Molly Ayala
There are several pain therapies that rely on electrical impulses. Transcutaneous electrical nerve stimulation (TENS) is a well-known and widely used therapy that uses mild electrical currents to block pain signals from reaching the brain. Functional electrical stimulation (FES) is another non-invasive therapy that applies electrical impulses to weak or paralysed muscles to generate functional muscle contractions and improve movement. Other electrical stimulation therapies include Iontophoresis, Russian stimulation, Interferential Current (IFC), High-Voltage Galvanic Stimulation (HVGS), and Peripheral Nerve Stimulation (PNS). These therapies use electrical impulses to relieve pain, improve blood flow, reduce swelling, and strengthen muscles.
| Characteristics | Values |
|---|---|
| Name of Therapy | Transcutaneous Electrical Nerve Stimulation (TENS) |
| Other Names | Electrical Muscle Stimulation (EMS), Functional Electrical Stimulation (FES), Functional Electrical Therapy (FET), Transcutaneous Electrical Stimulation (TES), Neuromuscular Electrical Stimulation (NMES) |
| Type of Therapy | Non-invasive |
| How it Works | Sends mild electrical current through electrodes placed on the skin to block pain signals from reaching the brain |
| Use Cases | Short-term pain (e.g. after an injury), long-term pain (e.g. arthritis, back problems, fibromyalgia, tendinitis, osteoarthritis), wound healing, muscle relaxation, improving muscle function and movement, preventing muscle loss |
| Safety Considerations | Assessment of biostability and harmlessness, pulse amplitude, stimulation frequency and duration |
| Devices | TENS unit, RehaMove 2, Sequence Mode |
| Device Characteristics | Battery-powered, small, adjustable intensity, frequency and duration of pulses |
| Administration | Administered by a knowledgeable professional, such as a physical therapist |
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What You'll Learn
Transcutaneous Electrical Nerve Stimulation (TENS)
TENS therapy is used to treat a wide range of acute and chronic conditions, including osteoarthritis, tendinitis, fibromyalgia, chronic pelvic pain, diabetes-related neuropathy, and peripheral artery disease. It is also used for short-term pain relief after injuries or surgeries. The intensity, frequency, and duration of the electrical pulses can be adjusted to suit the user's comfort level.
TENS is a non-invasive method of pain relief that has been shown to be effective for many people. However, it is important to consult with a healthcare provider before using a TENS unit to ensure it is safe and appropriate for your specific condition. TENS units are available by prescription or over-the-counter at pharmacies, but guidance from a healthcare professional is recommended to choose the right device and placement of electrodes.
While TENS has been shown to be effective for pain management, there is ongoing debate about its efficacy for specific pain syndromes and conditions. Researchers are still working to understand how TENS works and why it is more effective for some individuals than others. Nevertheless, TENS provides a complementary approach to pain relief that can be easily administered in office, hospital, or home settings.
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Iontophoresis
The procedure involves placing medicated pads on the affected area, such as a sore joint or tendon, and connecting them to a small device that sends the electrical current through the skin. The medication is chosen based on the goals of the treatment and can be applied to either the positive or negative electrode, depending on the type of medication. The patch is then applied to the body, and the electricity pushes the medication into the injured body part.
One advantage of iontophoresis is the local delivery of medication, which minimizes adverse drug reactions and interactions. The amount of medication required to reduce inflammation in a given area is also much lower compared to oral administration, reducing the chance of adverse side effects. However, it is important to note that heat or ice should not be applied simultaneously during iontophoresis treatment as they can significantly alter blood flow and skin sensitivity levels.
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High-voltage galvanic stimulation (HVGS)
The therapy uses electrodes placed on the skin near the problem area to deliver targeted stimulation. These electrodes are small, sticky pads connected to a machine by wires, which send the electrical current through the skin and into the underlying tissues and muscles. This process is known as e-stim or electrical stimulation.
High-voltage galvanic stimulation is particularly useful in acute injuries with significant tissue trauma, bleeding, or swelling. It helps to block pain signals from reaching the brain, providing pain relief without medication. Additionally, it can improve muscle strength and control by activating weak or inactive muscles, which is beneficial during recovery.
