Description of a Session
When TENS is used for pain control, patients and therapist work together to determine the parameters and intensities that work best. The therapist will ask a series of questions about the location and nature of the discomfort. Usually the electrodes are placed directly over the painful area, but sometimes a better effect is achieved by placing them over trigger or acupuncture points or cutaneous nerves. The pads will be positioned and moved if needed to get the maximum results. As the frequency is turned up the patient to a level of sensation that is comfortable. TENS units can be applied by a professional, although home use under supervision is also done.

Treatment times will vary by patient and condition. However studies show that effectiveness requires about 20- 30 minutes per session, and should be limited to this for low-frequency sessions, although the session could be repeated later that day. For high frequency, longer sessions may be needed to obtain several hours of relief. Some patients wear the unit at all times, turning it on as needed.

Course of Treatment
The course of treatment is specific to the patient and the condition being treated. Often TENS is integrated into an overall physical therapy regimen, the frequency of which will be determined by the prescribing physician. Some individuals, who are under care for chronic pain, utilize a TENS unit at home on an as needed basis, which can include daily usage as needed.

Side Effects
TENS usage generally has no major side effects. However, in approximately 35% of patients irritation of the skin may occur in the initial treatment period. These skin irritations can be due to the adhesive on the pads, in which case another type of unit should be used. Any other cause of skin irritation from a unit may be relieved by repositioning the unit slightly.

Before considering the use of TENS it is important to be aware of various health conditions in which its use is contraindicated (see Safety Issues section).

Safety Issues
Pain is a signal that something is wrong, and so it should not be masked by TENS treatment unless you have been properly diagnosed and this form of therapy has been prescribed for pain management.

If a TENS unit is used at home, it is important to follow the instructions provided by your health care practitioner. TENS units should not be used with conditions such as tuberculosis, thrombophlebitis, cancer, uncontrolled seizures, cognitive impairments, obesity, high or low blood pressure, or an acute inflammatory disease. Electrodes should never be placed on broken skin, areas of active hemorrhage, rashes or conditions like psoriasis. A TENS unit should never be placed over the eyes.

The level of the current and the depth to which it passes generally will not create any problems. However, those with cardiac conditions, a pacemaker, or pregnant women should consult with a physician first. TENS should also not be applied to the area around the head and neck without consulting a health care professional. If a unit is used at home it should never be used during sleep as the unit could become loose or too much pressure could be put on the electrodes causing skin irritation. Any skin irritation issues in general can be handled by locating the unit in a slightly different location or changing the type of electrode used.

Other Modalities That Work Well With This Approach
TENS therapy is often used in combination with other modalities which include ice packs, heat, exercise, ultrasound, biofeedback, pain management counseling, and visualization.

Content last modified on Sep 4, 2003