UPDATE Looking for TENS Unit Recommendations

[avi123]

Nick Danger, before I had my lumbar spinal stenosis surgery (open laminectomies with no fusion and no hardware) last March, at Duke, a local physical therapist, in my town, gave me a TENS unit to take home and play with it. He did not even show me where and how to place it. When I asked the therapist what this TENS unit does, he replied, nothing, it just causes you another pain to forget the original pain in your lower back. Next, they wanted me to sign a form that my obligation would be to secure a new Rx from my Internist every 30 days for using the TENS unit (I been on Medicare for more than 20 years). And if I lose it then I would have to pay them (actually the insurer who makes the money) from my pockets around $650. At that time I could buy this unit at Walgreens for $60. So with no hesitation I tore all the forms that they gave me to sign and said good by (for good!).

[HoseCrusher]

Once again it appears that the medical community has let patents down. Avi was given a unit with no instructions and in this vacuum found it didn't work.

This kind of reminds me of people who are given a CPAP machine with no instructions or feedback and decide that the therapy doesn't work because they can't figure out how to make it work.

The key to success in both cases is education. Fortunately this form exists to help people with CPAP. I don't know if there is a similar forum for people trying to figure out how to use TENS units, but there should be.

My exposure to TENS units has been very positive. Had a friend who had electrodes placed on either side of a broken leg and his leg healed in about half the normal time. Another couple of friends were having difficulty with spasms in the back and other back pain. The TENS unit worked very well at managing this issues.

Unfortunately, no one submitted papers on these experiences, so there are no formal studies on them. We don't know exactly how these units work, but for a lot of people they do work.

I think you have a couple of choices.

You can embrace your pain and learn to live with it.

Or

You can open your mind a little and try out a TENS unit and see if it helps. I am sure that if you look hard you can find some directions on where to place the electrodes and how to use the unit. There may even be some people here that can help with that.

Choice is yours...

[palerider]

a local physical therapist, in my town, gave me a TENS unit to take home and play with it. He did not even show me where and how to place it.

aaaaand, now we discover the root of avi's hatred for TENS.

[chunkyfrog]

I had PT for a muscle strain in my back, Including sessions on a TENS unit;
I have no residual pain, but I can't honestly say what did the trick.
I would do it again in a heartbeat.
(note: I would not discount the likelihood that the unit AVI tried was set on "taze")

[avi123]

...Hyperlexis, the OP who has been sort of pushing the TENS units with several posts over the recent years could not even point to one solid medical study data done correctly. It's always what she felt and what kept her happy. Sort of a cultish approach. What if the TENS units actually cause bodily damage to other folks in addition to the wasted money buying this snake oil product? I could post dozens of tests results from reliable sources of medical data such as the New England Journal of Medicine, the Mayo Clinic Health Letter, etc. that TENS units are sham. Even the regular Wikipedia tells you that "The benefit of TENS for pain is controversial...

Wow Avi. I am one solidly against the attacks on this forum on individuals (even on you) rather than simply rebutting their objectionable posts. Today you challenge my resolve. Funny, but I am reminded of our own crochety but oft helpful Snoredog - may he rest in peace. No, I have not offered you any links to studies on TENS use in general as they are prolific and you obviously have no trouble finding research articles. As with almost anything, there will be studies "proving" a point both pro and con. We each have to assess the evidence and decide what we believe. You have obviously decided to pick and choose those that support your beliefs. That doesn't mean the other position is not represented in reputable studies. But I will not be using my time searching them out to debate an issue for which there will be no agreeing.

I do want to point out my TENS was prescribed by a respected orthopedic doctor for low back pain. Only variable is I decided to see if using it before bedtime would quiet my legs at night. And it does. Wow, dangerous cult here. Can I point you to even one study proving that TENS is effective for PLMD? No. Because to my knowledge there have not been any studies - yet. But if I were a betting woman, I'd bet it on this conversation being totally different in a few years. In the words of Snoredog - Someday science will catch up with what I'm saying. I readily acknowledge I have only anecdotal evidence. Never once pretended it was anything more. But isn't most research born out of emerging anecdotal evidence? Again, your opinion has no bearing on the validity of my experience, but you are certainly free to have it. No offense taken.

