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According to new guidelines issued by the American Academy of Neurology, the popular pain-relief treatment called transcutaneous electric nerve stimulation, or TENS, is not likely to help the millions of Americans who live with chronic low back pain and should therefore not be recommended for that purpose. Currently, back pain is the second most common cause of disability in the U.S. with eight out of ten adults experiencing lower back pain in their lifetime. TENS is aimed at reducing this problem. It is administered through a small battery-operated generator, about the size of a Blackberry, which is connected to a set of electrodes placed at key points on the patient’s skin. Experts hope this will overstimulate the nerves that sense pain, which will confuse the brain in the process and block out the real pain signals. Although the process does not have many side effects and is relatively cheap (about $100), since the process is not proven to work, physicians are being asked to stop prescribing the treatment.

The guidelines were based on a series of studies that compared TENS with a mock TENS procedure, similar to a placebo, aimed at reducing chronic back pain, which is defined as pain that lasts longer than three months. Two of the studies showed no difference in chronic back pain when patients were given TENS, whereas the other studies had mixed results but were considered less reliable. Because the guidelines were based off of only a few tests, some physicians say the guidelines should not be considered "gospel". Two other studies have found the TENS technology to work in the cases of nerve pain associated with diabetes, though subsequent research is still needed.

In the new guidelines, professionals are calling for more studies of TENS particularly in patients that have never used the device before. In the meantime, some physicians say there is no reason that their patients should stop using TENS. It is an inexpensive, basically risk-free technology that may produce good results; if it does not produce the results the patient is receiving, they can return it.

7 Comments

  1. Gravatar for Rick Olderman

    This isn't surprising to me. I'm a physical therapist specializing in treating chronic pain and I never use TENS, ultrasound, ice, or heat. Instead fixing chronic pain issues, whether they are back, neck, hip etc involves correcting anatomical, biomechanical, and movement-based function. This is usually simple to do but most people don't understand the anatomy involved.

  2. These studies are always of interest, but it makes yu wonder about the real world cases where clients have been helped by TENS units. I assume the defense will now jump all over this as some reason to argue fraud or make this the plaintiffs fault. I have seen a lot of things help and have always believed that there is no perfect solution. More problems come when doctors lock into single solutions.

  3. Gravatar for Greg Webb

    Mr. Olderman,

    This guideline was surprising to me. I have had several clients of mine who used TENS units for low back pain and said the units were helpful in relieving pain. Perhaps this is a situation where each person's anatomic differences do make a difference in efectiveness. Regardless, I think it is important to note that physicians are apparently saying there is no harm in using the units. It will be interesting to see how this particular area of pain relief therapy progresses in the future. Thank you for reading the blog and commenting.

    Greg Webb

  4. Gravatar for Greg Webb

    Mike,

    Thank you for the comment. I agree with you. I often wonder about these studies; I think it is important to know who is funding them and who is actually running them. As I indicated earlier in a response to Mr. Olderman, I have had several clients swear by the pain relief they received from the TENS unit. Maybe it depends upon the individual? I appreciate your insight into this matter.

    Greg Webb

  5. Gravatar for Rick Olderman

    I agree with you, Mr. Webb, that a TENS unit may provide relief. Pain relief can fall along a great spectrum however. What I am describing is fixing the reasons for the pain in the first place. A TENS unit does not change the underlying poor function of muscles, biomechanics, or movement deficiencies that cause pain. Instead they typically "confuse" the brain so it doesn't focus on the pain signals coming from damaged tissue.

    So, while pain relief is possible with a TENS unit, it typically doesn't address the root causes of pain.

    I don't disagree with physicians that the units Aren't causing more damage.

  6. Gravatar for Greg Webb

    Mr. Olderman,

    Excellent points! I understand what you are saying - the TENS unit only helps the symptom for a bit, but does not fix the problem. I suppose that it is kind of like taking an OTC pain pill that only masks the pain for a while, but may not help with the underlying problem, like torn muscles or tendons. I am glad you pointed that out because I was not thinking in those terms. Thanks for commenting again.

    Greg Webb

  7. Gravatar for Mark Deshaies

    All great comments from people who do not suffer from chronic pain. I do....every minute of the day. I have tried surgery (nice try), Yoga (helped), drugs (got addicted to Vicodin...thanks Doc), physical therapy (emptied my wallet), chiropractic, (jury is out on that one), Ice (great in Maine in January), and TENS therapy...guess what, it helps! It's cheap, low impact and what the heck? I am not going to correct the underlying problem, unless I am born again with a better back so poo on you, TENS helps me on those really bad days!

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