TENS Units

Skyller Stickfort
November 4, 2012

Dr. Parish

Over the years, we have seen many new forms of therapies

come onto the scene to help with numerous types of pain and things
that plague us. A system that has intrigued many with its small but
capable power is the TENS unit. TENS stands for Transcutaneos Electric
Nerve Stimulator. TENS units are noninvasive, inexpensive, and easy to
use. The American Physical Therapy Association defines it as the
application of electrical stimulation to the skin for pain control via skin
surface electrodes (Sluka, p. 109). Electricity has been used for
thousands of years to control pain as Aristotle had the first written
documentation. In the mid-1800s and early 1900s doctors would use it
as an analgesic or anesthetic (Sluka, p. 109).
It wasnt until 1967 that the medical field really accepted
electrical stimulation as a valid pain reliever. It was demonstrated that
high frequency stimulation activates large afferent muscle fibers
reducing neuropathic pain (Sluka, p. 109). TENS also electrically
stimulate peripheral nerves via the skin surface electrodes (Brosseau,
p. 596). In clinics, TENS is usually applied in high frequency (more than
50 Hz) or low frequency (less than 10 Hz). The frequency levels depend
on the response of the patient when in comes to their sensory level or
motor level (Sluka, p. 109). With sensory level TENS the voltage is
increased until the patient feels a light tingling but there is no motor
contraction. With motor level TENS the intensity is high enough to

produce a motor contraction and this is referred to as conventional

TENS (Sluka, p. 110).
There are several theories to support the use of TENS. The most
common one would be the gate control theory of pain. According to
this theory, stimulation of large diameter afferents by TENS inhibits
nociceptive fiber evoked responses in the dorsal horn. It involves
segmental inhibition by using neurons in the spinal cord (Sluka, p.
112). This means that TENS produce inhibition to neurotransmitters
and their receptors thus blocking the pain (Sluka, p. 113). Another
theory states that TENS results in a release of endogenous opioids.
These opioid receptors are located in the spinal cord and brain.
Concentrations of endorphins increased in the bloodstream after TENS
was administered. This suggests that at the spinal level there are
different opioids released with different stimulation frequencies and
thus possibly different receptors are activated to produce the analgesia
with the TENS. This would lead to the conclusion that TENS can lead to
the relief of pain (Sluka, p. 113).
When it comes to testing theories of pain relief via methods of
therapy, good surveys are a must. Randomization and blind studies
must be conducted to get rid of the placebo effect and false data
(Carroll, p. 798). In a fully random trial, 786 patients used TENS after
various operative procedures from cardiothoracic to gastrointestinal
surgery. Ten different TENS machines were used and different control

setting were used as well. The results were measured on a pain scale
(Carroll, p. 799). The theory that TENS can relieve and control pain was
confirmed in this study. Nearly 90% of the test groups reported
analgesic effectiveness in relieving pain (Carroll, p. 799). The authors
of this study conclude that the success of this trial has direct
correlation with the full randomization. The degree of exaggeration of
treatment when randomization is insufficient can be nearly 40%
(Carroll, p. 801).
Ever since TENS was found to be successful in relieving pain,
studies were done to see how effective it was at relieving different
types of pain for different conditions. In another study, patients with
angina pectoris (chest pain) were tested with TENS to see if it would
relieve pain. Thirteen patients with severe angina pectoris resistant to
medical treatment between the ages of 45 and 64 were tested. These
patients were non-responsive to medications they were given
(Mannheimer, p. 308). Results from the group were compared to a
control group with a lack of TENS. The results were similar with the
control group in many facets, but there were some areas where the
group with TENS differed. Blood pressure and heart rate were slightly
lower with treatment compared with the control group. At the same
heart rate that caused the control group pain, ten out of the thirteen
TENS group did not report any pain during TENS treatment
(Mannheimer, p. 310). Evidence from the study shows there may be

endorphins being released that inhibit transmission of noxious stimuli.

According to the evidence in the study, TENS has a powerful painreducing effect in patients with angina pain (Mannheimer, p. 315). If
TENS can relieve angina pain effectively, it is believed that other pain
can be relieved just as successfully.
One of the most common problems with pain today is low back
pain. 60-90% of the population in the United States is at risk of
developing it sometime in their life. In this study, several types of TENS
were used with differing intensities, frequencies, and frequency types.
170 subjects were apart of the placebo group and 251 subjects were
administered active TENS. For every outcome measured between the
groups, no significant difference was found between the two groups.
This would create evidence against the theory that TENS control pain
(Brosseau, p. 599). This does not mean that TENS was not effective
though. Although treatment benefits were not statistically significant,
patients in the TENS group consistently reported less pain, better
functionality, and greater motivation to continue with TENS treatment
(Brosseau, p. 599). It is also important to note that there was no
difference in results when it came to low frequency and high frequency.
The evidence from this randomized study does not support TENS use
or the lack of TENS use (Brosseau, p. 601).
Like many therapy methods, there is positive and negative
evidence on the use of TENS. In the end, in comes down to personal

opinion. I myself have a TENS unit at home that I enjoy using. I have
less pain when I use it to treat sore muscles. These studies have shown
that there are many different opinions when it comes to TENS usage.
The important thing is to try it for yourself to see if it helps you.

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BIBLIOGRAPHY
Sluka, K, Walsh, D. (2003). Transcutaneous Electrical Nerve
Stimulation: Basic Science Mechanism and Clinical Effectiveness.
The Journal of Pain, Vol. 4, No. 3.
Carroll, D, Tramer, M, Mcquay, H, Nye, B & Moore, A. (1996).
Randomization is important in studies with pain outcomes:
systematic review of transcutaneous electrical nerve stimulation

in acute postoperative pain. British Journal of Anaesthesia; 77:

798-803.
Mannheimer, C. (1985). The effects of transcutaneous electrical nerve
stimulation in patients with severe angina pectoris. Circulation,
Journal of the American Heart Association. 71: 308-316
Brosseau, L, Tugwell, P. (2002). Efficacy of the Transcutaneous
Electrical Nerve Stimulation for the treatment of chronic low back
pain. SPINE volume 27, No. 6. Pp 596-603.