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Transcutaneous electrical nerve stimulation

transcutaneous electrical nerve stimulation, transcutaneous electrical nerve stimulation device
Transcutaneous electrical nerve stimulation TENS or TNS is the use of electric current produced by a device to stimulate the nerves for therapeutic purposes TENS, by definition, covers the complete range of transcutaneously applied currents used for nerve excitation although the term is often used with a more restrictive intent, namely to describe the kind of pulses produced by portable stimulators used to treat pain1 The unit is usually connected to the skin using two or more electrodes A typical battery-operated TENS unit is able to modulate pulse width, frequency and intensity Generally TENS is applied at high frequency >50 Hz with an intensity below motor contraction sensory intensity or low frequency <10 Hz with an intensity that produces motor contraction2 While the use of TENS has proved effective in clinical studies, there is controversy over which conditions the device should be used to treat3


  • 1 Medical uses
    • 11 Pain
    • 12 Labor pain
    • 13 Dentistry
  • 2 History
    • 21 Modern
  • 3 Safety
  • 4 References
  • 5 Further reading

Medical usesedit


TENS devices available to the domestic market are used as a non-invasive nerve stimulation intended to reduce both acute and chronic pain One review from 2007 felt that the evidence supports a benefit in chronic musculoskeletal pain4 while another review from the Cochrane Collaboration in 2008 deemed the evidence of poor quality and thus no conclusions were possible regarding chronic pain5 Results from a task force on neck pain in 2008 found no clinically significant benefit to TENS for the treatment of neck pain when compared to a placebo treatment6 A 2010 review did not find evidence to support the use of TENS for chronic low back pain78 There is tentative evidence that it may be useful for painful diabetic neuropathy7 As of 2015, the efficacy of TENS therapy for phantom limb pain is not known as no randomized controlled trials have been performed9

In principle, an adequate intensity of stimulation is necessary to achieve pain relief with TENS1011 An analysis of treatment fidelity meaning that the delivery of TENS in a trial was in accordance with current clinical advice, such as using "a strong but comfortable sensation" and suitable, frequent treatment durations showed that higher fidelity trials tended to have a positive outcome12

A few studies have shown objective evidence that TENS may modulate or suppress pain signals in the brain One used evoked cortical potentials to show that electric stimulation of peripheral A-beta sensory fibers reliably suppressed A-delta fiber nociceptive processing13 Two other studies used functional magnetic resonance imaging fMRI: one showed that high-frequency TENS produced a decrease in pain-related cortical activations in patients with carpal tunnel syndrome,14 while the other showed that low-frequency TENS decreased shoulder impingement pain and modulated pain-induced activation in the brain15

A head-mounted TENS device called Cefaly was approved by the United States Food and Drug Administration, on March 11, 2014, for the prevention of migraines The Cefaly device was found effective in preventing migraine attacks in a randomized sham-controlled trial16 This was the first TENS device which the FDA approved for pain prevention, as opposed to pain suppression17

Labor painedit

A significant number of TENS machine brands have been targeted for use for labor pain, although a 1997 report of a study done by the University of Oxford said that TENS "has been shown not to be effective in postoperative and labour pain"18 Use is documented in the attached references: in obstetric care, particularly in labor19


TENS has been extensively used in non-odontogenic orofacial pain relief20 In addition, TENS and ultra low frequency-TENS ULF-TENS are commonly employed in diagnosis and treatment of temporomandibular joint dysfunction TMD20 Further clinical studies are required to determine its efficacy20


Electrical stimulation for pain control was used in ancient Rome, 63 AD It was reported by Scribonius Largus that pain was relieved by standing on an electrical fish at the seashore21 In the 16th through the 18th century various electrostatic devices were used for headache and other pains Benjamin Franklin was a proponent of this method for pain relief22 In the 19th century a device called the electreat, along with numerous other devices were used for pain control and cancer cures Only the electreat survived into the 20th century, but was not portable, and had limited control of the stimulus23 Development of modern TENS unit is generally credited to C Norman Shealycitation needed


