Applications of Tens Therapy in Clinical Practice

Currently, there is an overall consensus favoring the use of TENS (Transcutaneous electrical nerve stimulation), with authorities differing on its value in different clinical situations. Generally, TENS provides initial relief of pain in 70-80% of patients. 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. Patients differ in their stimulus preferences and in their rates of compliance. In a 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)
  • Musculoskeletal pain – Examples of specific diagnoses include joint pain from rheumatoid arthritis and osteoarthritis, acute postoperative pain (eg, postthoracotomy), and acute posttraumatic pain. 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).  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.
  • Diabetic neuropathy – A literature-study report from the American Academy of Neurology stated that TENS is probably an effective therapy for painful diabetic neuropathy and should be considered for use in the treatment of this disorder (Level B).
  • Other disorders – TENS has been used successfully in patients with angina pectoris and urge incontinence, as well as in patients requiring dental anesthesia. 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.

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