The voltage used in HVGS can be adjusted to meet specific needs, with a typical range of 0-350 volts. The duration of treatment is also important, with studies suggesting that 60-120 minutes of application, seven days a week, is optimal for enhancing chronic dermal ulcer healing.
High-voltage galvanic stimulation has been found to be effective in wound healing and has been gaining popularity for conditions like edema reduction, Carpal Tunnel Syndrome, and Diabetic Foot.
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Peripheral nerve stimulation (PNS)
The placement of peripheral nerve stimulators can be done by anesthesiologists, pain management providers, or certified registered nurse anesthetists. Preparation for the procedure involves obtaining informed consent from the patient and assessing the patient's anatomy using ultrasound to determine the desired location for lead placement. The skin is cleaned with an alcohol-containing solution, and sterile gloves, a surgical cap, and a mask are worn during the procedure.
Absolute contraindications to PNS include allergy to any stimulator component or patient refusal. Relative contraindications include coagulopathy and local infection near the access site. Necessary equipment includes ultrasound for nerve identification, equipment to maintain sterility, appropriate needles for monopolar lead placement, and a sterile dressing.
Safety considerations for PNS involve assessing biostability and harmlessness. Extraneural electrodes have demonstrated superior long-term stability compared to intraneural electrodes. Chronic stimulation frequencies below 30 Hz and effective stimulation time below 50% are generally considered safe, while frequencies above 30 Hz require further study due to potential neural damage.
The StimRouter PNS system, for instance, has been US FDA-approved for treating peripheral mononeuropathy. It can be placed in various locations, such as the arms, trunks, and legs, to reduce pain scores and opioid consumption.
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Dorsal root ganglion stimulation (DRGS)
Dorsal root ganglion (DRG) stimulation therapy is a type of neurostimulation therapy designed to manage chronic pain in specific areas of the lower body, such as the foot, knee, hip, or groin. It is especially useful for patients with isolated chronic pain in the lower parts of the body who have not found relief from other treatments.
DRG stimulation therapy works by stimulating dorsal root ganglia (DRGs), which are structures along the spinal column made up of densely populated sensory nerves. These nerves act as regulators, controlling the signals and sensations that travel through nerve fibres along the spinal column to the brain. As each DRG is associated with a different area of the body, DRG stimulation therapy can target specific nerves to manage pain in particular parts of the body. This targeted relief makes it a reversible alternative for nerve problems that haven't responded to other treatments.
The procedure for DRG stimulation is minimally invasive. It begins with a trial period, during which temporary electrodes are placed near the dorsal root ganglion under anaesthesia and connected to an external stimulator that delivers electrical impulses. The patient then tracks their pain relief and daily activities during this trial, which typically lasts 5 to 7 days. After the trial, the temporary electrodes are removed, and the patient and physician decide if a permanent implant is appropriate. If so, the patient will be scheduled for a permanent DRG stimulator implant, which can be controlled by the patient to adjust the strength and location of stimulation or turn it off.
There are several advantages to DRG stimulation therapy. Firstly, it offers highly directed stimulation, limiting stimulation to the targeted area. Secondly, it has low energy requirements as the dorsal root ganglion is surrounded by a thin layer of spinal fluid, resulting in longer battery life. Finally, there is a marginal risk of lead migration as the dorsal root ganglion is in a confined space.
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Frequently asked questions
Electrical stimulation is a versatile tool used to target specific tissues. It can block pain signals, make muscles contract, improve blood flow, or deliver medication through the skin.
TENS therapy is a type of e-stim that uses a mild electrical current to reduce pain. It is often used to treat conditions like osteoarthritis, tendinitis, fibromyalgia, and arthritis. Small pads called electrodes are placed on the skin near the painful area and they send low-level electrical signals through the nerves to block pain messages from reaching the brain.
FES is a non-invasive treatment technique that applies electrical impulses to weak or paralysed muscles to generate a useful muscle contraction. It is often used to improve function and movement.
SCS is a neurostimulation therapy that has been used to manage intractable neuropathic pain in the lower limbs for over 50 years. It is an effective tool but it can be difficult to accurately target specific areas of pain like the groin, foot, low back, and knee.
