Transcutaneous electrical nerve stimulation (TENS) is a method in which mild electrical currents are used to relieve pain. Transcutaneous means “through the skin”. In other words, in this physical therapy method, nerve fibers are stimulated with electrical currents given over the skin. The TENS device is a small battery operated machine; At the other end of the cables connected to the machine, there are pads called electrodes that are attached to the skin.

Before the application, the skin is cleaned, then the pads are placed on the relevant area. The device generates small electric currents when powered; this is felt as tingling in the affected area. Electrical currents reduce pain signals from nerves to the spinal cord and brain; thus relieving pain and muscle spasm. With TENS, the release of endorphins, the body’s natural pain reliever molecules, can be stimulated.

What Is TENS Used For?

It is used in many problems and diseases that cause pain and muscle spasm. Low back pain, neck pain, knee pain, hip pain, sports injuries, waist-neck hernias, calcifications (osteoarthritis), fibromyalgia, MAS are the conditions in which TENS is frequently used. It is one of the most commonly used treatments in physical therapy programs. There are also types sold for home use, but we recommend that you consult a doctor before using these devices.

Does It Have Therapeutic Effects?

TENS is an effective and safe way to reduce pain. However, it has no curative effect. It is one of the methods often used within a broader treatment program. It is rarely used alone.

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The pain relief effect of TENS is explained by the gate control theory. Accordingly, the given electrical currents prevent the transmission of pain signals from the spinal cord to the brain. Another explanation is that it increases endorphins, the body’s natural pain relievers.

According to the gate control theory, the electrical currents given by TENS stimulate the A-beta type sensory nerves under the skin; This reduces the transmission rate of the signals of the C-type nerve fibers carrying the pain sensation from the spinal cord to the brain. A-beta nerve fibers are mostly stimulated by currents with a frequency of 90-130 Hz. Therefore, the TENS current frequency is mostly in this range.

A-delta nerve fibers are activated to use the endorphin mechanism. These nerve fibers are stimulated at a much lower frequency, such as 2-5 Hz. A-delta nerve stimulation causes the spinal cord to release a molecule called enkephalin that suppresses pain signals.

The “burst” mode can be used to use both mechanisms. In this mode, the device gives 2-3 Hz low frequency current between 100 Hz high frequency current. Although the strongest pain relief effect is obtained with burst current in many patients, it may be found to be more disturbing as it causes muscle contraction and scratching sensations.

There is no one effective method for everyone in TENS practice. It may take a few attempts at first to determine the frequency and type of current that is most effective in a particular person.

Reducing the pain of TENS may cause the person to tire himself/herself before full recovery and act recklessly. If the body biomechanics is corrected with flexibility and strength-enhancing exercises during the period when pain is reduced by physical therapy, long-term benefit is provided.

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Characteristics of TENS Currents

The features that distinguish TENS currents from each other are waveform, pulse duration (unit is microsecond), pulse frequency (beats per second, unit is Hertz), whether there is a burst, burst duration and current intensity (unit milliampere). The TENS waveform can be symmetrical, asymmetrical, or balanced biphasic. The pulse duration is generally between 50-400 microseconds. The pulse frequency can vary between 1 and 200 Hz.

TENS types:

  • conventional (conventional) type
  • Acupuncture type
  • short dense type
  • Burst mod
  • Modulation type

In which regions is it not used?

The front of the neck, temples, eyes, chest, areas with varicose veins, inflamed skin are the areas where this treatment is not used.

How to use?

First, electrodes are placed on the appropriate area while the device is turned off. It can be placed on the skin of the painful area, or it can be placed on the places (according to the dermatome) or acupuncture points that match the distribution of the sensory nerves. The distance between the two electrodes should be at least 2.5 cm. After the electrodes are placed, the device is turned on. It is operated with the lowest current power at first. A slight tingling is felt on the skin. Gradually the current intensity is increased. The intensity is increased until the current is felt strongly but not disturbingly. If the tingling sensation causes pain or discomfort, the current is slightly reduced. TENS can be applied in different flow patterns according to the characteristics of the pain. Treatment time can vary from 15 minutes to several hours. When the treatment is finished, the device is turned off and the electrodes are removed from the skin.

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Risk and Side Effects

It is a safe treatment that often does not cause any side effects. Pads used in 2-3% of people can cause allergies; In this case, non-allergenic pads can be used.

TENS is not used in people who have a pacemaker or other type of medical implant in their body.

It is not applied on the abdomen during pregnancy.

It should not be used without the advice of a doctor in epilepsy and heart failure.

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