted through a woman's vagina or man's rectum.
During TENS, the patient may feel a sensation of muscle tingling, vibration or tapping at the site of the electrode. There should be no strong muscle contractions. However there may be discomfort or pain, depending on the method of TENS being used. However, this usually indicates that the intensity of the stimulation is too strong and should be reduced.
The first time the device is used, a physician or other healthcare provider may start the treatment using a low intensity, which will be gradually increased as the patient's tolerance to the electrical impulses increases. It may take several minutes for the appropriate level of TENS to be reached.
If used at home, the patient should follow instructions given during training on when to ease intensity or end a session.
Depending on the condition, TENS may be used multiple times during the day. The most common therapy involves 80 to 100 impulses a second for 45 minutes, three times a day, according to the American Pain Foundation. Patients can typically go about their usual routine during the treatment. A physician or healthcare professional may need to adjust the frequency, intensity or duration of a session to identify the most effective settings for a patient.
It is generally recommended that, unless the electrodes need to be placed on noticeable part of the body such as the face, they be left in placed all day, with the unit hooked to the belt or clothing. This allow for TENS to be used frequently throughout the day. The unit should not be worn while bathing, and it should not be worn at night because of the risk of becoming entangled in the electrode wires.
When the sessions are finished, the TENS unit should be kept in a safe place out of reach of children.
Potential benefits and risks of TENS
The primary potential benefit of transcutaneous electrical nerve stimulation (TENS) is pain management. Although it does not help everyone who tries it, many people report fast relief that may last hours.
Other benefits of TENS include : -
- Lack of side effects common with analgesics (painkillers) such as sedation
- A possible reduction in need for opioids or other analgesics
- Feelings of empowerment, as patients gain control over their pain
- Moderate cost
TENS is generally considered safe, but improper application can cause problems. TENS should not be used near wet areas, such as in the bath or shower.
It should be avoided or used with caution by the following populations : -
- People who have had medical implants such as pacemakers or spinal cord stimulators, unless approved by a physician.
- People with certain heart conditions. TENS may alter the heart rate of some people.
- People with epilepsy or other seizure disorders. TENS may increase the risk of seizures in some cases, such as if the electrodes were to be placed on the scalp or face.
- Women who are pregnant, unless strictly supervised by a physician. Pregnant women are especially advised not to use TENS over the abdomen or pelvic area. The effect of TENS on fetal health is unknown and has not been studied.
- Children. TENS has not been evaluated for use in children.
Additionally, TENS should not be used in the following areas of the body : -
- Over the carotid sinus. This is a large blood vessel in the neck just below the jaw. Application of TENS there could cause blood pressure to drop.
- Over the throat. Application of TENS there could cause the laryngeal muscle to spasm.
- On broken or damaged skin.
- Over the eyes or mouth.
The most common side effect associated with the use of TENS is skin irritation at the sites where the electrodes are placed. However, this is usually associated with the adhesive material on the electrodes, and switching to another type of electrode may help.
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