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TENS Unit

 

What is TENS unit?

 

TENS is an acronym for Transcutaneous Electrical Nerve Stimulation.  It is a battery operated device, slightly bigger than a beeper, which can rest comfortably on your belt or waist.  It is a safe, non-invasive, drug-free method of pain management.  The TENS unit sends electrical impulses through electrodes placed on the skin near or over the painful site.

 

How does TENS work?

 

To understand how TENS works, a basic understanding of how pain is perceived is necessary.  So, how do we feel pain? Pain generally begins with the nociceptors, which are the free nerve endings of small myelinated A-delta fibers.  Nociceptors are located all over your body.  The interpretation of pain occurs when the nociceptors are stimulated and subsequently transmits signals through the spinal column, which relay to different areas of the brain, specifically to the thalamus and then to the cortex.  Local injury releases inflammatory mediators which cause nearby nociceptors to depolarize (become active), which allows them to transmit the pain message towards the dorsal horn of the spinal cord.  This is the beginning of the pain pathway.  Nociception denotes the activity in the nerve pathways.  Nociception does not become pain until the higher cognitive functioning interprets the input from these signals and gives meaning to it.  A person is not fully aware of pain until the signal reaches the cortex. 

Also, your body has a natural ability to modify the perception of pain.  This is accomplished by the body’s own production of natural opioid like substances, endorphins and encephalins.  These substances have been found to suppress the transmission of painful stimuli, therefore dulling the perception of pain.

 There have been two mechanisms proposed for the way in which TENS works.  The first has to do with inhibiting or stopping these signals from reaching the cortex, thereby stopping a person from being aware of pain.  The said mechanism of action is that nociceptive inhibition at the presynaptic level in the dorsal horn of the spinal cord limits its central transmission (the signal reaching the cortex).  The second proposed mechanism of action of TENS is that the electrical impulses stimulate the body to release more endorphins and encephalins.  This second mechanism has not been proven by research and is still under debate.

 

What is TENS used for?

 It is used for chronic intractable pain and as an adjunctive treatment in the management of post-surgery or post-traumatic acute pain problems.  It is an effective form of pain management for arthritis, but it has been used in a wide range of applications such as: 

  • Multiple types of arthritis including rheumatoid and osteoarthritis
  • Neck and back pain
  • Headaches; including tension and migraine
  • Post-herpetic neuralgia
  • Sciatica
  • Lumbago
  • Reflex Sympathetic Dystrophy
  • Complex Pain Syndrome
  • Lateral epicondylitis (Tennis Elbow)
  • Childbirth
  • Muscle strains
  • Trigeminal neuralgia
  • Phantom limb pain
  • Shingles
  • Cancer Pain
  • Bladder incontinence
  • Fibromyalgia
  • Whiplash
  • Knee pain
  • Shoulder bursitis

 

It is ineffective for pain of central origin like appendicitis or hepatitis.  It should not be used in the eye area or on the front part of the neck, specifically the carotids or the laryngeal muscles. Of course, it should not be used on any open wounds.

 

Who should not use TENS?

 

It is contraindicated for use in patients who have a pacemaker or defibrillator (ICD).  The safety for use in pregnancy has not been established.  Patients who have a metal plate or pin should not use it.  Patients should not go to sleep with the machine on.  It is not recommended for patients with abnormally high blood pressure, cardiac disease, diabetes or epilepsy.  For any concerns or if you might fit into one of these categories please discuss TENS unit usage with your doctor!

 

Are there side effects associated with TENS use?

 

People have reported skin irritation or redness from using TENS.  However, this is most likely due to the adhesive tape used to secure the electrodes or the gel used under the electrodes.  The irritation disappears quickly and can be prevented by using alternative gels, tape and electrodes.

 

What does it feel like to use TENS?

 

People have described the feeling as a pleasant sensation as well as soothing and relaxing.  You are in complete control of the machine so it is very simple to adjust it to a setting most comfortable to you.

 

How do I get a TENS unit?

 

A prescription from the doctor is necessary to purchase a TENS unit.  Many health insurance programs, including Medicare, give reimbursements for the machine.  The machines are relatively inexpensive ranging from 50-500 dollars.  There are many websites that offer great deals on the machines.  Your physician can help you decide which machine will work best for you.

 

Some things to keep in mind:

 

TENS does not change the underlying cause for arthritis or other type of pain, it is not curative, it only relieves the symptoms of pain!

 

Pain is a critical component of the body’s defense system; it is nature’s way of warning us about injury and preventing further damage.  So be sure to speak with your doctor first to find the problem precipitating the pain.

 

 

Authors:  Lauren Baldinger, B.S., New York College of Osteopathic Medicine, Old Westbury, NY

                David R. Baldinger, M.D., Rheumatologist; Internal Medicine Associates, Fort Meyers, FL

 

 

 

 

 

 

 Arthritis MD. © 2005