Electrotherapy – for Relief of Muscle and Joint Pain

Stop Your Pain NOW before it becomes Chronic – as you read all about T.E.N.S., you will begin to understand why you can’t afford to waste anymore time getting less than everything life has to offer!

T.E.N.S.(Transcutaneous Electrical Nerve Stimulation) – An Effective Pain Management Tool

T.E.N.S.is a highly effective treatment for pain whereby electrodes are placed on or near the area of pain and soothing pulses are sent via the electrodes through the skin and along the nerve fibers. The pulses (controlled by the user at all times) suppress pain signals to the brain. T.E.N.S. also encourages the body to produce higher levels of its own natural pain killing chemicals called Endorphins and Encephalin.

Recognition of T.E.N.S. by healthcare professionals has increased dramatically over the years as results from an enormous amount of research continue to illustrate its effectiveness. Studies on T.E.N.S. have been going on since 1965 when a landmark paper entitled “Pain Mechanism:A New Theory” was written by Melzack and Wall. T.E.N.S. is used worldwide by physical therapists, pain clinics, doctors and other medical practitioners. In recent years, health professionals have been recommending T.E.N.S. for home use on a more frequent basis. By easing pin, T.E.N.S. often results in a decrease of drug intake. For many, the relief is dramatic.

Not only does T.E.N.S. help relieve pain, but the sensation felt is very pleasant and soothing and is totally controlled by the user. It is extremely easy to operate and we ensure that you will understand all instructions provided. T.E.N.S. on its own, is highly effective in MANAGING pain. However, in combination with the right exercises and proper posture, application of T.E.N.S.can actually ELIMINATE your pain within days!

You can now take this technology with you and alleviate your pain in the comfort of your own home. Don’t be intimidated by a T.E.N.S. unit – take the time to read about everything you need to know before using one effectively. You’ll be saying “Why didn’t I do this a long time ago!” Armed with specialized knowledge about injury prevention and pain reduction, our experienced Physical Therapists will guide you through the T.E.N.S. selection process and will answer any questions you still may have about T.E.N.S. Finally, do something about your pain – Buy a T.E.N.S. unit today!

About Electrotherapy

Are you concerned about taking pain relief medication because of possible side effects and health risks? Consider electrotherapy, a non-invasive pain relief technology that has been used in clinical settings for many years.

What is Electrotherapy?

Electrotherapy is a physical therapeutic treatment whereby electrical stimulation is applied to nerves and muscle-motor fibres via electro-pads placed on the skin. There are different types of electrotherapeutic devices in rehabilitation clinics today, with T.E.N.S. being one of the most popular options. Electrotherapeutic programs, utilizing prescribed variations in electrical frequencies and intensities, serve to interrupt, alter or induce specific electrical impulses in order to affect the perception of pain and/or facilitate wound healing and muscle rehabilitation. These effects are achieved by:

• reducing localized inflammation
• increasing blood flow
• stimulating muscles
• triggering the release of endorphins, hormones that act as the body’s natural analgesic

Click here to read more about how electrotherapy helps to reduce pain.

All of our electrotherapeutic medical devices have 510(k) FDA clearance, are CSA and Health Canada licensed, and may be covered up to 100% by your Extended Medical Plan! If you require assistance finding this information, please ask us and we will help.

Our experienced physical therapists will ensure that you follow the optimal T.E.N.S. pad placement for your specific condition. With a purchase of a T.E.N.S. unit, we will include the appropriate directions to help you reduce your pain as soon as possible! We strongly suggest that if you have a painful condition, that you first receive professional attention from your doctor or physical therapist. Electrotherapy is often used as an adjunct to professional treatment and should be considered as more of a pain management tool rather than comprehensive therapy on its own (it should not be a substitution for physical therapy). Once the outcome of your treatment has been determined through consultation with your health care practitioner, then it is more appropriate at this point in time to decide whether or not a T.E.N.S. unit for home use is for you.

