I had previously written a post about 10 potential topical options for pain management. You can read about those here:
healthunlocked.com/cure-par...
And Here :
healthunlocked.com/cure-par...
For this post, I am writing about another option for management of pain that offers the following benefits :
The following is a list of the benefits of using a TENS Unit for pain management. Although TENS Unit Therapy (TUT) may not control pain completely in some cases, it has shown synergy with other types of pain relievers and can make a major contribution toward effective pain management, but in many instances it has been shown to be sufficient at controlling pain very well by itself. Here are some benefits of TUT :
Non-addictive.
Generally lasts at least as long as many drug options.
Is easily obtainable without a prescription.
Is compatible with almost all medications.
Has minimal to no side effects when used properly.
Works directly at the area of pain.
Generally quite effective for many different forms of pain.
Inexpensive.
Non-invasive.
Does not require professional assistance.
May provide other health benefits other than pain relief.
Easy to use.
The body does not seem to buildup a resistance or tolerance to it.
People do not smell you coming as is the case with some topical pain relievers.
TUT can also be employed with other pain-relieving modalities for added synergy. These are all features that would be highly desirable when it comes to pain management.
What Does A TENS Unit Do Exactly?
TENS stands for Transcutaneous Electrical Nerve Stimulation. Average TENS Units are roughly the size of a pack of cigarettes, and the devices vary in terms of features from fundamental options to more advanced options. Still, the basic therapy is the same in all units.
TENS Units deliver electrical pulses through the skin to stimulate nerves which causes specific muscles to contract and release in the area being treated, which can be visibly seen and felt by the patient as muscles contracting and relaxing with no effort needed by the patient, if the device is set to high.
The TENS device has electrical leads coming out of it via plugs on the TENS unit. The number of leads varies from 2 on a basic device up to 4 on a more advanced unit. More leads allow for a larger area of body coverage or possibly two different areas simultaneously, such as a right knee and lower back at the same time per treatment.
Another option is for one pair of leads to run a specific program for the lower back while the leads to the knee can run a particular program for the knee with each program to adjust the intensity to each one individually.
Each lead's end is a replaceable, electrically conductive, sticky pad of various size options. The sticky pad adheres to the body surface during treatment and is removed at the end of the treatment cycle. The pads are reusable for a limited number of treatments and are easily replaced when they no longer properly adhere to the skin. If multiple users will use the TENS unit, it is probably best to replace the pads for each person using the device. Another very useful option that can be found on units over $100 is wireless pads where there are no wires running form the unit to the electrode pads. Although I can wear my unit while working or walking, I have to make sure the wires are tucked away and will not get caught on anything such as a door knob. With the wireless pads, this is never an issue, but it does come at a price premium.
So those are many of the available features and options, but how well does TUT work for pain management, and can it do more than give pain relief? To answer these two questions, we will now look at some literature that explains what a TENS unit can do. I will also discuss my experiences.
How Long Has TUT Been In Use?
TUT has been available for well over 50 years, so it has a proven track record. It is employed by pain management clinics, chiropractors, massage therapists, physical therapists, athletic medical personnel, and patients for in-home use. TUT has shown efficacy when other options have failed or proved less ideal for longer-term use.
When I was a kid, we had a TENS unit in our house, but then it was more of a toy that we would use to see how much we could make our muscles contract. The only adjustability was in the intensity of the electrical pulses and an on and off switch, if I remember correctly. There were no adjustments for different areas of the body as there are on today's devices. There were only two electrical leads with a type of suction cup at the end of each lead that you would use to attach to the skin, but you could not move around too much while operating the device, or the suction cups would fall off the skin. Today's units use the self-stick pads, which conduct the electrical pulses through the skin, and you can pretty much move around unhindered while having a treatment. I generally treat myself now while sitting at my computer working or when lying down in bed.
You can buy today's units with different options such as 4 leads instead of 2, two leads that are independent from the other 2 leads in terms of adjustability, a built-in adjustable timer that will shut the unit down after the desired treatment time has been met, belt clips, rechargeable lithium-ion battery with more uses between charges compared to older units that did not recharge and needed frequent battery changes.
Today's units also have multiple preprogrammed choices for different areas of the body, and a few units have a soft touch screen for faster program changes and more convenience. Prices are also significantly lower than yesteryear's models. Overall, I consider today's TENS units to be much more versatile than in years past.