The first modern, patient-wearable TENS was patented in the United States in 197424 It was initially used for testing the tolerance of chronic pain patients to electrical stimulation before implantation of electrodes in the spinal cord dorsal column25 The electrodes were attached to an implanted receiver, which received its power from an antenna worn on the surface of the skin Although intended only for testing tolerance to electrical stimulation, many of the patients said they received so much relief from the TENS itself that they never returned for the implant

A number of companies began manufacturing TENS units after the commercial success of the Medtronic device became known The neurological division of Medtronic, founded by Don Maurer, Ed Schuck and Charles Ray, developed a number of applications for implanted electrical stimulation devices for treatment of epilepsy, Parkinson's disease, and other disorders of the nervous system

Today many people confuse TENS with electrical muscle stimulation EMS EMS and TENS devices look similar, with both using long electric lead wires and electrodes TENS is for blocking pain, where EMS is for stimulating muscles


There are several anatomical locations where TENS electrodes are contraindicated:

  • Over the eyes due to the risk of increasing intraocular pressure26
  • Transcerebrally27
  • On the front of the neck due to the risk of an acute hypotension through a vasovagal response or even a laryngospasm2628
  • Through the chest using an anterior and posterior electrode positions,26 or other transthoracic applications understood as "across a thoracic diameter"; this does not preclude coplanar applications28
  • Internally, except for specific applications of dental, vaginal, and anal stimulation that employ specialized TENS units26
  • On broken skin areas or wounds, although it can be placed around wounds26
  • Over a tumor/malignancy based on in vitro experiments where electricity promotes cell growth2628
  • Directly over the spinal column

TENS used across an artificial cardiac pacemaker or other indwelling stimulator, including across its leads may cause interference and failure of the implanted device Serious accidents have been recorded in cases when this principle was not observed A 2009 review in this area suggests that electrotherapy, including TENS, "are best avoided" in patients with pacemakers or implantable cardioverter-defibrillators ICDs They add that "there is no consensus and it may be possible to safely deliver these modalities in a proper setting with device and patient monitoring", and recommend further research The review found several reports of ICDs administering inappropriate treatment due to interference with TENS devices, but notes that the reports on pacemakers are mixed: some non-programmable pacemakers were inhibited by TENS, but others were unaffected or auto-reprogrammed29

The use of TENS is likely to be less effective on areas of numb skin/decreased sensation due to nerve damage It may also cause skin irritation due to the inability to feel currents until they are too high26 There's an unknown level of risk when placing electrodes over an infection possible spreading due to muscle contractions, but cross contamination with the electrodes themselves is of greater concern30 TENS should also be used with caution in people with epilepsy or pregnant women; do not use over area of the uterus as the effects of electrical stimulation over the developing fetus are not known2831


