The Relaxation SystemTherapeutic Modalities
Len Wisneski in The Scientific Basis of Integrative Health, 2017
Transcutaneous electrical nerve stimulation (TENS) is a modality used by many physical therapists since the early 1970s to relieve both acute and chronic pain. Dr. C. Norman Shealy developed TENS for pain management. The procedure involves attaching two electrodes to the skin. The electrodes are connected to an electricity-generating device that delivers a low-voltage current to the nerves in the vicinity of the pain. TENS works by stimulating endorphin production and by interrupting or blocking the neurological communication pathway of the pain (Kahn, 1994). It is commonly used in physical therapy, but also can be used at home. There are over 100 FDA-approved types of units available. Several studies have shown TENS to be less effective than acupuncture for pain control (e.g., Freeman and Lawlis, 2001; Lehmann et al., 1986).
Physical Therapy and Pain Management
Mark V. Boswell, B. Eliot Cole in Weiner's Pain Management, 2005
In 46 a.d., Scribonius Largus described the use of the torpedo fish, an electric eel, to control pain. This was the beginning of the technique of electrical stimulation for the relief of pain. TENS uses electrodes to stimulate the skin in the treatment of acute and chronic pain conditions. In 1967, Drs. Shealy and Mortimer (1970) developed a dorsal column stimulator for surgical implantation in patients with chronic intractable pain. At the time, they used TENS as a screening device for their patients. Eventually, they eliminated the surgery because they found that the screening process alone brought relief. At that point, TENS, as an alternative method of pain management, became a reality. In addition, Drs. Melzack and Wall’s Control Therapy of Pain Perception convinced the medical community of the benefits of electrical neuromodulation of pain. The physiological basis for the treatment is the stimulation of large myelinated afferent fibers, a-delta fibers, which at the level of the spinal cord tend to block the passage of painful impulses carried by smaller unmyelinated afferent fibers – c fibers. (Fernando, 2002.)
Clinical Management of Spasticity and Contractures in Multiple Sclerosis
Anand D. Pandyan, Hermie J. Hermens, Bernard A. Conway in Neurological Rehabilitation, 2018
Miller et al. compared a 1-hour and 8-hour daily application of TENS for 2 weeks in terms of spasticity, pain, and spasm (Miller et al. 2007). The Global Spasticity Score was used, which encompasses the MAS, the clonus score, and the patellar tendon reflex. Spasm was assessed with the Penn Spasm Scale and pain using a simple visual analogue scale. Neither TENS application time resulted in a statistically significant reduction in lower limb spasticity, although there was more improvement with the 8-hour application as compared to the 1-hour application. However, pain and spasm reduced significantly when using TENS for 8 hours per day. The small but non-significant effect on spasticity, as measured by the Global Spasticity Scale, was encouraging, but longer-term studies are required. No adverse events were reported.
Effect of electromyographic activity using capacitive and resistive electric transfer on non-specific chronic low back pain: a double-blind randomized clinical trial
Published in Electromagnetic Biology and Medicine, 2022
Michio Wachi, Takumi Jiroumaru, Ayako Satonaka, Masae Ikeya, Yasumasa Oka, Takamitsu Fujikawa
Non-pharmacological therapy, therapeutic exercise, manual therapy, passive modality therapy (ultrasound, TENS, and capacitive and resistive electric transfer [CRET]), and orthotic therapy are administered for NSCLBP treatment. In passive modality therapy, the effects have been reported to reduce pain and improve functional disability (Ansari et al. 2006; Ebadi et al. 2018; Tashiro et al. 2020). Although ultrasound not only reduces pain, but also improves lumbar range of motion, endurance during the Biering-Sorensen test, and functional disability, there were no significant effects on muscle fatigue and H-reflex (Ansari et al. 2006; Ebadi et al. 2012). Similarly, TENS reduces pain through the interception of painful sensations by stimulating the peripheral sensory nerves with a lower threshold (Binny et al. 2019; Johnson et al. 2015). Using CRET for NSCLBP also relieves pain and deep vasodilation, increases the temperature in deep tissue, and improves hemoglobin saturation and ROM (Takahashi et al. 1999; Tashiro et al. 2017, 2020; Yokota et al. 2018). Each modality of therapy focuses on each tissue (surface/deep, nerves, muscles, or blood vessels), and results in different treatment effects. Previous studies did not examine the effect of CRET on functional effects such as muscle activity in NSCLBP.
Transcutaneous electrical nerve stimulation (TENS): a review of applications in dermatology
Published in Journal of Dermatological Treatment, 2020
Michael J. Visconti, Wasim Haidari, Steven R. Feldman
A transcutaneous electrical nerve stimulation (TENS) unit is a noninvasive, inexpensive, battery-operated device that was originally designed to provide modulation of the afferent nervous system to relieve pain. By providing alternating current through cutaneous electrodes, TENS activates large-diameter afferent fibers of the nervous system (A-beta fibers), which are proposed to diminish pain neurotransmission in the spinal cord according to the gate control theory of pain (1). In addition, TENS may secondarily activate descending inhibitory signals that also reduce pain neurotransmission in the spinal cord (2,3). The use of TENS is wide-reaching; conditions that can be treated include postoperative pain, low back pain, osteoarthritis pain, diabetic peripheral neuropathy, fibromyalgia, and neuropathic pain (2).
Effect of pain neuroscience education and transcutaneous electrical nerve stimulation on trigeminal postherpetic neuralgia. A case report
Published in Physiotherapy Theory and Practice, 2022
Mauro Barone, Fernando Imaz, Diego Bordachar, Isabella Ferreira, Leonardo Intelangelo
TENS is a widely used method for the treatment of neuropathic pain (Caño Silva and Serrano Afonso, 2019; Zeb, Arsh, Bahadur, and Ilyas, 2018). Evidence suggests that TENS may reduce pain via different neurobiological mechanisms at: peripheral (i.e. activation of large diameter afferent fibers and stimulation of the opioid receptors μ and noradrenergic receptors α-2); medullary (i.e. increase in extracellular GABA and serotonin concentrations, reduction in glutamate and aspartate concentrations); and supramedullary (i.e. activation of the parietal cortex S1 and S2, and release of endogenous opioids by the periacueductal gray matter and the rostral ventral medulla, causing diffuse descending inhibition) (DeSantana et al., 2008). Although clinical evidence about the effectiveness of TENS in the prevention (Stepanovic, Kolsek, Kersnik, and Erculj, 2015) and treatment (Ing, Hellreich, Johnson, and Chen, 2015; Xǔ et al., 2014) of PHN is increasing, recent systematic reviews show low-quality evidence (Gibson, Wand, and O’Connell, 2017; Lin, Lin, Lao, and Chen, 2019). Lin, Lin, Lao, and Chen (2019) have suggested that TENS must be considered as a first-line treatment, given its non-invasiveness, low cost, and safety. The lack of confident evidence may be influenced by factors such as methodological aspects, the relatively low incidence of the disease, the time spent until the beginning of the treatment, discrepancies in the initial severity of the symptoms and sensorial loss, and the differences in the setting of the stimulation parameters, electrode placement and treatment duration among studies.
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