Comment,

kteague, please take it easy. I regret getting into this discussion about TENSes b/c I have no interest in it. I am ready to delete all my posts in this thread if it would satisfy anyone. I am too busy listening all day long to the situation in the Middle East where part of my family is. CHAMAS, ISIS, Iraq, Syria, Gaza, Iran, no U.S. boots on the ground, and a lousy U.S. Congress situation, and on top of it Ferguson, MO, are the issues that are important to me now. Sorry.

[letsride]

My Empi Tens definitely help with my pain management.
Maybe for some people they don't work but for me I'm thankful for it.

[BlackSpinner]

Nick Danger, before I had my lumbar spinal stenosis surgery (open laminectomies with no fusion and no hardware) last March, at Duke, a local physical therapist, in my town, gave me a TENS unit to take home and play with it. He did not even show me where and how to place it. When I asked the therapist what this TENS unit does, he replied, nothing, it just causes you another pain to forget the original pain in your lower back. Next, they wanted me to sign a form that my obligation would be to secure a new Rx from my Internist every 30 days for using the TENS unit (I been on Medicare for more than 20 years). And if I lose it then I would have to pay them (actually the insurer who makes the money) from my pockets around $650. At that time I could buy this unit at Walgreens for $60. So with no hesitation I tore all the forms that they gave me to sign and said good by (for good!).

Well so some incompetent didn't teach you how to use and it didn't work for you. That sounds just like most peoples experience with cpap - so we also throw out our cpap machines?

The placement of the pads is actually quite important. The more accurate you are with them the better it works. Sort of the same way shoes fit on the left n right foot.

[kteague]

Avi, no need to erase anything unless you just want to. There certainly are more important things going on in life than this thread. Sure hope your family members are and stay safe.

[jencat824]

I bought this one a few months ago.

How do you like it? I have been mulling over getting a TENS to maybe help with my neck and SI joint pain. Been getting worse lately and slowing me down. I have never used a TENS unit.

I just noticed this thread & wanted to add my experience.

I began using a TENS unit regularly last August when I reinjured my already damaged neck. It made the difference from eating pain pills & muscle relaxers to just sampling them occasionally. I will swear to anyone that the TENS unit made recovery possible for me without surgery. The MRI showed that I needed surgery to stabilize my neck ASAP & I chose physical therapy instead, in spite of having to locate another neurosurgeon. My ortho gave me the order for PT 'against his better judgment', and one of the first things my therapist did was get me a TENS unit. Without it I don't know if I could have done the required exercises at home daily, in between PT visits.

Now that I've got my neck under control I still use the TENS unit at least weekly, sometimes more often when needed. For me, the relaxation of those tight muscles alleviates the pain in a way no pain pill or muscle relaxer can. Its an actual physical release of the tightness & pain, whereas meds just dull the feeling. I've also found its great for pain from a pulled muscle, better for me than reaching for the meds.

Jen

[avi123]

Did you mean this source:

Johnson M (2014) Transcutaneous electrical nerve stimulation: review of effectiveness. Nursing Standard. 28, 40, 44-53



The currently proposed mechanisms by which TENS produces neuromodulation include the following:

•Presynaptic inhibition in the dorsal horn of the spinal cord


•Endogenous pain control (via endorphins, enkephalins, and dynorphins)[5]


•Direct inhibition of an abnormally excited nerve


•Restoration of afferent input


The results of laboratory studies suggest that electrical stimulation delivered by a TENS unit reduces pain through nociceptive inhibition at the presynaptic level in the dorsal horn, thus limiting its central transmission. The electrical stimuli on the skin preferentially activate low-threshold, myelinated nerve fibers. The afferent input from these fibers inhibits propagation of nociception carried in the small, unmyelinated C fibers by blocking transmission along these fibers to the target or T cells located in the substantia gelatinosa (laminae 2 and 3) of the dorsal horn.

Studies show marked increases in beta endorphin and met-enkephalin with low-frequency TENS, with demonstrated reversal of the antinociceptive effects by naloxone.[6] These effects have been postulated to be mediated through micro-opioid receptors. Research indicates, however, that high-frequency TENS analgesia is not reversed by naloxone, implicating a naloxone-resistant, dynorphin-binding receptor. A sample of cerebral spinal fluid in those subjects demonstrated increased levels of dynorphin A.

