Transcutaneous Electrical Nerve Stimulator

Medref

Transcutaneous Electrical Nerve Stimulation, more commonly referred to as a "TENS" is defined by the American Physical Therapy Association as application of electrical current through the skin for pain control (APTA, 1990). The unit is usually connected to the skin using two or more electrodes. A typical battery-operated TENS unit is able to modulate pulse width, frequency and intensity. Generally TENS is applied at high frequency (>50 Hz) with an intensity below motor contraction (sensory intensity) or low frequency (<10 Hz) with an intensity that produces motor contration (Robinson and Snyder-Mackler, 2008).

Uses

TENS is a non-invasive, safe method to reduce pain, both acute and chronic. While controversy exists as to its effectiveness in the treatment of chronic pain, a number of systematic reviews or meta-analysis have confirmed its effectiveness for postoperative pain, osteoarthritis, and chronic musculoskeletal pain [cite journal |author=Johnson M, Martinson, M |title=Efficacy of electrical nerve stimulation for chronic musculoskeletal pain: A meta-analysis of randomized controlled trials |journal=PAIN |volume=130 |issue=1 |pages=157-165 |year=2006 |pmid= |doi=10.1016/j.pain.2007.02.007 |url=http://www.painjournalonline.com/article/S0304-3959(07)00073-5/abstract] . Conversely, results from the Bone and Joint Decade 2000 - 2010 Task Force on Neck Pain accumulated data showing no clinically significant benefit to TENS for the treatment of neck pain when compared to sham treaatment [The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders: Executive Summary. Spine:Volume 33(4S) Supplement15 February 2008pp S5-S7] . Recent clinical studies and meta-analysis suggest that using adequate intensity of stimulation is necessary to obtain analgesia with TENS (Bjordal et al., 2003; Rakel and Franz, 2003).

Basic science studies show that high and low frequency TENS produce their effects by activation of opioid receptors in the central nervous system. Specifically, high frequency TENS activates delta-opioid receptors both in the spinal cord and supraspinally (in the medulla) while low frequency TENS activates mu-opioid receptors both in the spinal cord and supraspinally. Further high frequency TENS reduces excitation of central neurons that transmit nociceptive information, reduces release of excitatory neurotransmitters (glutamate) and increases the release of inhibitory neurotransmitters (GABA) in the spinal cord, and activates muscarinic receptors centrally to produce analgesia. Low frequency TENS also releases serotonin and activates serotonin receptors in the spinal cord, releases GABA, and activates muscarinic receptors to reduce excitability of nociceptive neurons in the spinal cord.

In palliative care and pain medicine, TENS units are used in an attempt to alleviate neuropathic pain [T. Forst, M. Nguyen, S. Forst, B. Disselhoff, T. Pohlmann, and A. Pfutzner, Impact of low frequency transcutaneous electrical nerve stimulation on symptomatic diabetic neuropathy using the new Salutaris device. Diabetes Nutr. Metab. 17:163–168 (2004).] (pain due to nerve damage). Some patients benefit from this approach, while others may not, depending on individual differences [L. S. Chesterton, P. Barlas, N. E. Foster, G. D. Baxter, and C. C. Wright, Gender differences in pressure pain threshold in healthy humans. Pain 101:259–266 (2003).] , and pain threshold [L. S. Chesterton, N. E. Foster, C. C. Wright, G. D. Baxter, and P. Barlas, Effects of TENS frequency, intensity and stimulation site parameter manipulation on pressure pain thresholds in healthy human subjects. Pain 106:73–80 (2003).] . Further use is documented in the attached references: in obstetric care, particularly in labour [J. T. van der Spank, D. C. Cambier, H. M. De Paepe, L. A. Danneels, E. E. Witvrouw, and L. Beerens, Pain relief in labour by transcutaneous electrical nerve stimulation (TENS). Arch. Gynecol. Obstet. 264:131–136 (2000).] ; knee pain [M. M. Ng, M. C. Leung, and D. M. Poon, The effects of electro-acupuncture and transcutaneous electrical nerve stimulation on patients with painful osteoarthritic knees: a randomized controlled trial with follow-up evaluation. J. Alternat. Complement. Med. 9:641–649 (2003).] [G. L. Cheing, A. Y. Tsui, S. K. Lo, and C. W. Hui-Chan, Optimal stimulation duration of tens in the management of osteoarthritic knee pain. J. Rehabil. Med. 35:62–68 (2003).] [M. Osiri, V. Welch, L. Brosseau, B. Shea, J. McGowan, P. Tugwell, and G. Wells, Transcutaneous electrical nerve stimulation for knee osteoarthritis. Cochrane Database Systematic Reviews 4:CD002823 (2000).] ; lithotripsy or bladder-stone removal [A. Kararmaz, S. Kaya, H. Karaman, and S. Turhanoglu, Effect of the frequency of transcutaneous electrical nerve stimulation on analgesia during extracorporeal shock wave lithotripsy. Urol. Res. 32:411–415 (2004).] ; limb pain [W. P. Cooney, Electrical stimulation and the treatment of complex regional pain syndromes of the upper extremity. Hand Clin. 13:519–526 (1997).] .

