A Guide To TENS
INTRODUCTION:
Whenever any new treatment is used, the doctor and the patient are usually apprehensive. Also, even after several interviews between doctor and patient, they will probably have forgotten some important facts and will need answers to many questions. Since Tanscutaneous Electrical Nerve Stimulation presents an entirely new aspect of treatment of pain, we believe, that they both should know in advance the answers to a number of questions. The patient will then be able to derive the greatest amount of benefit from the course of treatment. T.E.N.S. has been used as treatment on thousands of patients with extensive success.
1. WHAT IS T.E.N.S.?
In the treatment known as T.E.N.S., Tanscutaneous Electrical Nerve Stimulation, a weak electric current is passed across the patient's skin into the nerve fibers that lie just beneath the skin. The source of electricity is usually a 9-volt battery or a rechargeable nickel-cadmium cell. The parts of the equipment that are placed in contact with the skin are two pads called electrodes, through which the electric charge, may be transmitted to the skin. A substance that will conduct electricity must be placed between the skin and each electrode. This substance either is installed in the electrode or is in the form of a gel, which is applied to the electrode as a coating. The arrangement is somewhat similar to that used in acupuncture, except that in acupuncture a steel needle is inserted through the skin to carry the electric current. Sometimes the electrodes for a T.E.N.S. unit are placed over acupuncture points to increase the effectiveness of the electric stimulation.
2. HOW RECENT IS THE USE OF ELECTRICITY TO CONTROL PAIN?
In the year 54 A.D. the Romans had used electric eel for the treatment of headaches and arthritis. Moreover, there is evidence that, even earlier, the Egyptians used torpedo fish to produce an electric charge to ease pain. For several centuries electricity that was generated by animals was used in many places throughout the world. Such treatment then lapsed into disuse for a long time. Electric stimulation regained popularity in modern times when electricity became readily available. About one hundred years ago, the use of electricity was very much a method for treating nearly every kind of complaint. In the 1920's and 1930's, the subject of electric stimulation then came under the scrutiny of the FDA because of unfounded claims of benefits to be derived from electrical therapy, its use was stopped. As a result of the recent development of microelectronics, T.E.N.S. has become an established and legitimate form of treatment for the relief of pain. It should be reassuring to both doctors and patients to know that T.E.N.S. is now a thoroughly documented type of treatment. And one of the most commonly used devices in the physiotherapy departments of hospitals. Furthermore, most private insurance companies will cover the rental or purchase of a T.E.N.S device.
3. HOW DOES T.E.N.S. RELIEVE PAIN?
Two possible ways to explain the effectiveness of T.E.N.S. in the relief of pain seem to be the Gate Theory and the Theory that T.E.N.S. increases the liberation of a pain killing substance (Endorphin) that exists in the blood and spinal fluid. According to the Gate Theory, there is a gate between the source of the pain and the area of the brain that perceives the pain. Normal non-sensations pass through this gate from the area of the source of pain. As a result of the treatment with the T.E.N.S. unit, the strength of these sensations can be increased enough to squeeze out the pain impulses and permit the gate to block them. According to the other theory, the increase in the liberation of Endorphin by T.E.N.S. acts to block the transmission of impulses to the brain. The natural analgesics (or pain reliever), which are produced in the blood and the spinal fluid, can be purchased for research purposes. However, the drug industry is now spending large sums of money to discover similar synthetic analgesics. To quote the following statement by Lars Termius, who carried on a great deal of basic work with T.E.N.S.: “The body has a natural pain fighting mechanism that only needs activating. There are a number of techniques for such causing activation, and I believe that one of the most important is T.E.N.S.”
4. CAN T.E.N.S. BE USED FOR ALL KINDS OF PAIN?
Based on world literature, there is little doubt that T.E.N.S. will block out many forms of pain. Such as that caused by childbirth, surgery, trauma, organic lesions and arthritis. It is important to realize that pain as such may be a very useful warning to indicate that something is wrong. To block out such pain would be ignoring that warning and could be harmful. Yet some types of pain serve no useful purpose. Among these are the chronic pain syndromes (the cause of which either cannot be removed or is not known) and the pains that result in unnecessary limitation of the movement or function of a particular part of the body. The blockage of such useless pain by T.E.N.S. is very helpful.
5. CAN T.E.N.S. BECOME ADDICTIVE?
When a patient has chronic pain that cannot be treated directly, he or she may have to take pain pills for relief. A method in which there is a real hazard of addiction to the medication, requiring increasing dosages to achieve an effect. There are as well, possible undesirable side effects. We are specifically interested in the use of T.E.N.S. that activates the body's natural pain-fighting mechanisms. There has been no evidence to show that T.E.N.S. is addictive.
