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What do you think of TENS for chronic pain patients?
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What do you think of TENS for chronic pain patients? - April 3, 2004 7:21:00 PM
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chiroortho
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For those of you that recommend TENS as a therapy for chronic pain patients, how do you decide which unit to recommend?
There are a myriad of units out there, ranging from $30 to $400 or more.
What makes one unit better than another, and why?
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Greg Priest, DC, DABCO
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Re: What do you think of TENS for chronic pain patients? - April 4, 2004 1:27:00 AM
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sinistre
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If we're considering a unit that a patient should use at home I'd prefer one that is easy to use for the patient. Plug and play. With a timer so that it turns it self off perhaps. And with a posibillity to prevent the patient from messing with the settings.
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Re: What do you think of TENS for chronic pain patients? - April 4, 2004 3:53:00 AM
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Andrew M. Ball PT PhD
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I'm partial to the ones that offer multi-modulation. Specifically, the ones set at high pulse rates work by pre-synaptic inhibition, are comfortable to the patient, but only relieve pain for a time duration about equal to the time the unit is used (e.g. 20 minutes of use will yield relief during the 20 minutes of use, plus an additional 20 minutes). These parameters are very powerful for intense pain, but not particularly long lasting.
Low pulse rate parameters serve to simulate the release of beta-endorphins --- yielding a much longer duration of pain relief (5 to 6 hours per 20 minute treatment). The problem is that the 20 minute treatment isn't all that comfortable.
Both Empi and Rehabilicare offer bi-modulated and multi-modulated units that ramp the pulse rate from 2pps to 160pps during the treatment cycle, adjusting for milliamp intensity accordingly.
For these reasons, these are generally my TENS units of choice.
Most of the chronic pain patients, however, respond best, in my experience, to AccuTens, which is an electric probe that is used to stimulate accupuncture points.
Drew
[This message has been edited by Andrew M. Ball PT PhD (edited April 04, 2004).]
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Re: What do you think of TENS for chronic pain patients? - April 4, 2004 4:48:00 AM
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Bournephysio
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Whenever I use tens, I stimulate accupuncture points. Not as specific as an accutens but easier to stimulate longer. Codotron is specifically designed to stimulate accupoints and has different modulations. It is not very portable though.
Doug
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Re: What do you think of TENS for chronic pain patients? - April 4, 2004 6:40:00 AM
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Dr.Wagner
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My firm belief is that TENS is fantastic both for acute, sub acute, and chronic pain.
Compliance is the key to success. With that being said, a user friendly device is ideal. Furthermore, devices that are small, compact, and can be hidden are also nice options.
While much of the reasons for "why" TENS works are primarily theory, it has been shown that it does work. Making this option friendly and easy for the patient is absolutely key.
Doc, DO PT
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Re: What do you think of TENS for chronic pain patients? - April 4, 2004 6:55:00 AM
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miklavda
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Conventional TENS (high frequency,low intensity)is the most used of the TENS current types.This type of TENS is effective in phantom pain,scar pain,post operative pain,low back pain... The most effective frequency is between 50 and 100 Hz,and short phase duration (<150 ms).There should be no muscle contractions or fasciculations.
Burst TENS uses a large phase duration (150-200 ms),low burst frequency (1-5 Hz),and a high amplitude.Visible and strong contractions should occur in the muscles. The burst TENS is used for problems that are not acute.
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Re: What do you think of TENS for chronic pain patients? - April 4, 2004 7:19:00 AM
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Diane
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As someone who applied lots of TENS to lots of patients over (too long) a period of time while working in voluminous PT practices that were insurance driven I have this to say about TENS:
1. The theory is nice, and I don't doubt that Ron Melzack is a nice man, and excellent researcher with good intentions. In fact I am reading up on him right now. (Topical Issues in Pain 3) But he has moved on to the brain in the last 25 years and so should we.
2. Anyone who is from a country where electrical torture is practiced, who has undergone such a serious violation, will definitely NOT benefit from TENS, will in fact find it a nocebo. I have treated such patients.
3. It will always feel "electrical."
4. Regardless of how sophistocated a unit you devise or purchase, the brain will find it boring after awhile and will adapt.
5. To sum up, TENS is overrated and underwhelming. Pain is a wily opponent and we have to be far more wiley treating it than just sticking TENS on people, or selling it to them to make $.
Diane
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Re: What do you think of TENS for chronic pain patients? - April 4, 2004 8:29:00 AM
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Barrett
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Diane,
I agree entirely. Enough experience with this should lead many to the same conclusions, especially if they read the newer work in neurobiology. Why it doesn't I can't say.
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Re: What do you think of TENS for chronic pain patients? - April 4, 2004 10:20:00 AM
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PTupdate.com
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Diane,
I agree with your rationale if it applies to the earlier phases in someones treatment. Trying to identify the causes of someones pain and removing those issues is certainly better in the interests of the patient than just sending them home with a TENS unit. However, the unit may be beneficial in certain phases of this recovery, and may be necessary for certain persons, including:
A chronic pain patient who has not responded to any other conservative treatments, and is at risk when on pain meds.
Terminally ill persons
Those struggling through the first few weeks of a spinal compression fracture
Duffy
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Re: What do you think of TENS for chronic pain patients? - April 4, 2004 2:33:00 PM
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chiroortho
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Replies have been thus far very helpful and much appreciated. Thanks to all.