  1. ^ Robertson
  2. ^ Robinson, Andrew J; Lynn Snyder-Mackler 2007-09-01 Clinical Electrophysiology: Electrotherapy and Electrophysiologic Testing Third ed Lippincott Williams & Wilkins ISBN 0781744849 
  3. ^ DeSantana JM, Walsh DM, Vance C, Rakel BA, Sluka KA December 2008 "Effectiveness of Transcutaneous Electrical Nerve Stimulation for Treatment of Hyperalgesia and Pain" Curr Rheumatol Rep 10 6: 492–499 PMC 2746624  PMID 19007541 doi:101007/s11926-008-0080-z 
  4. ^ Johnson M, Martinson M 2007 "Efficacy of electrical nerve stimulation for chronic musculoskeletal pain: A meta-analysis of randomized controlled trials" Pain 130 1–2: 157–165 PMID 17383095 doi:101016/jpain200702007 
  5. ^ Nnoaham KE, Kumbang J 2008 Nnoaham, Kelechi E, ed "Transcutaneous electrical nerve stimulation TENS for chronic pain" The Cochrane Library 3: CD003222 PMID 18646088 doi:101002/14651858CD003222pub2 
  6. ^ Haldeman S, Carroll L, Cassidy JD, Schubert J, Nygren A 2008 "The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders" Spine 33 4 Suppl: S5–S7 PMID 18204400 doi:101097/BRS0b013e3181643f40 CS1 maint: Multiple names: authors list link
  7. ^ a b Dubinsky RM, Miyasaki J 2009 "Assessment: Efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders an evidence-based review: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology" Neurology 74 2: 173–176 PMID 20042705 doi:101212/WNL0b013e3181c918fc 
  8. ^ Khadilkar A, Odebiyi DO, Brosseau L, Wells GA 2008 Brosseau, Lucie, ed "Transcutaneous electrical nerve stimulation TENS versus placebo for chronic low-back pain" The Cochrane Library 4: CD003008 PMID 18843638 doi:101002/14651858CD003008pub3 CS1 maint: Multiple names: authors list link
  9. ^ Johnson MI, Mulvey MR, Bagnall AM August 2015 "Transcutaneous electrical nerve stimulation TENS for phantom pain and stump pain following amputation in adults" Cochrane Database of Systematic Reviews 8: CD007264 PMID 26284511 doi:101002/14651858CD007264pub3 
  10. ^ Bjordal JM, Johnson MI, Ljunggreen AE 2003 "Transcutaneous electrical nerve stimulation TENS can reduce postoperative analgesic consumption A meta-analysis with assessment of optimal treatment parameters for postoperative pain" European Journal of Pain 7 2: 181–188 PMID 12600800 doi:101016/S1090-38010200098-8 
  11. ^ Rakel B, Frantz R 2003 "Effectiveness of transcutaneous electrical nerve stimulation on postoperative pain with movement" The journal of pain : official journal of the American Pain Society 4 8: 455–464 PMID 14622666 doi:101067/S1526-59000300780-6 
  12. ^ Bennett MI, Hughes N, Johnson MI 2011 "Methodological quality in randomised controlled trials of transcutaneous electric nerve stimulation for pain: Low fidelity may explain negative findings" Pain 152 6: 1226–1232 PMID 21435786 doi:101016/jpain201012009 
  13. ^ Ellrich J, Lamp S 2005 "Peripheral Nerve Stimulation Inhibits Nociceptive Processing: An Electrophysiological Study in Healthy Volunteers" Neuromodulation: Technology at the Neural Interface 8 4: 225–232 PMID 22151549 doi:101111/j1525-1403200500029x 
  14. ^ Kara M, Ozçakar L, Gökçay D, Ozçelik E, Yörübulut M, Güneri S, Kaymak B, Akinci A, Cetin A 2010 "Quantification of the Effects of Transcutaneous Electrical Nerve Stimulation with Functional Magnetic Resonance Imaging: A Double-Blind Randomized Placebo-Controlled Study" Archives of Physical Medicine and Rehabilitation 91 8: 1160–1165 PMID 20684895 doi:101016/japmr201004023 
  15. ^ Kocyigit F, Akalin E, Gezer NS, Orbay O, Kocyigit A, Ada E 2012 "Functional Magnetic Resonance Imaging of the Effects of Low-frequency Transcutaneous Electrical Nerve Stimulation on Central Pain Modulation" The Clinical Journal oF Pain 28 7: 581–588 PMID 22699130 doi:101097/AJP0b013e31823c2bd7 
