Pain Management and Pain Relief Information

Transcutaneous Electrical Nerve Stimulation, or TENS, is used for such pain conditions as post-surgical, visceral, neurological, sympathetically mediated, arthritic, myofacial and low back. It is also used to treat bladder incontinence. It is one of the most commonly used types of electro analgesia. Neuromodulation is produced by restoration of afferent input, direct inhibition of abnormally excited nerves, endogenous pain control and presynaptic inhibition in the dorsal horn of the spinal cord.

The unit includes one or more electrical signal generators, electrodes and a battery. It is programmable and small and can deliver stimuli with changeable current, pulse widths and pulse rates. Biphasic is the favorite waveform. Patients are advised to experiment with intensities and frequencies to find the best setting to provide pain control. Electrodes are placed over the area of pain and other points such as acupuncture sites, trigger points and cutaneous nerves.

There are three standard setting options used that include conventional, acupuncture-like and pulsed.

• With the conventional setting it uses a high frequency and low setting of intensity. The duration of the pulse is short. Pain relief is effective while the device is on but pain returns when it is off. Patients will leave the electrodes on all day and turn them on in 30 minute intervals. In some patients the effects can last beyond the stimulus intervals.

• The acupuncture-like setting delivers a low frequency high intensity stimulus. It can be uncomfortable and some patients cannot tolerate it, it is used when the conventional method does not work.

• Pulsed uses low intensity firing in high frequency bursts.

The comfort of the patient is very important in determining the efficacy of the treatment. The higher pulse widths are more painful and the higher intensity impulse is as well. Electroconductive gel is applied on skin under the electrodes to minimize any blockage of the current. Complications are rare but sometimes people will have skin irritation. The tape used on the electrodes can cause irritation. People with pacemakers can have problems as well.

Initial relief of pain is experienced in 70 to 80 percent of patients but it decreases after a few months to around 20 to 30 percent. Many patients use the device on a daily basis. Pulse frequencies and patterns are adjusted consistently. The range of outcomes fluctuates a great deal, most are favorable.

After surgery TENS is very effective in treating mild to moderate pain but is not effective in treating severe pain. There have been beneficial results in using it for myofacial and lower back pain. It has been helpful in treating diabetic neuropathy, urge incontinence and angina pecoria. For regaining motor function in stroke patients and to help with nausea in patients in chemotherapy it has been successful.

TENS should not be used on patients who have pacemakers. It may cause premature labor in pregnant women. It should not be applied over the carotid sinuses or the anterior neck. Electrodes should not be placed over areas that have been burned. TENS should be used carefully with patients that have an intrathecal pump or a spinal cord stimulator.

Transcutaneous Electrical Nerve Stimulation may help to relieve some types of pain. It is good for short-term relief as it is not as effective on chronic pain. It stimulates the production of endorphins.