I have a related question: What is the latest thought as to the relative and absolute contraindications to TENS?
Your input and advice is greatly appreciated.
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Greg Priest, DC, DABCO
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Re: What do you think of TENS for chronic pain patients? - April 4, 2004 3:02:00 PM
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j
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Dr. Wagner,
Any thoughts on why something that is fantastic for pain relief has compliance problems?
This is a serious question by the way.
Thanks, Jon
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Re: What do you think of TENS for chronic pain patients? - April 4, 2004 3:51:00 PM
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Dr.Wagner
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J and others,
Compliance issues in chronic pain patients come with the territory. They have a zillion reasons for not doing this or that.
While I do not think TENS is the second coming...one must realize, physicians prescribe LOTS of meds and it certainly can be said there are limits to how long one can be placed on 1. opiates 2. NSAIDS leading one to choose an alternate approach for pain control (i emphasize pain control not cure). Furthermore, there has been considerable RECENT use of TENS for post operative pain (c-sections) and pain in trauma (broken ribs)...I myself am considering a research study regarding TENS and acute injury (I am in the ED lending me to the most acute presentation)...there are multiple contraindications to medications in the acute setting. Furthermore, tens has a quicker onset than oral medications making it handy when you are in a high volume busy ED that it takes 45 min just to order and distribute medication (for ankle sprains), longer than slapping on a TENS.
While I do not live in a country where electrical torture is commonplace (what an odd comment diane), chronic pain patients are in dire need for control...and a device that does NOT inhibit control while at work (can't take opiates on the job) or while driving a car.
But I suppose if they have been tortured in the past by electricity...uhhh, choose something else.
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Re: What do you think of TENS for chronic pain patients? - April 4, 2004 4:12:00 PM
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Bournephysio
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Barrett, How does newer work in neurobiology suggests we shouldn't be using TENS?
Doug
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Re: What do you think of TENS for chronic pain patients? - April 4, 2004 4:57:00 PM
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Diane
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Hi Dr. Wags,
"While I do not live in a country where electrical torture is commonplace (what an odd comment diane.."
One patient I offered TENS to was from El Salvador. He informed me he'd been tortured and politely (with beads of nervous sweat on his forehead) declined the wonderful possibilities inherent in TENS. (After that I asked people how they felt about electrical treatment before assuming they would automatically be happy to have it.) Electrical torture (one kind among many) is rampant in many many countries. Why did you consider this an odd comment?
Diane
[This message has been edited by Diane (edited April 04, 2004).]
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Re: What do you think of TENS for chronic pain patients? - April 4, 2004 5:10:00 PM
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Barrett
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The research doesn't suggest we shouldn't be using it, it just makes it clear that it probably won't produce the profound changes the company selling them would suggest. We can do better with movement, awareness, education and time spent with the patient. There isn't a shortcut for that though many who sell the machines would have us believe so. Monetary factors are also important here.
I never found anything amazing about the technology and feel people don't comply for a simple reason-it doesn't help them.
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Re: What do you think of TENS for chronic pain patients? - April 4, 2004 6:05:00 PM
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Dr.Wagner
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D,
It is both a funny an odd comment, because I would hope it would go without saying that if a patient was tortured using a therapeutic device you were offering...you may decline. I just laughed, in a good way.
So let us exclude those with electrical torture in their history from this discussion on TENS.
As for TENS, I like the short term use. I like its use for chronic management of injuries while patients are at work or using heavy equipment. It is an option for home, work, or maybe even the ED. All of my reasons are listed above. It does not take the place of any therapy or treatment. Hopefully that will satisfy all readers.
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Re: What do you think of TENS for chronic pain patients? - April 4, 2004 6:25:00 PM
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j
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My personal experience with TENS is that the care provider derives greater benefits from TENS use than does the care receiver and the benefits to either are often short lived.
jon
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Re: What do you think of TENS for chronic pain patients? - April 4, 2004 10:00:00 PM
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chiroortho
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Jon, goodness, what's wrong with short term pain relief for a patient in chronic pain? Maybe it'll allow them to vacuum their floor or make their bed without so much pain. I don't think that's such a bad thing.
As DocWagner points out, opiates aren't the long term answer for most chronic pain patients, and for those patients that just want to perform their ADLs with less pain I'm at a loss to think of a negative in that regard.
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Greg Priest, DC, DABCO
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Re: What do you think of TENS for chronic pain patients? - April 4, 2004 10:35:00 PM
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nari
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I have to agree with Diane and Barrett.
TENS can be useful in the short term only if it actually alters the brain's interpretation of why chronic pain is necessary in a particular patient.
For acute and subacute, it may have a physiological effect, or placebo effect; which may still be helpful. It does not replace early activity, and education on the nature of pain.
The brain does start to ignore its impulses after a while, and for long term, it is less useful.
The high cost and often uncertain compliance with instructions, makes other options more useful, in my opinion.
It was the 'rage' of the 80s in Aust; its use now is the last resort if nothing else helps at all.
Nari
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Re: What do you think of TENS for chronic pain patients? - April 5, 2004 3:06:00 AM
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j
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While I never stated short term pain relief is worthless I do feel it is of limited worth. My biggest problem with short term pain relief for chronic pain is that well, it's short term. One more thing that "failed". How does that leave the patient feeling? Are they really empowered or still dependent on someone to help them?
jon
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