The mechanism of the analgesia produced by TENS is explained by the gate-control theory proposed by Melzack and Wall in 1965.[7] The gate usually is closed, inhibiting constant nociceptive transmission via C fibers from the periphery to the T cell. When painful peripheral stimulation occurs, however, the information carried by C fibers reaches the T cells and opens the gate, allowing pain transmission centrally to the thalamus and cortex, where it is interpreted as pain. The gate-control theory postulates a mechanism by which the gate is closed again, preventing further central transmission of the nociceptive information to the cortex. The proposed mechanism for closing the gate is inhibition of the C-fiber nociception by impulses in activated myelinated fibers.

Technical Considerations

A transcutaneous electrical nerve stimulation (TENS) unit consists of 1 or more electrical-signal generators, a battery, and a set of electrodes. The TENS unit is small and programmable, and the generators can deliver trains of stimuli with variable current strengths, pulse rates, and pulse widths. The preferred waveform is biphasic, to avoid the electrolytic and iontophoretic effects of a unidirectional current. The usual settings for the stimulus parameters used clinically are the following:

•Amplitude - Current at a comfortable, low intensity level, just above threshold


•Pulse width (duration) - 10-1000 microseconds


•Pulse rate (frequency) - 80-100 impulses per second (Hz); 0.5-10 Hz when the stimulus intensity is set high


When TENS is used analgesically, patients are instructed to try different frequencies and intensities to find those that provide them with the best pain control. Optimal settings of stimulus parameters are subjective and are determined by trial and error. Electrode positioning is quite important. Usually, the electrodes are initially placed on the skin over the painful area, but other locations (eg, over cutaneous nerves, trigger points, acupuncture sites) may give comparable or even better pain relief.

The 3 options for the standard settings used in different therapeutic methods of TENS application include the following:

•Conventional TENS has a high stimulation frequency (40-150 Hz) and low intensity, just above threshold, with the current set between 10-30 mA. The pulse duration is short (up to 50 microseconds). The onset of analgesia with this setup is virtually immediate. Pain relief lasts while the stimulus is turned on, but it usually abates when the stimulation stops. Patients customarily apply the electrodes and leave them in place all day, turning the stimulus on for approximately 30-minute intervals throughout the day. In individuals who respond well, analgesia persists for a variable time after the stimulation stops.


•In acupuncturelike settings, the TENS unit delivers low frequency stimulus trains at 1-10 Hz, at a high stimulus intensity, close to the tolerance limit of the patient. Although this method sometimes may be more effective than conventional TENS, it is uncomfortable, and not many patients can tolerate it. This method often is considered for patients who do not respond to conventional TENS.

•Pulsed (burst) TENS uses low-intensity stimuli firing in high-frequency bursts. The recurrent bursts discharge at 1-2 Hz, and the frequency of impulses within each burst is at 100 Hz. No particular advantage has been established for the pulsed method over the conventional TENS method.

Patient comfort is a very important determinant of compliance and, consequently, of the overall success of treatment. The intensity of the impulse is a function of pulse duration and amplitude. Greater pulse widths tend to be more painful. The acupuncturelike method is less tolerable, because the impulse intensity is higher.

The amount of output current depends on the combined impedance of the electrodes, skin, and tissues. With repetitive electrical stimuli applied to the same location on the skin, the skin impedance is reduced, which could result in greater current flow as stimulation continues. A constant current stimulator, therefore, is preferred in order to minimize sudden, uncontrolled fluctuations of current intensity related to changes in impedance. An electroconductive gel applied between the electrode and skin serves to minimize the skin impedance.

Medical complications arising from use of TENS are rare. However, skin irritation can occur in as many as 33% of patients, due, at least in part, to drying out of the electrode gel. Patients need to be instructed in the use and care of TENS equipment, with particular attention to the electrodes.

In some cases, individuals react to the tape used to secure the electrodes. Skin irritation is minimized by using disposable, self-adhesive electrodes and repositioning them slightly for repeated applications. The use of TENS is contraindicated in patients with a demand-type pacemaker, because the stimulus output of the TENS unit may drive or inhibit the pacemaker.

A variety of newer transcutaneous or percutaneous electrical stimulation modalities have emerged. They include the following:

•Interferential current therapy (IFC) is based on summation of 2 alternating current signals of slightly different frequency. The resultant current consists of a cyclical modulation of amplitude, based on the difference in frequency between the 2 signals. When the signals are in phase, they summate to an amplitude sufficient to stimulate, but no stimulation occurs when they are out of phase. The beat frequency of IFC is equal to the difference in the frequencies of the 2 signals. For example, the beat frequency and, hence, the stimulation rate of a dual channel IFC unit with signals set at 4200 and 4100 Hz is 100 Hz.