Conditions and Types of Pain that T.E.N.S. Helps

Electrotherapy’s pain and injury management applications include treatment for:

• Acute and chronic ankle pain and ankle joint arthritis
• Acute and chronic low back pain associated with spinal nerve and disc pain or spinal osteoarthritis/degenerative disc disease(DDD)
• Acute and chronic neck pain associated with soft tissue injury to the muscles, ligaments or spinal discs, joint inflammation and spinal arthritis
• Acute, chronic and post surgical knee pain associated with muscle, tendon, ligament or joint arthritis problems
• Acute and chronic shoulder pain associated with muscle, tendon, ligament or shoulder joint arthritis
• Carpal tunnel syndrome – pain associated with compression of the nerves in the carpal tunnel
• Foot pain including Plantar Fasciitis, Achilles Tendinopathy, Morton’s Neuroma and Peripheral Neuropathy
• Post lumbar laminectomy – a type of surgery to the spine
• Use in labour and delivery
• Dental pain including TMJ pain(jaw joint)
• Facial paralysis
• Trigeminal Neuralgia
• Hip pain
• Post-operative pain
• Sciatica
• Bicipital tendonitis
• Tennis elbow
• Wrist pain
• Shin splints
• Diabetes neuropathy
• Fibromyalgia
• Degenerative Joint Disease (DJD)
• Reflex Sympathetic Dystrophy (RSD)
• Acute Herpes Zoster/Post Herpetic Neuralgia
• Rheumatoid Arthritis (RA)

How Safe is Electrotherapy?

Contra-Indications – Circumstances in which you should NOT use T.E.N.S. Remember that the current emitted from a T.E.N.S. unit travels through the skin between pairs of electrodes and only penetrates to a depth of 1-2 inches (to the level of the underlying nerve fibres). Such a small electrical current does not pose any danger. However, although electrotherapy is one of the safest treatments available, there are a few circumstances in which it should NOT be used:

DO NOT use T.E.N.S. in the following circumstances:

• If you are in your first trimester of pregnancy (it is okay to use during labor – please consult your doctor)
• If you have numbness or less feeling over a painful area
• If you have pre-existing lymphoedema. T.E.N.S. may affect lymphatic circulation, causing further fluid retention. Issues of skin integrity should also be considered

CONSULT YOUR DOCTOR before using T.E.N.S. for the following circumstances:

• If you have a pacemaker
• If you have a cardiac condition
• If you currently have Cancer or if you have previously had cancer
• If you have recently experienced unexplained noticeable weight loss
• If you have undiagnosed pain
• If you have epilepsy
• If you have had a stroke (Cerebrovascular Accident – CVA) or mini-stroke (Transient Ischemic Attack – TIA)

DO NOT use T.E.N.S. in the following ways:

• While driving or operating potentially dangerous machinery
• While in the shower
• Do not use internally (inside your body)
• Do not place pads in a way that directs the current through the chest wall (i.e. by placing one electrode on the back and the other opposite this on the front of the chest)
• Do not place pads on the front of your neck. This risks stimulating the carotid sinus, which could cause cardiac problems (usually hypotension)
• Do not apply pads over the eyes
• Do not place pads across the temples on the head
• Do not place pads over incisions or broken skin, sores and areas of eczema and psoriasis
• Do not use with very high intensity if you find that your skin feels like it burns (dermal reaction due to electrical irritation)
• Do not use if an allergy develops to the pads, adhesive or tape that is used. Find alternative materials

Notes

Drinking 3 cups or more of caffeine per day may reduce the effectiveness of T.E.N.S. There is also no evidence that T.E.N.S. can become addictive, as it merely activates your body’s own pain-fighting mechanisms.

T.E.N.S. Treatment Protocols

When you purchase a T.E.N.S. unit from us, our physical therapists will ensure that you understand how to operate your unit as effectively as possible. Based on your diagnosis or condition, we will answer your questions regarding preparation for electrode application, correct electrode (pad) placement, and correct control settings and can also provide specific treatment recommendations. This may include suggestions for duration of treatment, frequency, mode and intensity. Furthermore, we recommend that you keep a daily T.E.N.S. diary to keep a record of pad placements and settings and the corresponding pain level – this will help you determine the most effective settings for pain relief. Please contact us and we will guide you through the entire process.