  16. ^ Schoenen J, Vandersmissen B, Jeangette S, Herroelen L, Vandenheede M, Gérard P, Magis D Feb 2013 "Migraine prevention with a supraorbital transcutaneous stimulator: a randomized controlled trial" Neurology 80 8: 697–704 PMID 23390177 doi:101212/WNL0b013e3182825055 
  17. ^ "FDA allows marketing of first medical device to prevent migraine headaches" fdagov 
  18. ^ McQuay HJ, Moore RA, Eccleston C, Morley S, Williams AC July 1997 "Systematic review of outpatient services for chronic pain control" Health Technology Assessment 1 6: i–iv, 1–135 PMID 9483161 
  19. ^ van der Spank JT, Cambier DC, De Paepe HM, Danneels LA, Witvrouw EE, Beerens L 2000 "Pain relief in labour by transcutaneous electrical nerve stimulation TENS" Archives of gynecology and obstetrics 264 3: 131–136 PMID 11129512 doi:101007/s004040000099 
  20. ^ a b c Chipaila, Nicolae; Sgolastra, Fabrizio; Spadaro, Alessandro; Pietropaoli, Davide; Masci, Chiara; Cattaneo, Ruggero; Monaco, Annalisa 2014-04-01 "The effects of ULF-TENS stimulation on gnathology: the state of the art" Cranio: The Journal of Craniomandibular Practice 32 2: 118–130 ISSN 0886-9634 PMID 24839723 doi:101179/0886963413Z00000000018 
  21. ^ Jensen JE, Conn RR, Hazelrigg G, Hewett JE 1985 "The use of transcutaneous neural stimulation and isokinetic testing in arthroscopic knee surgery" The American journal of sports medicine 13 1: 27–33 PMID 3872082 doi:101177/036354658501300105 
  22. ^ "Transcutaneous electrical nerve stimulation for pain relief" 
  23. ^ "What is TENS-Therapy" 
  24. ^ Maurer, D "Transcutaneous stimulator and stimulation method" US Patent 3,817,254, Publication date June 18, 1974
  25. ^ Burton C 1974 "Instrumentation for dorsal column stimulator implantation" Surgical neurology 2 1: 39–40 PMID 4810453 
  26. ^ a b c d e f g Watson, p 266
  27. ^ Bracciano, AG 2008 Physical Agent Modalities: Theory and Application for the Occupational Therapist 2 ed SLACK Incorporated p 232 ISBN 1556426496 
  28. ^ a b c d Robertson, p 159
  29. ^ Digby GC, Daubney ME, Baggs J, Campbell D, Simpson CS, Redfearn DP, Brennan FJ, Abdollah H, Baranchuk A 2009 "Physiotherapy and cardiac rhythm devices: a review of the current scope of practice" Europace 11 7: 850–859 PMID 19411677 doi:101093/europace/eup102 
  30. ^ Robertson, p 160
  31. ^ Watson, p 265
Books cited
  • Robertson, Valma J; Alex Ward; John Low; Ann Reed 2006 Electrotherapy Explained: Principles and Practice 4th ed Butterworth-Heinemann Elsevier ISBN 978-0-7506-8843-7 
  • Watson, Tim 2008 Electrotherapy: evidence-based practice 12th ed Elsevier Health Sciences ISBN 0443101795 

Further readingedit

  • Cekmen N, Salman B, Keles Z, Aslan M, Akcabay M Feb 2007 "Transcutaneous electrical nerve stimulation in the prevention of postoperative nausea and vomiting after elective laparoscopic cholecystectomy" J Clin Anesth 19 1: 49–52 PMID 17321927 doi:101016/jjclinane200605025 
  • Gan LS, Prochazka A, Bornes TD, Denington AA, Chan KM Mar 2007 "A new means of transcutaneous coupling for neural prostheses" IEEE Trans Biomed Eng 54 3: 509–17 PMID 17355064 doi:101109/TBME2006886664 
  • Ozawa M, Tsuchiyama K, Gomi R, Kurosaki F, Kawamoto Y, Aiba S Dec 2006 "Neuroselective transcutaneous electric stimulation reveals body area-specific differences in itch perception" American Academy of Dermatology 55 6: 996–1002 PMID 17097397 doi:101016/jjaad200608032 
  • Vrbová G, Hudlicka O, Schaefer Centofanti K 2008 Application of Muscle/Nerve Stimulation in Health and Disease Springer ISBN 978-1-4020-8232-0 

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