Transcutaneous Electrical Nerve Stimulation: Mechanisms, Clinical Application and Evidence

Abstract

• Transcutaneous electrical nerve stimulation (TENS) is a non-invasive, inexpensive, self-administered technique to relieve pain. • There are few side effects and no potential for overdose so patients can titrate the treatment as required. • TENS techniques include conventional TENS, acupuncture-like TENS and intense TENS. In general, conventional TENS is used in the first instance. • The purpose of conventional TENS is to selectively activate large diameter non-noxious afferents (A-beta) to reduce nociceptor cell activity and sensitization at a segmental level in the central nervous system. • Pain relief with conventional TENS is rapid in onset and offset and is maximal when the patient experiences a strong but non-painful paraesthesia beneath the electrodes. Therefore, patients may need to administer TENS throughout the day. • Clinical experience suggests that TENS may be beneficial as an adjunct to pharmacotherapy for acute pain although systematic reviews are conflicting. Clinical experience and systematic reviews suggest that TENS is beneficial for chronic pain.

Hydrogel bioelectronics

“…One classical example of epidermal bioelectronic stimulation is transcutaneous electrical nerve stimulation (TENS), which has been widely adopted in clinical settings for pain relief. [55][56][57][58] Despite the broadness in forms and applications, all electrodebased bioelectronic stimulations share common physical principles. On the tissue side, the transmembrane potential comprises the most basic bioelectronic activity at the nm scale.…”

Efficacy of transcutaneous electrical nerve stimulation in the treatment of chronic pelvic pain

“…Ancient Egyptians (1200 BC) and Romans (46 AD) have used fishes to deliver electric current therapy for various ailments. [45] TENS is based on the gate control theory of abolishing the local pain reflex arc. [6] TENS triggers the hypothetical gate located in the lamina V of dorsal horn ganglia of the spinal cord to close.…”

Cycling Sacral Root Neuromodulation: Pilot Study to Assess the Effectiveness of This Mode in Neuromodulator Programming for the Treatment of Chronic Pelvic Pain Syndrome

“…CSNM works exactly like TENS, utilizing the same neurophysiological pathways and mechanisms of action, but only recruiting a larger number of fibers with a better result, avoiding the fatigue of muscles and overstimulation of nerves present with continuous SNM, and with less pelvic floor contracture, the latter being a fundamental part of pain persistence [35]. Recent research with PET scanning indicates that at the level of the brain, the activity of centers in the paraventricular grey matter can be enhanced or reduced by sacral nerve stimulation [36].…”