Transcutaneous Electrical Nerve Stimulation (TENS)

Transcutaneous Electrical Nerve Stimulation (TENS) is a technique that uses electrical stimulation to block pain signals to the brain. TENS and ultrasound are both techniques that may be used in a PT clinic or chiropractor office to treat severe back pain, back pain that has not responded to other treatments. TENS therapy is administered with patched stuck to the skin, near the area of the spine where the patient is feeling the pain. The patches are connected to electrodes, which are connected to a portable device that delivers various intensities of electrical energy. The TENS procedure is safe, as the amount of electricity delivered to the patient is neither painful nor dangerous, and the energy delivered to the patient is restricted to a small area where the patient is feeling symptoms of back pain.

The TENS unit channels low-level electrical energy through the electrode wires and sticky patches, around the site of discomfort/pain. The practitioner administering the treatment can alter the level of current coming to the patient. The current will usually be turned up to a level that the patient feels strongly, but not to the point of discomfort/pain. The current that the patient is receiving is a low-level shock, but is experienced as a tingling sensation, not a jolt. If this treatment proved effective, patients should experience temporary back pain relief.

Transcutaneous Electrical Nerve Stimulation (TENS) is an effective temporary treatment for back pain that works well for some and not others. Some patients will respond very well to TENS after only one treatment, while others never respond to it. Unlike other specialty equipment such as ultrasound, there are TENS units out there that are available for home purchase and use. Some TENS home devices available include the TENS Pros Dual Channel EMS Unit - EMS-7500, 3 Mode Muscle Stimulator and the TwinStim Plus Platinum TENS Unit and Muscle Stimulator 4 Channel Combo Unit. The TENS units may vary in the number of channels that can be used simultaneously and the intensity (frequency) of the stimulation. Some TENS devices give users the ability to adjust the frequency of stimulation from low-frequency stimulation (<10 Hz) to high-frequency stimulation (60 - 200Hz). The type of frequency that is selected may affect both patient comfort levels (how long they can tolerate the treatment) and the length of time that they experience pain relief. Low-frequency stimulation, sometimes called "acupuncture-like" is tolerable for shorter periods of time (usually no longer than 20-30 minutes), but tends to provide with longer periods of back pain relief. High-frequency stimulation is tolerable for hours, but often provides patients with shorter intervals of pain relief.



There is no exact correct protocol of placement that will work for all users. Users may experiment with various placements of the electrodes, with a placement of some of them directly over the area of stiffness or pain. Electrodes are typically placed over the most painful area, surrounding the painful area, and on the nerve supplying the painful area. Patients may consult with their doctor or chiropractor to locate the main nerve supplying the area of pain.

Trial periods for these devices may take several days before a correct placement and frequency settings may be adjusted to their optimum clinical benefits. A home trial that offers patients the ability to adjust these settings over a period of days to weeks is preferable.

Inferential Current (IFC): Inferential Current uses high frequency settings (4000 Hz) to clinically penetrate the deepest soft tissues below the skin. This high frequency carrier transform reaches the deeper muscles and soft tissues closer to the spine and spinal nerves, compared to traditional TENS Units. IFC currents provide less comfort than TENS units to treat the deeper structures. IFC units may provide more favorable treatment outcomes for patients who failed to receive relief from TENS units.

Unfortunately, at over $2000 per unit, these units are too expensive for those people whose insurance programs don't cover these devices.

Galvanic Stimulation (GS): Galvanic Stimulation may be most beneficial for acute injuries with major tissue trauma with swelling or bleeding. Galvanic stimulators apply direct current, online IFC and TENS units, which apply alternating current. GS units use multiple pads that simultaneously provide a positive and negative current to affect blood circulation in and around tissue trauma. The positive pad reduced inflammation to reduce swelling. The negative pad speeds the healing process by increasing circulation.

Here is a list of companies that offer home units, supplying electrical stimulation units to provide pain relief.

Omron (omron.com) Electro Therapy Pain Relief Device PM3030: This device uses TENS electrotherapy that has been tried and tested for pain relief benefits in clinics and at home. This device is small and lightweight, so that their users may make easy adjustments to time and frequency settings. This device fits easily into the palm of the users hand and has an interface that is easy to read and make adjustments with. This device is designed to supply electrical nerve stimulation to several sites on the body at once, ensuring that patients will be able to get all the pain relief therapy they need in a single session.