T.E.N.S. can be applied in four different ways:

• directly to the painful area
• over peripheral nerves
• over spinal nerve roots
• specifically to motor, trigger and acupuncture points

A medical professional can decide on the probable cause and location of your pain and then choose the most appropriate mode and method of application. Contact us – we can help!

T.E.N.S. Pad Placement

The distance between the electrodes is important. If they are too close together the current will “short” and bypass the person, but if they are too far away from each other stimulation may be lost. Ideally pads should be a “pads width” apart. For further information, contact us.

About Ideal Treatment Periods

Studies have shown that in most cases at least 20 minutes is needed for a T.E.N.S. treatment to begin to be effective. However, in the case of using low-frequency or “burst” mode for acupuncture-like effects, 20 minutes would be considered the maximal treatment time, though it could be repeated later in the day. On the other hand, for high-frequency or “conventional” T.E.N.S., there are no rules governing total treatment times. Most people find that anywhere between 20-60 minutes can provide them with several hours of relief.

It is normally not recommended that you use your T.E.N.S. when sleeping, but rather for a couple of hours before bed-time. Rolling over on your electrodes may cause them to come off or may put excess pressure on them which could result in skin irritation.

Although we can provide very helpful information specific to your needs, we still advise you to seek medical advice from your doctor to receive an accurate diagnosis and additional treatment recommendations.

How to Buy a T.E.N.S. Unit

How Does Electrotherapy Reduce Pain?

Research into how T.E.N.S. eases pain has revealed two main ways by which it works:

1. GATE CONTROL

The ‘Gate Control’ theory was first proposed in 1965. The main concept of this theory is that the brain can only pay attention to one stimulus(or message) at a time. When a painful stimulus causes a pain receptor (specialized cell that detects painful stimuli) to send a message to the brain via a ‘pain nerve’, the brain perceives that message as ‘pain’. Similarly, if a touch receptor is stimulated, a message is sent to the brain by a ‘touch nerve’ so that the brain perceives that message as ‘touch’ rather than pain. Experience tells us that even if we feel pain after hitting our elbow, the natural response is to rub the elbow and suddenly the pain is not as intense. This is because the ‘touch nerve’ is larger and sends its information to the brain faster so that the pain message never really gets recognized by the brain. This is the same mechanism by which mom’s kisses seem to help most of the pain that children experience! T.E.N.S. also works by this method. The appropriate electrical signal stimulates the touch receptors, and via a bit of fancy signaling in the spinal cord, the pain message is not acknowledged by the brain. It is important to recognize though, that this phenomenon doesn’t take away what is causing the pain and the pain relief doesn’t last forever. It simply provides a “rest from pain” (as in the following quote by John Dryde, (1631-1700) English poet and dramatist: “For all the happiness mankind can gain is not in pleasure, but in rest from pain”) to permit you to move better and thus assist the body in getting the nutrition and activity that it needs to complete the healing of the painful area both at rest and during appropriate exercises. Pain relief usually does not continue beyond 6 hours. This time frame is similar to that of many common pain medications yet without the unwanted side-effects.

2. RELEASE OF NATURAL PAIN-RELIEVING SUBSTANCES

The other way that T.E.N.S. works to relieve pain is by stimulating the release of natural chemicals in the body which the body usually releases when there is injury or stress. The chemical substances released are known as endorphins and enkephalins. Endorphins are also naturally released by the body during prolonged exercise to produce the feeling of euphoria known as the “runner’s high”. Enkephalins are normally released with more intense but shorter duration exercise. The T.E.N.S. unit can be adjusted to selectively stimulate the release of either enkephalins or endorphins. A physical therapist can help you to select which settings of the T.E.N.S. would be most appropriate for your pain.

The small electrical signal which is developed by the T.E.N.S. device is delivered to the body by specialized pads called electrodes. These electrodes are placed around the area of pain or on other areas of your body which are known to affect perception of pain. They are designed to ensure safe and effective treatment. It is important though that you ask your physical therapist to address with you the best ways to keep the electrodes working properly and optimally. Cleaning your electrodes and washing your skin (only where you are going to place the electrodes) with warm water before each treatment can prevent your skin from becoming irritated by the treatment. A physical therapist can also help you identify exactly where the electrodes should be placed on your body to optimize your pain relief.