On the other hand, I remember the one we had when I was a kid used to take quite a beating and just kept going and going. In contrast, I suspect that today's units may not take as much abuse as the older units, but if you treat it carefully as a medical device should be treated, they may have a long life ahead of them. Our old unit had no screen and no readout of any type, not even an on/off indicator light, whereas today's models have digital LED screens and a few even have the soft touch screen.
Research Studies on TENS Units for Pain
Osteoarthritis
1. In this first study, the researchers tested TUT against knee Osteoarthritis in 100 patients at both high frequency and low frequency. While the high frequency showed effect quicker than low frequency, both proved to have similar long-term effects, which appeared to be quite effective.
ncbi.nlm.nih.gov/pmc/articl...
Here is an interesting quote from the study, and I will cover more studies on knee Osteoarthritis simply because this is a widespread use for TUT.
>>> ' Based on this 12th week follow-up, both groups will continue to improve with time. A longer study should be conducted to see it this improvement will eventually plateau off or continue to improve until the patient is symptom free. ' <<<
2. In this next study, the researchers tested TUT against another form of electrotherapy called Transcranial Direct Current Therapy. They found both to be similarly effective for pain from Osteoarthritis of the knee.
pubmed.ncbi.nlm.nih.gov/329...
Here is a quote from the study :
>>> ' Significant improvement was observed in all outcomes in both TENS and tDCS groups at each follow up compared to baseline although the early improvement (first follow-up) in the WOMAC index was not significant in the TENS group. ' <<<
3. In this third study on knee OA, they tested TUT against Electroacupuncture in a meta-analysis of Randomized Controlled Studies (RCTs), which is vital in determining effectiveness because it tends to weed out the weak studies carries more weight in assessing the effectiveness of TUTS.
pubmed.ncbi.nlm.nih.gov/325...
Here is an important quote from this study:
>>> ' The present analysis indicated that both EA and TENS exert significant pain-relieving effects in KOA. Among the four treatments, H-TENS was found to be the optimal treatment choice for managing KOA pain in the short term, and EA the second-best treatment option. ' <<<
4. In this fourth study on knee Osteoarthritis, it is determined that TUT increases stair-climbing capacity.
ncbi.nlm.nih.gov/pmc/articl...
Muscle Strength and Gait Speed
The following study suggests that TUT may be a helpful tool when used with taping to improve muscle strength and gait speed.
ncbi.nlm.nih.gov/pmc/articl...
Here is a good quote from the study :
>>> ' Thus, TENS combined with taping may be useful in improving spasticity, muscle strength, and gait ability in stroke patients. Based on these results, an additional application of taping could be used to enhance the antispastic effect of TENS or other electrical stimulation treatments in the clinic. '<<<
Low Back Pain
This following study (March 2021) determined that TUT and IFC, another type of electrotherapy, offered almost immediate low back pain relief.
pubmed.ncbi.nlm.nih.gov/343...
Here is a quote from this study :
>>> ' Both TENS and IFC presented immediate analgesic effect in CLBP, with emphasis on the interferential current of 4 kHz modulated at 100Hz. ' <<<
Fibromyalgia
The following July 2021 RCT suggests that TUT is a helpful option for Fibromyalgia pain.
ncbi.nlm.nih.gov/pmc/articl...
Here is a useful quote from the study :
>>> ' This study demonstrated modest treatment effects of reduced disease impact, pain and functional impairment from wearable TENS in individuals with fibromyalgia. Subjects with higher pain sensitivity exhibited larger treatment effects than those with lower pain sensitivity. Wearable TENS may be a safe treatment option for people with fibromyalgia. ' <<<
Pain and Anxiety in Children
This next study determined that TUT reduces pain and anxiety in children who are getting local anesthesia.
ncbi.nlm.nih.gov/pmc/articl...
Overactive Bladder
1. The following study suggested that TUT may help some children with overactive bladder during the day.
ncbi.nlm.nih.gov/pmc/articl...
2. The following study is similar to the last about Overactive Bladder (OAB) in children, except it appeared noticeably more successful in adults.
pubmed.ncbi.nlm.nih.gov/342...
