TENS for pain managment

Managing pain is a difficult task. There are a number of medications that can provide relief for conditions like fibromyalgia and neuropathy such as lyrica, gabapentin and nortriptyline. However medications often cause unwanted side effects and might not fully relieve symptoms. I struggled for months trying to find a good option for controlling the constant nerve pain in my leg/foot after surgery. I was on gabapentin for awhile but that increased my blood sugar which worried me since diabetes runs in my family. It was also just really unpleasant to feel constantly hungry no matter how much I ate (which is a sign of high blood sugar). I then tried nortriptyline which helped but didn’t fully get rid of the pain and made me feel like a zombie due to it’s sedating effect. Painkillers like percocet helped slightly but after 6 months I was told I could no longer use painkillers to manage my pain.

After several failed attempts to get my health insurance company to pay for a topical cream that was supposed to help with the pain, I decided it was time to look into alternatives to the options I was being given. I had a friend who used a TENS unit (transcutaneous electrical nerve stimulation) to help with her neck pain after a cervical fusion. After doing some research on using TENS for nerve pain I asked her to borrow it to see if it would help me. There is some clinical research supporting the use of TENS for pain management (for postoperative pain, neuropathy and fibromyalgia) however there is not enough research to conclude one way or the other if it really does treat pain effectively.

So what is a TENS unit and how does it help relieve pain? A TENS unit is a battery powered device with typically two or four electrodes that are placed on the skin and send an electrical current from the electrodes to your skin. Exactly why this helps with pain is not fully understood. Research in animals shows that TENS usage increases neurotransmitters GABA and serotonin. These two neurotransmitters are endorphins which act as natural pain killers. There is some evidence that TENS intensity (amplitude) is critical for effective pain relief, with high intensity being the most effective. A study of postoperative pain after hip fracture surgery showed that patients who received 30 minutes of TENS therapy 5 times daily, starting 24 hours after surgery,  had significantly less pain when walking and had increased mobility. However, this study also showed that the patients did not experience greater pain reduction at rest compared to the control (non-TENS) group. A review of five different trials of TENS for lower back pain concluded that there was no significant difference between people who received TENS therapy and those who didn’t. They do point out that certain factors were not consistent between trials including intensity, duration of treatment and position of the electrodes. These factors most likely have a significant effect on the results.

While the results are mixed and larger studies are needed to draw accurate conclusions, there are some people who seem to benefit significantly from TENS therapy. As with any modality TENS is not for everyone. People with a pacemaker, seizure disorder, pregnant women and people with heart problems should not us TENS. The adhesive pads should never be put on the neck, temples, or on/near the eyes. It is best to seek out a medical professional to show you how to use TENS properly if you want to purchase one. Many physical therapist will use them during treatment.

After testing out the TENS unit I borrowed I noticed it did seem to help my pain even if it didn’t completely get rid of it. I turned up the intensity enough to feel it, but not so much that it hurt. The sensation is very strange at first. It’s like an intense vibration. If I turned it up too high it felt like a sharp stab. This is why it’s important to start at a low frequency and work your way up to see what’s best for you. If you haven’t looked into trying TENS for pain management I feel it’s worth a try. Compared to other treatments there are minimal risks and usually no side effects. It is unlikely to replace the need for medications but can be an effective addition to other therapies to help make pain more manageable.

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