6. WHAT DANGERS MAY EXIST WITH T.E.N.S.?
When reasonable precautions are taken, treatment with a T.E.N.S. machine should be safe. The source of electricity for a T.E.N.S. unit is usually a 9-volt battery, similar to one used in a transistor radio or a small rechargeable cell. With no danger of a serious shock, the only inconvenience that may occur is the possibility of a minor irritation of the skin, from the gel used with the electrodes. Using a different brand of gel or using electrodes that are activated by water or other materials can prevent this irritation quite easily.
THE FOLLOWING PRECAUTIONS SHOULD BE TAKEN:
· A T.E.N.S. machine should never by used by a person who wears a heart pacemaker.
· An electrode should not be placed over the front of the neck. Because the current may then stimulate one of the receptors that controls blood pressure and thus produce a harmful change in conditions, or the continuous stimulation may produce a spasm of the vocal cords.
· An electrode should never be placed over the heart.
· Special care in the use of T.E.N.S. should be taken when the patient has coronary artery disease.
· An electrode should never be placed close to an eye.
· When a T.E.N.S. machine is used while the patient is driving a car or operating a machine, it is possible that the movement of an electrode can increase the intensity of the stimulation and produce a sudden reaction.
· The stimulator and the electrodes should be kept dry. This would prevent damage to the T.E.N.S. device and prevent the spread of the electric current over a larger area of the skin than prescribed. In case the pressure produced on the skin by electrodes changes, the patient should be conscious in order to be aware of such a change.
7. WHAT ARE THE BEST POSITIONS OF THE ELECTRODES?
The best position of the electrodes depends on the location of the pain and on the following of instructions given by the patient's personal physician or therapist. The experience of our clinics has shown that the best results are obtained, when it is possible to place the electrodes over the actual site of the pain or the nearest point.
8. HOW LONG SHOULD A T.E.N.S. TREATMENT LAST?
Based on the results of our own experience during the last few years, we have become increasingly convinced that the reason for failure of the T.E.N.S. treatment, in clinical treatments, is an insufficient period of stimulation time. Within clinics and hospitals, the treatment periods usually last between 20 and 30 minutes, due to heavy patient loads. Also, the patient remains in the same position during the entire period. We believe that many pains, which persist after such a short period of treatment, would respond better to a much longer treatment, such as several hours of stimulation. Many patients with constant pain will wear a T.E.N.S. stimulator for periods of time in excess of eight to ten hours, allowing relief for many pains that would otherwise have persisted.
8. HOW LONG SHOULD A T.E.N.S. TREATMENT LAST? (Continued)
The required movement or lack of movement of the patient while performing a certain kind of work or exercise can cause pain. For example, continual bending often causes a backache. Also, pains can be caused by the way a person holds his body or the type of effort he expends in his activity. When a pain is related to work or play, it has been found by experience that T.E.N.S. treatment while the patient remained stationary was not as effective as similar treatment applied while the patient was actively working or playing. In the case of using T.E.N.S. while sleeping, unless the stimulator is equipped with a timer device to automatically turn the machine off after an hour or less, it is not recommended.
9. CAN T.E.N.S. CURE A PAIN OR MAKE IT WORSE?
It is very difficult to determine in advance what effect a T.E.N.S. treatment will have on pain. There are many different kinds of pain, and all patients do not react to a certain treatment for a certain type of pain in the same way. However, it could be safe to say that T.E.N.S. hardly ever makes a pain worse. The results with our patients can be summarized briefly as follows:
Some patients obtained partial relief after two or three treatments; other patients had complete relief after three or four weeks and suffered recurrence of the pain between one year to two years later. And still other patients could experience relief only while the machine was being used. A patient in the last group would need his or her own machine to obtain continuous relief. We believe that the most common result was as follows:
The patient reached complete relief after treatment of between two and three weeks; and about 30 percent of those patients suffered a recurrence of the pain some years later that did require further treatment. Also, it was noticed that the recurring pain usually responded to treatment quicker than did the initial pain.
10. CAN T.E.N.S. BE USED FOR OTHER PURPOSES?
Although the principal reason for using T.E.N.S. is to treat chronic pain, T.E.N.S. has been used in different places around the world to relieve many of types of pain. Since T.E.N.S. blocks out acute pain, and chronic pain, this treatment has been used for sports related injuries and to ease the pain after surgery. Pain that results from a sport related injury only prevents the athlete from being able to train and perform to the best of his ability. Physiotherapists to relieve the pain and muscle spasms, adding to the restoring of mobility to a joint or strengthening of a muscle, have used T.E.N.S. However, the therapist must be certain that the treatment will not block out useful pain that prevents the patient from causing more harm to themselves after an injury.