Acute or Chronic Pain

T.E.N.S. can be used for either acute (recent or short-term) or chronic (long-term) pain. The settings on the T.E.N.S. unit can be adjusted to more effectively treat either type of pain. Again, a physical therapist can assess your pain and advise you on the settings that would be best for your type of pain.

The two electrodes that attach to the TENS machine are called the anode and the cathode. The anode is positively charged, and sometimes represented by a + (plus) sign (sometimes coloured black). The cathode is negatively charged, and sometimes represented by a – (minus) sign (sometimes coloured red).The electrical current travels from the anode to the cathode, so the sensation is often stronger under the anode.

THREE basic modes of relieving pain with T.E.N.S.

• 1. CONTINUOUS(Constant or Normal)- The standard T.E.N.S. treatment (also known as “conventional” or “high-frequency”) is performed when the Pulse Rate is set to 60-100 pulses per second or more (in this method, rate, width (usually 200mcsec – and intensity settings are fully adjustable). It is thought that in this mode, pain relief is achieved through the gate control theory. The sensation produced with this setting can be described as a steady “buzzing” or “tingling” feeling between the electrodes. At this frequency the unit produces an electrical signal that is stronger than the pain signal that the body produces. Because the signal is perceived as stronger, it effectivelyblocks the pain signal from traveling along nerves to the brain. Most patients find that high-frequency treatments produce the quickest relief from pain, as well as providing hours of relief after the treatment if it is long enough.
• 2. BURST – A “low-frequency” or “burst” type treatment is produced when the Pulse Rate setting on the T.E.N.S. unit is below 10 pulses per second ie. 2Hz (set manually) or at “burst” mode (automatic) (in this mode, width (often set at 200mcsec) and intensity settings are fully adjustable, however, the rate setting is not adjustable). Low-frequency treatments are done at an intensity that produces visible muscle twitching. The sensation at these settings is describedas a “tapping” or “pulsating” feeling. The body reacts to this type of stimulation by releasing “endorphins” (pain-killing chemicals produced naturally in the body). These endorphins act as a chemical nerve block, effectively reducing pain by interrupting the flow of pain signals along the nerves. Patients find that this type of treatment sometimes takes longer to be effective (30 to 45 minutes), but once pain relief is experienced, it lasts for a longer period of time.
• 3. MODULATED – Pulse width is automatically varied in a cyclic pattern at intervals of 6 seconds. The modulation range of pulse width varies from the control setting value to 40% less than that value. Rate, width and intensity are fully adjustable. Modulation of the T.E.N.S. output parameters (width, rate and amplitude) may prevent the nervous system from accommodating to the continuous mode of T.E.N.S., thus improving duration of pain relief.

Other Reviews on TENS

Despite being introduced more than 30 years ago, the efficacy of TENS, based on scientific research, is still controversial. Evidence for TENS has been systematically reviewed by the Cochrane Library and by Bandolier, which produces evidence-based healthcare reviews.

The Cochrane reviews of TENS included osteoarthritis of the knee, primary dysmenorrhoea (painful menstruation), chronic pain and chronic low back pain.

With respect to knee osteoarthritis (OA), TENS was shown to be more effective in pain control than placebo but the reviewers suggested that more well-designed studies with an adequate number of participants are needed to conclude the effectiveness of TENS in the treatment of OA of the knee.

Regarding the condition of dysmenorrhoea, high frequency TENS was found to be effective in a number of small trials, but there was insufficient evidence about the effectiveness of low frequency TENS.

As for chronic low back pain, the meta-analysis carried in August 2000 found no evidence to support the use of TENS in the treatment of chronic low back pain. Regarding generalized chronic pain, results were inconclusive and multi-centred randomised controlled trials of TENS are needed for chronic pain.

Finally, for labour pain or post-operative pain, Bandolier concluded that TENS does not alleviate labour pain or post- operative pain and further trials are required to prove that it is effective for chronic pain.