Transcutaneous Electrical Nerve Stimulation (TENS)
Transcutaneous electrical nerve stimulation (TENS) has been used to treat a variety of pain conditions. Success rates range greatly due to many factors including electrode placement, chronicity of the problem, and previous treatments. It is generally used in chronic pain conditions and not indicated in the initial management of acute pain. Documentation of greater than 50% reduction in pain with a treatment trial may help substantiate its true beneficial effects as opposed to a placebo response.
Modalities should always be considered an adjunct to an active treatment program in the management of acute pain. They should never be used as the sole method of treatment. The prescribing physician should first be aware of all indications and contraindications for a prescribed modality and have a clear understanding of each modality and its level of tissue penetration.
The goals of treatment should be clear to the patient and the treating therapist from the onset of treatment. Patients are done an injustice when a therapeutic physical therapy program is modality-intensive as opposed to exercise-based. A poor functional outcome has been demonstrated in patients treated with a passive, modality-intensive program compared to those in an exercise-based program. If at all possible, patients should be instructed in the use of simple modalities at home prior to their physical therapy sessions and in conjunction with their home exercise program.
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