•IFC therapy can deliver higher currents than TENS can. IFC can use 2, 4, or 6 applicators, arranged in either the same plane, for use on such regions as the back, or in different planes in complex regions (eg, the shoulder).

•Percutaneous electrical nerve stimulation (PENS) combines advantages of electroacupuncture and TENS. Rather than using surface electrodes, PENS uses acupuncturelike needle probes as electrodes, with these placed at dermatomal levels corresponding to local pathology. The main advantage of PENS over TENS is that it bypasses local skin resistance and delivers electrical stimuli at the precisely desired level in close proximity to the nerve endings located in soft tissue, muscle, or periosteum.[3]

Applications of Tens in Clinical Practice


Literature on the effectiveness of transcutaneous electrical nerve stimulation (TENS) in a variety of medical conditions reports a wide range of outcomes, from very positive to negative. Currently, there is an overall consensus favoring the use of TENS, with authorities differing on its value in different clinical situations. Generally, TENS provides initial relief of pain in 70-80% of patients, but the success rate decreases after a few months or longer to around 20-30%. To exclude a false-negative response, a trial of TENS for at least 1 hour should be given to confirm potential benefit from subsequent continuous use.

According to Johnson, the time from the start of stimulation to the onset of analgesia varies from almost immediate to hours (on average, 20-30 minutes in over 75% of patients and 1 hour in 95% of patients).[8] The duration of analgesia also varies considerably, continuing only for the duration of stimulation in some patients and providing considerable, prolonged poststimulation relief in others. The same TENS protocol may have different degrees of antinociception in acute experimental pain compared with chronic clinical pain in patients with chronic low back pain (LBP).[9, 10, 11]

Patients differ in their stimulus preferences and in their rates of compliance. In Johnson's study of compliance in patients who benefited from TENS, 75% used the device on a daily basis. Patients showed individual preferences for particular pulse frequencies and patterns, and they consistently adjusted their stimulators to these settings in subsequent treatment sessions.

Indications for the use of TENS

Neurogenic pain (eg, deafferentation pain, phantom pain), sympathetically mediated pain, postherpetic neuralgia, trigeminal neuralgia, atypical facial pain, brachial plexus avulsion, pain after spinal cord injury (SCI)[12]

Musculoskeletal pain - Examples of specific diagnoses include joint pain from rheumatoid arthritis and osteoarthritis, acute postoperative pain (eg, postthoracotomy), and acute posttraumatic pain.[13, 14, 15, 16, 17, 18, 19] After surgery, TENS is most effective for mild to moderate levels of pain, and it is ineffective for severe pain. The use of TENS in chronic LBP and myofascial pain is controversial, with placebo-controlled studies failing to show statistically significant beneficial results. A literature-study report from the American Academy of Neurology recommended against the use of TENS for the treatment of chronic LBP, stating that the strongest evidence indicates that it is ineffective against this condition (Level A).[20] Uncertainty also exists about the value of TENS in tension headache.

Visceral pain and dysmenorrhea - TENS has been successfully applied to these conditions as well.[21]


Diabetic neuropathy - A literature-study report from the American Academy of Neurology stated that TENS is probably an effective therapy or painful diabetic neuropathy and should be considered for use in the treatment of this disorder (Level B).[20]

[My, Avi, comment:

From NIH: Peripheral Neuropathy Fact Sheet

More than 100 types of peripheral neuropathy have been identified, each with its own characteristic set of symptoms, pattern of development, and prognosis. Impaired function and symptoms depend on the type of nerves-motor, sensory, or autonomic-that are damaged. Motor nerves control movements of all muscles under conscious control, such as those used for walking, grasping things, or talking. Sensory nerves transmit information about sensory experiences, such as the feeling of a light touch or the pain resulting from a cut. Autonomic nerves regulate biological activities that people do not control consciously, such as breathing, digesting food, and heart and gland functions. Although some neuropathies may affect all three types of nerves, others primarily affect one or two types. Therefore, doctors may use terms such as predominantly motor neuropathy, predominantly sensory neuropathy, sensory-motor neuropathy, or autonomic neuropathy to describe a patient's condition.]