Here is an interesting quote from the study :
>>> ' Applying daily TENS over the sacral region for 90 days to patient with neurogenic overactive bladder improved OAB symptoms of patients whose response to anticholinergic drugs is far inferior. ' <<<
Parkinson's Disease Tremor
As you can see so far, TUT has health effects beyond simple pain management, and this next study helps to illustrate that point even further. This study suggests that TUT may be useful as an adjunctive treatment for tremors in Parkinson's Disease.
ncbi.nlm.nih.gov/pmc/articl...
Here is an interesting quote from the study.
>>> ' The average percentage of suppression was 61.56% in tremor across all joints of all subjects, and 47.97% in EMG of all muscles ' <<<
Low Back Disc Herniation
The next study shows that TUT helps relieve pain from a lower back disc herniation (LDH).
pubmed.ncbi.nlm.nih.gov/341...
Here is a critical quote from this study :
>>> ' A single session with either TENS, IF current or CTPI is sufficient to improve the range of motion and degree of radicular pain associated with LDH. ' <<<
Diabetic Peripheral Neuropathy
The following study (May 2021) suggests that TUT has usefulness in diabetic peripheral neuropathy pain.
ncbi.nlm.nih.gov/pmc/articl...
Here is a quote from the review :
>>> ' A pair of small trials in the 1990s showed improvements in both pain and other neuropathic symptoms in patients with PDN when receiving TENS compared to sham controls [70,71]. In the first of these, TENS produced pain relief by 54% in 18 subjects and improvement of neuropathic symptoms in 15, significantly more than the 18% decline in pain scores and neurologic improvement in 5 of 13 sham-treated controls [71]. The second prospective, randomized study tested TENS in 14 subjects with PDN who had not responded to four weeks of treatment with amitriptyline. In this trial, TENS plus amitriptyline produced 66% pain relief, which was significantly more than the 55% pain relief in subjects receiving amitriptyline plus sham stimulation [70]. No AEs were reported in either trial among patients receiving TENS stimulation. ' <<<
I think this is plenty of studies to confirm that TUT is a useful alternative pain management tool with all the attributes mentioned in the first paragraph at the top of this page.
It is also very inexpensive, making it a pain management tool that many more people will be able to afford. After all, what good is it to recommend a pain management tool that nobody can afford unless they are well off?
Insurance is not likely to pay for one of these devices because it would likely be considered experimental or untested even though many studies, anecdotal evidence, and over 50 years of use demonstrate its efficacy in pain management.
I would like to have included more studies as there are many more for migraine relief, which is important, but the length of this is already quite substantial, so I have to limit the number of studies I reference.
My Personal Review
Based on all of the above, I bought one of these newer TENS units intended for home use instead of professional use to test myself to have a basis for comparison to the studies above. I also got extra sticky pads since I will be testing the unit on friends who want me to.
As some of you may know, I have been having recent hip pain, so I decided to try it there first. Similar to the last unit I had about 20 years ago, it gave good pain relief that lasted longer than any topical or oral pain relievers I have tried. Did it completely stop the pain? No, but it came as close as it could come without completely eliminating the pain, so to me, that is impressive after just one use. Perhaps if I had not known I had previously had pain in my hips, I would not have realized there was a little pain barely present, but I was actively looking for any indications of pain or discomfort.
I then tried it on my right shoulder next because I, have been having pain in that shoulder, and it brought that pain down considerably, but not completely. It increased my range of motion after just one treatment to almost normal, but if I tried to really exert that right shoulder, I could tell it was not 100%, but then again, I don't think many pain management tools or pain relievers could make my shoulder 100% after just one treatment. I will test the TENS unit more on my shoulder as time goes by.
Next I tried it on a friend who had pain and decreased range of motion in their shoulder over the past two months. I only did one 20 minute treatment and the pain was alleviated and range of motion was very significantly increased. That was 3 days ago and the pain is still not noticeable according to my friend.
One study that I linked to above mentioned that regular use of TENS seemed to have somewhat of a cumulative effect and seemed to offer steady improvement with use everyday.
They even went so far as to speculate that had the test period been more extended, they thought it possible that the pain could potentially be eliminated. Next, I will test it on one of my neighbors who has pretty severe knee Osteoarthritis (KOA) to the point of needing cortisone shots regularly in the knees. To me, that will be a very good test of how well it works for KOA.
