Transcutaneous Electrical Nerve Stimulation: pain relief with electricity

According to estimates, every third person in the world suffers from chronic pain. The most common discomforts include back pain, headaches, and nerve pain. For many sufferers, the pain is so severe that it impacts their job, social life or mind. The pain has its own clinical significance and must be treated – with electric current for example.

In this MEDICA-tradefair.com interview, Professor Berthold Langguth talks about pain treatment using transcutaneous electrical nerve stimulation, explains when it is especially beneficial and clarifies why it should not be considered an alternative healing method.

Professor Langguth, how does transcutaneous electrical nerve stimulation work?

Prof. Berthold Langguth: Transcutaneous electrical nerve stimulation (TENS) involves – as the name suggests – the electrical stimulation of nerves. This method is used for pain management because pain signals can be modulated as they travel to the brain via the stimulation of nerve pathways.

To do this, you only need a small battery-operated device. This battery is connected by cable to electrodes on the skin that are placed near the injured areas that require stimulation – on the trunk, the arms or on the legs. This is typically the area where the pain is located. Via the electrodes on the skin, low-voltage electric current is delivered, which the patient perceives as a slight tingling sensation along the nerves. The intensity level, as well as the pattern of stimulation, can be adjusted on the device. A therapy session lasts between 20 and 30 minutes.

What types of pain can be treated with this method?

Langguth: TENS therapy is used to treat a variety of chronic pain symptoms. Even though the therapy does not provide 100 percent pain relief, it significantly reduces acute and chronic pain. Electrical stimulation is especially important to manage nerve pain that is otherwise very difficult to treat. TENS therapy can provide relieve even in cases of pain caused by tissue injuries or joint deterioration – to manage severe arthritis pain for example.

Why should you use TENS therapy versus a medication-based treatment?

Langguth: In many cases, TENS is used to complement a medication-based treatment, and is not intended as a replacement. Chronic pain in particular always indicates a multimodal treatment. Multimodal means that the pain is treated at various levels by using multiple methods that work together. This typically includes medication-assisted treatment. The pain also involves orthopedic or physiotherapy treatment. The idea here is to release muscle tightness. The multimodal approach to pain management also includes psychosocial treatment, which refers to the management of pain. The goal is to find ways to avoid stressful situations that increase and intensify pain. For the most part, TENS therapy alone is not enough, but it is definitely beneficial when used in combination with other forms of treatment.

When should you withhold TENS therapy?

Langguth: TENS is generally a well-tolerated therapy with no significant contraindications or problems. Needless to say, patients living with pacemakers or other implanted electrical devices should be careful because electrical stimulation may affect the device's function. Skin diseases in the electrode application area can also limit the use of this method. As a general rule, TENS is not suitable for severe acute pain. Apart from that, you can always try this therapy for all chronic pain symptoms. That being said, not all patients benefit from TENS therapy. If the patient experiences no pain relief, it obviously makes little to no sense to continue the treatment. In other words, this is a treatment option that is not always effective.

How do patients embrace this type of therapy?

Langguth: TENS is a type of therapy with no major side effects and is therefore well-tolerated. In light of this, patients are willing to try this method. Needless to say, it also depends on the level of relief that patients are experiencing. When patients feel relief from regular electrical stimulation, their willingness to try this method is high. But when patients only experience minor relief, they typically consider it too much effort to go through with the treatment.

Many people are skeptical about alternative methods to conventional medicine. How do you think this skepticism could be overcome?

Langguth: The question is whether TENS can be referred to as an alternative healing method. I don't see it as such. TENS therapy is based on fundamental scientific research on pain management. These findings were gained more than 50 years ago. As they travel to the brain, pain signals generated in the body can be affected by sensory stimulation. We all know that pain can often be alleviated when a spot on our body hurts and we apply pressure nearby. We can modulate pain signals by activating neural pathways that transmit sensory information to the brain. This is called the gate control theory and it is where TENS comes in. We use it to manage the transmission of pain to the brain and alleviate it before it enters the central nervous system. This makes it a therapy that’s based on scientific findings. I believe we should also convey this fact to patients. If we explain how this therapy method works, they are more willing to try it. TENS therapy, in particular, is such a scientifically well-proven concept to where I would not consider it an alternative healing method.