In some rare cases, the application of T.E.N.S. near the hairline at the back of the neck maybe very effective in relieving tension or a headache induced through tension. Also, there is evidence that T.E.N.S. and Electro-acupuncture reduce small amounts of cortisone in the body, and that such treatment may have an effect on patients suffering from certain forms of arthritis.
11. WHY ARE CERTAIN CONTROLS USED ON A T.E.N.S. UNIT?
Nearly every T.E.N.S. unit is equipped with a device for controlling the strength of electric current in order that the stimulation may be adjusted. The current should be great enough to make the treatment effective but not painful. Most units also have a device for controlling the frequency. An ideal range should be from zero to about 150 cycles per second, there is evidence that pain responds best when the frequency is less than 5 cycles per second. Other pain should be treated at higher than 140 cycles per second. The more expensive machines have a device for varying the width of the cycle, we do not consider that width is important. A number of machines have a polarity switch in order for the operator of the machine to reserve the direction of the flow of the current. Such a switch is useful when treatment for several hours is required. Because, changing the direction of the current prevents the build up of body fluids.
12. WHY ARE CERTAIN CONTROLS USED ON A T.E.N.S. UNIT?
An attachment, which is useful but not essential, is one that makes it possible to change the pattern of the stimulation from a sequence of regularity to one of irregularity. When a machine without such an attachment is used continuously for a relatively long period of time, the patient's body adapts itself to the regular stimulation, reducing the affectivity of the treatment. The irregular pattern of stimulation then prevents such adaptation by the patient’s body.
Other features that may be found on a T.E.N.S. unit will include a light to indicate that the unit is on, this light may flicker with the frequency of the current. Other machines will have a light or other indictor to show when the batteries are weak. While others still, may have a meter or light to indicate the strength of the current being used.
13. CAN MEDICINE BE TAKEN WHILE T.E.N.S. IS BEING USED?
There is no reason for a patient to stop taking medication or change medication while they are using T.E.N.S. This combination of treatments does not have harmful effects on the patient. One purpose of T.E.N.S. is to permit the doctor to reduce the amount of analgesic medication that is needed, eventually making the use of such medication unnecessary. It seems logical yet reasonable to presume that activating the patient's own production of analgesic should reduce the required amount of intake from outside sources. A T.E.N.S. treatment may use a sedating antidepressant that makes it easier to get a good night's sleep, this type of medication may even increase the effectiveness of a treatment. This is not addictive and has helped to relieve depression that is associated with most cases of chronic pain syndrome. The patient should discuss the use of an antidepressant with their personal physician. Also a number of pain clinics make extensive use of detoxification and weaning procedures.
14. IS T.E.N.S. TREATMENT PAINFUL?
While a patient is using a T.E.N.S. unit, they will usually feel a tingling or prickling sensation under the electrodes, which should be free of any pain. If the intensity of the stimulation is increased the patient may feel a twitching or contraction. Sometimes, when there is pain around the joints, the intensity of the stimulation may produce increased muscular contraction, which is beneficial. Such an increase should not produce pain. A patient must be able to wear a T.E.N.S. unit for many hours without discomfort. If they suffer pain during the treatment they should consult their personal physician.
15. WHAT KIND OF CARE DOES A T.E.N.S. UNIT REQUIRE?
The parts of a T.E.N.S. unit that receives the hardest wear are the electrodes. Therefore, the patient should follow closely the instructions furnished by the manufacturer of the unit in regard to the care of the electrodes. A common cause of the reduction of effectiveness of a T.E.N.S. treatment is a build-up of the skin’s oils in the electrodes. The greatest resistance to stimulation occurs around the electrodes, this resistance is reduced to a minimum by keeping the electrodes clean.
16. IS T.E.N.S. READILY AVAILABLE?
The battle against chronic pain must often be waged 24 hours a day. Before a T.E.N.S. treatment the only relief that could be obtained quickly and easily was that afforded by pain pills. It was seldom possible to get an injection or other suitable treatment on short notice. Patients of a T.E.N.S. treatment feel that it gives them a weapon against pain which is available 24 hours a day at the touch of a switch, without side effects, addiction, or increasing tolerance. Most T.E.N.S. units can even be worn while the patient is working or traveling. However, special care must be taken under such circumstances, as mentioned previously.
17. WHAT ARE POSSIBLE FUTURE USES OF T.E.N.S.?
In the last few years’ great strides have been made in the use of electric and magnetic forces. The most widespread practice of this kind at present is the use of electromagnetic forces to heal fractures in bones, when prolonged conventional treatment has failed to produce satisfactory results. The result is knowledge pertaining to the effects of electromagnetic forces on the cellular structure of the bones and tissues. This is opening an entirely new field of research that could possibly lead to rejuvenation of tissues in the human body by electrical impulses.