I am testing it on different areas of my back where I was not even aware that I might have pain issues or tightness, but there are some tight areas, and it seems this device is slowly loosening them up. I should add here that there may be a tendency to think that a lot must be better if a little is good. Still, in the case of TENS, too much may make you feel temporarily worse or cause you to feel sore in a way that you previously didn't until there was an over-application of TENS. So starting low and slow is not a bad idea until you are used to how your body reacts to different levels of stimulation.
I am also finding that placement of the sticky pads is important in finding the best possible response to TUT. When working on a specific problem area, it seems more advantageous to use 4 pads and utilizing both program A and program B with the pads placed in an X or + pattern to optimize the pain relieving effect.
There is a learning curve to this TENS unit. It takes time to familiarize yourself with the device and its different settings and adjustments and which program settings seem to work best for individual areas of the body. This particular device has 12 body area program options: back, neck, hand/foot, shoulder, hips, elbow, knee, etc. With each body area, there are two program choices, so altogether, there are 24 preset settings to choose from. From what I have found, some of the settings are significantly more comfortable to use than others, so I tend to use the ones I find more comfortable and still benefit even though the program I may be using is intended for another part of the body. It takes experimenting and trial and error to find the best ways to use this TENS unit for me. Just placing and removing the pads takes a little practice, as does changing the pads. Since they are sticky pads, they may stick to your fingers until you get used to handling them. Always replace the plastic cover on the pads when not in use and store them properly. They can retain their stickiness longer if you are careful to keep them from getting dirty from skin oils or handling them with dirty hands. The manufacturer of the unit I purchased recommends cleaning the skin area where you will be attaching the pads with hand sanitizer and let fully dry before applying the pads to help the pads to maintain their "stickiness" longer and last longer.
That covers most of what I have learned so far, but if there are any questions, I can try and answer them.
WARNING!
I must give the following warning regarding the "Intensity Level" for any given program. Always increase the intensity level very slowly because although this unit is small and only runs on a rechargeable battery, the output to the pads through the skin can be very powerful and can potentially hurt you or, at a minimum, scare you with its intensity!
If you decide to test one of these devices, ask your doctor first to make sure it is not contraindicated with any health issues you may have. If you have any electronic device in your body, such as a pacemaker or metal, a TENS unit is a definite no!
Here is a warning and suggestions for using a TENS Unit from the NHS UK:
nhs.uk/conditions/transcuta...
Here is an important quote from their link above:
Are there any risks of side effects?
For most people, TENS is a safe treatment with no side effects.
Some people may be allergic to the pads, and their skin may become red and irritated, but special pads for people with allergies are available.
TENS is not safe for everyone to use. Do not use it without first getting medical advice if:
you have a pacemaker or another type of electrical or metal implant in your body such as DBS,
you're pregnant, or there's a chance you might be pregnant – TENS may not be recommended early in pregnancy
you have epilepsy or a heart problem
So overall, a TENS machine seems like an excellent device to have in your health care cabinet if you are dealing with chronic or acute pain and are looking for a non-drug approach or not interested in topical pain relievers. A TENS unit seems like a reasonable alternative to consider. I feel confident I will end up using this unit more, or another unit as I have plenty of friends with various pains and pains seem to be inevitable as we age, so for me, it makes sense, but if you are younger and in excellent condition, maybe not so much.
Where to Buy and How Much Do They Cost?
I bought my unit on Amazon as Amazon has a relatively large selection. I didn't buy the most expensive as this one is mainly for testing. Still, the unit I got has some good features, such as the rechargeable battery, which seems to go a long time between charges based on the battery level still showing all three bars after my testing so far, 24 different preset programs, and dual output or two channels (A/B) to handle four leads instead of just two. This is useful for when you want to work on two separate areas simultaneously, such as your left and right knee, upper and lower back both hands, feet, elbows, or shoulders. This feature can save you considerable treatment time if you have a lot of areas you want to work on your body. This unit also has an adjustable timer that can go up to 60 minutes in increments of 10 minutes, automatically shutting the unit down once your preset program time has been reached. The unit I bought cost under $40. There are much more expensive units that approach the $500 area, and there are units under $30. I am not recommending the one I got or any unit for that matter, just letting you know what I am using for this test.
Here is a link to many units on Amazon:
amazon.com/s?k=TENS&ref=nb_...
Here is a link to the TENS unit I am testing:
amazon.com/Massager-Lifetim...
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