TENS units are also used by the BDSM community for erotic play involving electrical stimulation. See also Erotic electrostimulation.

History

Electrical stimulation for pain control was used in ancient Greece, 63 A.D. It was reported by Scribonius Largus that pain was relieved by standing on an electrical fish at the seashore. [cite journal |author=Jensen J E, Conn R R, Hazelrigg, G, Hewitt, J |title=The use of transcutaneous neural stimulation and isokinetic testing in arthroscopic knee surgery |journal=The American Journal of Sports Medicine |volume=13 |issue=1 |pages=27-33 |year=1985 |pmid= |doi=/ |url=http://ajs.sagepub.com/cgi/content/abstract/13/1/27] In the 16th through the 18th century various electrostatic devices were used for headache and other pains. Benjamin Franklin was a proponent of this method for pain relief. In the 1900s a device called the electreat, along with numerous other devices were used for pain control and cancer cures. Only the electreat survived into the twentieth century, but was not portable, and had limited control of the stimulus.

The first modern, patient-wearable TENS was patented in the U.S.A. on June 18, 1974 (US patent|3817254). It was initially used for testing the tolerance of chronic pain patients to electrical stimulation before implantation of electrodes in the spinal cord dorsal column. [Burton C. Instrumentation for dorsal column stimulator implantation. "Surg Neurol." 1974 Jan;2(1):39-40.] The electrodes were attached to an implanted receiver, which received its power from an antenna worn on the surface of the skin. Although intended only for testing tolerance to electrical stimulation, many of the patients got so much relief from the TENS itself that they never returned for the implant.

A number of companies manufacturing TENS appeared after the commercial success of the Medtronic device became known. The neurological division of Medtronic, founded by Don Maurer, Ed Schuck and Dr. Charles Ray, developed a number of applications for implanted electrical stimulation devices for treatment of epilepsy, Parkinson's disease, and other disorders of the nervous system. Maurer founded Empi, Inc. in 1977, and in the late 1980s purchased the TENS product line from Medtronic. Today many people confuse Tens with Ems. Ems and Tens devices look similar and both use long electric lead wires and electrodes. Tens is for blocking pain, where Ems is for stimulating the muscle.

afety

TENS Electrodes should never be placed:

*On or near the eyes
*In the mouth
*Transcerebrally (on each temple)
*On the front of the neck (due to the risk of acute hypotension through a vasovagal reflex)
*On areas of numb skin/decreased sensation
*On broken skin areas or wounds
*On or near the trigeminal nerve if you have a history of herpes zoster induced trigeminal neuralgia (Postherpetic neuralgia)

TENS should also be used with caution in people with epilepsy or pregnant women (do not use over area of the uterus as the effects of electrical stimulation over the developing fetus are not known). TENS should not be used by people with an artificial cardiac pacemaker due to risk of interference and failure of their implanted device. Possible failure of these warnings can result in a cardiac arrhythmia.

ee also

* Action Potential
* PTNS
* MENS
* Neuromuscular dentistry

References

G. Vrbová, O. Hudlicka, K. Schaefer Centofanti; [http://www.springer.com/medicine/book/978-1-4020-8232-0 l "Application of Muscle/Nerve Stimulation in Health and Disease"] ;Springer 2008.

External links

* [http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17355064&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum transcutaneous coupling for neural prostheses]
* [http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17321927&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum vestibular TENS for reducing post operative nausea and vomiting]
* [http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17097397&ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum body area-specific differences in itch perception]
* [http://www.bbc.co.uk/health/conditions/tens1.shtml BBC article on TENS]