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MOD216 – Transcutaneous Electrical Nerve Stimulation (TENS)
Definition:
Transcutaneous Electrical Nerve Stimulation (TENS) is a pain relief method that uses low-voltage electrical currents applied through electrodes on the skin to stimulate nerves and reduce pain signals or alter pain perception. It is a non-invasive, drug-free approach to pain management.
Explanation:
TENS works by delivering small electrical pulses through electrodes placed on the skin near the area of pain. The mechanism of action is based on two main theories:
- Gate Control Theory: TENS stimulates non-painful sensory nerves, which can “close the gate” on pain signals travelling to the brain.
- Endorphin Release Theory: TENS may stimulate the body to produce natural pain-relieving chemicals called endorphins.
Key aspects of TENS therapy include:
- Frequency: Typically ranges from 1 to 150 Hz
- Intensity: Adjusted to produce a strong but comfortable sensation
- Pulse Width: Usually between 50 to 250 microseconds
- Duration: Sessions can last from 15 minutes to several hours
TENS is commonly used for various types of pain, including:
- Chronic pain conditions (e.g., arthritis, fibromyalgia)
- Acute pain (e.g., labour pain, post-operative pain)
- Musculoskeletal pain (e.g., back pain, neck pain)
- Neuropathic pain
TENS devices can be used in clinical settings or at home, with portable units available for personal use. The therapy is generally considered safe, but it’s not suitable for everyone, particularly those with certain medical conditions or implanted electrical devices like pacemakers.
Evidence to Efficacy:
The evidence for the efficacy of TENS is showing some benefits. Here’s a summary of some key findings:
- A Cochrane review by Johnson et al. (2015) found that TENS is more effective than placebo for pain relief, but the evidence was of low quality.
- Research by Vance et al. (2014) in the journal Pain Medicine demonstrated that TENS can significantly reduce movement-evoked pain in individuals with fibromyalgia.
- A systematic review by Zeng et al. (2015) in the Journal of Rehabilitation Medicine found that TENS was effective for pain relief in osteoarthritis of the knee.
- A study by Dailey et al. (2013) in the Journal of Pain showed that TENS reduced pain and fatigue in people with fibromyalgia during activity.
Governing Body:
In the UK, TENS is primarily used by physiotherapists and pain management specialists as part of their broader treatment plans. As such, it falls under the governance of overarching healthcare regulatory bodies.
What Good Looks Like:
A high-quality TENS experience should encompass several key elements:
Treatment Application:
- Correct electrode placement based on the pain location
- Proper setting of frequency, intensity, and pulse width
- Gradual increase in intensity to a comfortable level
- Appropriate duration of treatment
Patient Experience:
- Sensation of tingling or buzzing without pain
- Noticeable reduction in pain during or after treatment
- No skin irritation or adverse reactions
A good TENS experience should leave the patient feeling empowered to manage their pain, with a clear understanding of how to use the therapy effectively and safely. The practitioner should demonstrate knowledge, skill, and attentiveness throughout the process, ensuring both the effectiveness and safety of the treatment.
What to Ask a Practitioner:
“How do you determine if TENS is appropriate for my specific pain condition?”
Desired answer: Explanation of their assessment process and consideration of your individual case.
“What TENS parameters (frequency, intensity, duration) do you recommend for my condition, and why?”
Desired answer: A detailed explanation tailored to your specific pain condition and symptoms.
“What should I expect to feel during and after the TENS treatment?”
Desired answer: Clear description of expected sensations and potential short-term effects.
“Are there any activities I should avoid while using TENS?”
Desired answer: Specific guidance on safe use and any precautions.
“What are the potential risks or side effects of TENS?”
Desired answer: Honest discussion of possible risks and how they’re mitigated.
“Can you provide instructions for safe home use of TENS?”
Desired answer: Detailed guidance on proper electrode placement, device settings, and usage duration.
Resources for further information:
Pain Concern – UK charity providing information on pain management, including TENS.
“TENS: An Evidence Based Approach” by Mark I. Johnson – A comprehensive book on TENS therapy.
Related Therapies:
Electrical Muscle Stimulation (EMS) (MOD211): Application of electrical impulses to muscles to induce contractions, used for strength training, rehabilitation, and pain management.
Acupuncture (MOD007): A traditional Chinese medicine practice that involves inserting thin needles into specific points on the body to balance energy flow (Qi) and promote healing. Acupuncture can complement Reiki by addressing energetic blockages.
Heat Therapy (MOD210): Use of heat to treat muscles, joints, and tissues to increase blood flow, reduce pain, and improve flexibility.
Cryotherapy (MOD209): Application of cold temperatures to the body or specific areas for therapeutic purposes, including pain relief and reducing inflammation.
Cognitive Behavioural Therapy (MOD026): A psychotherapeutic approach that addresses dysfunctional emotions, behaviours, and thought patterns through goal-oriented techniques, often incorporating mindfulness practices.
Biofeedback (MOD136): Biofeedback is a therapeutic technique that teaches individuals to control physiological processes by providing real-time data about their bodily functions, often using instruments to monitor heart rate, muscle tension, or brain activity.
Mindfulness-Based Stress Reduction (MOD106): A structured program that combines mindfulness meditation and yoga to cultivate awareness and reduce stress.
These related therapies often work in conjunction with TENS to provide comprehensive pain management strategies.