Transcutaneous electrical nerve stimulation
The transcutaneous electrical nerve stimulation ( TENS ; English transcutaneous electrical nerve stimulation ) is an electromedical electrical stimulation therapy with mono- or (mostly) biphasic square pulses ( alternating current ) low frequency , 2–4 Hz (low), or high frequency, 80–100 Hz (high ), which is mainly used to treat pain (analgesia) and to stimulate muscles. The current forms can be the burst tens either as a constant pulse sequence of square needle pulses or as an interrupted pulse sequence . The TENS method was developed in the 1970s. Experiments with neurostimulation have been carried out for a long time, but a rational application did not begin until the gate control theory of pain ( Patrick David Wall / Bill Sweet, C. Norman Shealy et al.).
Mode of action
The electrical impulses are transmitted to the skin surface via electrodes . Frequencies between 1 and 100 Hz are commonly used. The electrodes are placed near the painful areas. The stimulus itself is not painful. At most, a tingling sensation can be felt on the skin. When irritated with “high”, irritation occurs directly over the painful area or the nerve that supplies this area of the skin ( dermatome ). The irritation with “low” should be selected if the after-effects of “high” are not long enough.
The aim of this therapy is to influence so-called afferent nerve tracts (stimulus tracts of the central nervous system from the periphery to the brain, i.e. sensitive nerve tracts serving to conduct pain) in such a way that the transmission of pain to the brain is reduced or prevented. The pain threshold is supposed to be raised by the TENS. According to the gate control hypothesis, it is assumed that, on the one hand, the body's own inhibiting mechanisms for the pain fibers in the spinal cord are activated by stimulating afferent, rapidly conducting A-delta fibers. On the other hand, descending inhibitory nerve tracts should be stimulated and the endorphin release increased. Frequency-modulated electromagnetic nerve stimulation (FREMS) is a special form.
In Germany, TENS therapy is a recognized health insurance benefit for some forms of pain. The cost of renting a therapy device and, in individual cases, purchasing it will be reimbursed by the health insurance company.
effectiveness
The effectiveness of TENS is controversial. There are both studies that prove effectiveness compared to placebo treatment and studies that could not show any benefit for TENS. There are insufficient data from studies available for a final assessment of the effectiveness.
A working group of the American Academy of Neurology (AAN) led by R. Dubinsky wanted to know whether TENS is effective in the treatment of pain in neurological diseases and carried out a meta-analysis . Up to April 2009 a total of eleven studies were identified that met the inclusion criteria, i. H. compared TENS with either a placebo or another therapy and included at least ten patients. There were two Class II studies on back pain that appeared to show moderate benefit. Two class I studies, however, which were powered to detect a 20 percent difference in the number of patients who benefited from the treatment, and another class II study could not demonstrate a positive effect. Since class I studies generate the stronger evidence, TENS must be classified as ineffective for the treatment of back pain, according to the authors.
Two class II studies are available for the treatment of mild distal polyneuropathy pain in diabetics, which compared TENS with sham TENS, and a class III study in which high-frequency muscle stimulation was tested against TENS. Compared to placebo, a moderate reduction in pain intensity on a visual analog scale was found for real TENS in the two class II studies, while in the class III study a larger proportion of those treated felt that they felt a benefit under the muscle stimulation. The authors conclude that TENS may show some efficacy in the treatment of painful diabetic neuropathy. However, there are a number of other therapeutic approaches for these symptoms, none of which has so far been directly compared with TENS. For such a frequently used therapy as TENS for pain syndromes, the evidence for an effectiveness is very poor, is the conclusion of the neurologists. Based on level A evidence, they cannot recommend the method for use in back pain . TENS can be considered for use in patients with diabetic pain, but the quality of the evidence for this is not very high.
Indications
Chronic pain syndromes that cannot be influenced causally, e.g. B. chronic headache syndromes, radicular syndromes, pseudoradicular syndromes, arthralgias, neuralgias, stump pain and postoperative pain syndromes.
Contraindications
It is not suitable for pacemaker wearers, psychogenic syndromes, central syndromes (thalamus syndromes) or anesthetic areas.
Other fields of application
TENS devices are u. a. Used in the BDSM area as part of erotic electrical stimulation .
safety
The adhesive electrodes must not be affixed to skin inflammations, open wounds or fresh scars. Also not on the eyes and mouth, on the front neck, the heart region, genitals, temples and fingers.
Care should also be taken to avoid treatment for patients with epilepsy. You should also refrain from using it if you have a pacemaker or if you are pregnant. This type of therapy should also be avoided with inflamed joints and organs. Safe use in cancer has not been proven.
literature
- B. Kolster, G. Ebelt-Paprotny: Guideline Physiotherapy. ISBN 3-437-45160-X .
- Knauth, Reiners, Huhn, Physiotherapeutic recipe book. ISBN 3-7985-0699-X .
Web links
Individual evidence
- ↑ KE Nnoaham, J. Kumbang: Transcutaneous electrical nerve stimulation (TENS) for chronic pain. In: Cochrane Database Syst Rev. 2008 Jul 16; (3): CD003222. Review. PMID 18646088
- ↑ A. Khadilkar, DO Odebiyi, L. Brosseau, GA Wells: Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database Syst Rev. 2008 Oct 8; (4): CD003008. Review. PMID 18843638
- ^ L. Brosseau: Efficacy of the Transcutaneous Electrical Nerve Stimulation for the Treatment of Chronic Low Back Pain: A Meta-Analysis. Spine. 27 (6): 596-603, March 2002
- ↑ RM Dubinsky, J. Miyasaki, Neurology 2010; 74: 173-176, cited in Medical-Tibune, May 28, 2010, p. 12
- ↑ cf. Arne Hoffmann: The Lexicon of Sadomasochism. The Inside guide to dark eroticism: practices and instruments, people and institutions, literature and film, politics and philosophy. Schwarzkopf & Schwarzkopf, 2000, ISBN 3-89602-290-3 , p. 100.
- ↑ Operating instructions for the device Tem-250 from Dittmann GmbH (2015), p. 9 ( PDF )