TENS in Multiple Sclerosis

TENS in multiple sclerosis

Transcutaneous electrical nerve stimulation (TENS) is the electrical stimulation of peripheral nerves for analgesic effects.

A TENS machine is a small battery operated unit that people can use to help them manage long-standing pain. It is totally portable and should not restrict a persons activity in any way except when showering, swimming and in some instances, when driving.

In theory TENS broadly works in two ways. Firstly it exploits Melzack and Walls gate control theory of pain. TENS stimulation can produce pre-synaptic inhibition of noxious information in the afferent C fibres.

Historically MS has been regarded as having a painless pathology. More recent evidence strongly refutes this idea. Over 50% of people with MS present with pain syndromes associated with, if not directly caused by, their pathology.

It is important to be aware that pain in MS can be intrinsic, ie directly due to the demyelinating lesion, but it can also be extrinsic in origin. Extrinsic problems, for example low back pain, can affect people with MS just like anyone else.

Acute pain syndromes such as trigeminal neuralgia, painful tonic seizures and Lhermittes sign are probably not the types of pain to be using TENS for. It is more appropriate to use TENS for chronic pain syndromes.

There are three main locations of chronic pain experienced by people with MS:
Dysasthetic extremity pain -the pain that is described as burning, tingling or shooting in nature;
Back pain often caused by reduced mobility, poor posture and the use of wheelchairs and other aids;
Painful leg spasms - TENS may be useful where antispasmodics are not tolerated.

Settings for the TN11 TENS machine.
This TENS has 5 settings, the settings used being determined by the type of pain a person is experiencing:

1. Pulse frequency (rate)
The pulse frequency (sometimes called pulse rate) - is the number of pulses per second, or Hertz (Hz) of current delivered. The frequency range typically available in TENS units is 0-250Hz.

2. Pulse duration (width)The pulse duration or width is the length of time each pulse lasts, usually in microseconds (mcsecs). The common clinically useful range of adjustment is 50-250mcsecs.

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

TENS machines have 1 Continuous mode, 2 Burst modes and 2 Modulation modes.

In the Continuous mode it is thought that the gate control theory of pain works. The frequency should be set at 80-150Hz and the pulse width at between 50mcsec - 200mcsec.
In this mode the machine can be used for long periods of time (minimum 15 minutes).

In the Burst mode it is thought the body produces endorphins.
The frequency should be 2Hz and the pulse width 200mcsec. The treatment time with this mode is around 45 minutes, 4-5 times a day.

Modulation 1 and 2 modes gives both gate control and endorphins in rotation.

TENS can be applied in four different ways:
directly to the painful area;
over peripheral nerves;
over spinal nerve roots; or
specifically to motor, trigger and acupuncture points.

TENS pads,
Traditionally black carbon rubber pads, gel and tape have been used with TENS machines. However, these are messy and may be difficult for a person to manage at home. They can also leave the patient susceptible to burns, skin irritation or allergies to the tape.

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.

Individuals must be motivated to help themselves. If they are expecting a cure or do not want to achieve some level of pain relief then using a TENS is inappropriate;

The individual or a carer must be able to apply the pads to the required area;

Individuals should be given a 15 minute trial of TENS under the supervision of a trained professional.

Precautions
Driving - individuals need to inform their insurance company if they are going to drive with the machine on as it may invalidate their insurance.

Electrode sites - do not use around the anterior cervical spine. This risks stimulating the carotid sinus, which could cause cardiac problems (usually hypotension). Neither should stimulation be attempted over the eyes due to the delicate nature of this organ.

Skin condition - electrodes should not be placed over broken skin, sores or areas of acute eczema and psoriasis.

Contact allergy - an allergy may develop to the pads, adhesive or tape used. If this occurs alternatives should be found.

Pre-existing lymphoedema - TENS is thought to have an effect on the circulatory system.

Caffeine intake - a high intake of coffee (above four cups a day) is thought to reduce the effectiveness of TENS.

Contraindications to using TENS
on-demand pacemakers;
percutaneous central venous catheter (PCVP);
1st trimester of pregnancy;
undiagnosed pain;
a confused patient;
not to be used in the shower.
people who suffer from epilepsy

Some information has been taken from Amanda Howarth RGN, B Med Sci, MSc (Pain)Lecturer, CARER Department, School of Nursing and Midwifery, The University of Sheffield

Regards peter Thornton

Posted by Peter Thornton at 10:45 AM

TENS.com.au

Welcome

Contact Info

Newsletter Signup

Useful Resources

TENS: SAFE DRUG FREE PAIN RELIEF

TENS in Multiple Sclerosis

Help With...

Featured Product

Confidentiality,
Privacy and
Security

TENS.com.au

Welcome

Contact Info

Newsletter Signup

Useful Resources

TENS: SAFE DRUG FREE PAIN RELIEF

TENS in Multiple Sclerosis

Help With...

Featured Product

Confidentiality, Privacy and Security

Confidentiality,
Privacy and
Security