Other disorders - TENS has been used successfully in patients with angina pectoris and urge incontinence, as well as in patients requiring dental anesthesia.[22, 23] Reports discuss the use of TENS to assist patients in regaining motor function following stroke, to control nausea in patients undergoing chemotherapy, as an opioid -sparing modality in postoperative recovery, and in postfracture pain.[24, 25, 26, 27, 28, 29, 30, 31, 10]


Contraindications for the use of TENS

TENS should not be used in patients with a pacemaker (especially of the demand type).


TENS should not be used during pregnancy, because it may induce premature labor.


TENS should not be applied over the carotid sinuses due to the risk of acute hypotension through a vasovagal reflex.


TENS should not be placed over the anterior neck, because laryngospasm due to laryngeal muscle contraction may occur.


The electrodes should not be placed in an area of sensory impairment (eg, in cases of nerve lesions, neuropathies), where the possibility of burns exists.


A TENS unit should be used cautiously in patients with a spinal cord stimulator or an intrathecal pump.


Comparison Between Tens and Other Electrical Modalities


A number of studies have compared transcutaneous electrical nerve stimulation (TENS) with similar therapeutic modalities, including percutaneous electrical nerve stimulation (PENS), interferential current therapy (IFC), and acupuncture.[21, 32] The results included the following:

•In one study of elderly patients with chronic low back pain (LBP), acupuncture and TENS had demonstrable benefits, with the acupuncture group demonstrating improvement in spinal flexion.


•In patients with chronic LBP and sciatica, PENS was more effective than TENS in providing short-term pain relief and improved function, including an improved quality of sleep and sense of well-being.


•Overall, 91% and 73% of patients, respectively, chose PENS as the preferred modality for pain relief in LBP and sciatica.


•PENS has been used successfully for pain relief in patients with acute herpes zoster and in persons suffering from cancer with bony metastases.


•IFC and TENS had a statistically significant effect on the median nerve excitation threshold in young women.

[kteague]

Regarding the Johnson M (2014) Transcutaneous electrical nerve stimulation: review of effectiveness. Nursing Standard. 28, 40, 44-53...
That extremely helpful review, though at times over my head, explained a lot to me about the mysteries of not just the TENS but also the workings of the nervous system. Helped me understand why a setting that was comfortable for me at onset could become painful as treatment progresses. The one thing the technicalities in this information did indicate to me is that I would likely benefit from professional guidance in my use of this device to optimize its potential. There may be more effective electrode positions that my general low back placement is not achieving, and/or more effective settings. It also helped me understand why the wide variety of experiences with the device. So many variables that the word "pain" encompasses. Easy to see why the discrepancies in experiences using TENS. For some, it doesn't work, whether due to usage practices or pain specifics. Thanks for this information. More to think about. And confirmation once again in my mind and a reminder that we don't have to have the same experiences and in cases like this it is not a matter of right or wrong.

[StuUnderPressure]

Someone mentioned a prescription for a Tens Unit.

Is a prescription really needed to purchase a Tens Unit?
Or, would a prescription be required only by Medicare & other insurances before they would pay for a Tens Unit?

What is the general cost range for a reliable Tens Unit?

Looks like the cost of a Tens Unit is linked to the number of sensors.
What are the minimum & maximum number of sensors one would need?

[BlackSpinner]

Someone mentioned a prescription for a Tens Unit.

Is a prescription really needed to purchase a Tens Unit?
Or, would a prescription be required only by Medicare & other insurances before they would pay for a Tens Unit?

What is the general cost range for a reliable Tens Unit?

Looks like the cost of a Tens Unit is linked to the number of sensors.
What are the minimum & maximum number of sensors one would need?

I bought it off the shelf for $100 Cdn so it will be less in the USA. The original one she had was a prescription but that was 20 years ago when they were very expensive. If you want your insurance to pay for top of the line model you will probably need a prescription along with a referral to a PT specialist.

[squid13]

My wife and I got ours from Medicare and you need a prescription and we picked up the EMPI Select from the PT department at our Medical Center. We were given complete instructions on how to use and pad placement, really quite through with there presentation.

[StuUnderPressure]

My wife and I got ours from Medicare and you need a prescription and we picked up the EMPI Select from the PT department at our Medical Center. We were given complete instructions on how to use and pad placement, really quite through with there presentation.

Follow up Questions Please:

Do you & your wife EACH have a Tens Unit?

Does Medicare buy it outright OR does it try to rent it like an APAP?

Since you bought yours from a PT Dept, I assume that Medicare does NOT require that you obtain it from a DME?

How many pads does the Empi Select have?