Excerpt
Transcutaneous electrical nerve stimulation, known by its acronym TENS, is a modality that uses electric current to activate nerves for therapeutic reasons. The TENS unit is a small device, often battery-operated, which can sometimes even fit into a pocket. It utilizes electrodes placed on the skin and which connect to the unit via wires to address a targeted therapeutic goal. The units are said to be titratable, permitting for a high degree of user tolerance with few side effects. Compared to many medications, the device is free from the risk of overdose. TENS units are often highly adjustable, allowing the user to control pulse width, intensity, and frequency. Low frequency of < 10Hz in conjunction with high intensity is used to produce muscle contractions. High frequencies of > 50 Hz are used with low intensity to produce paresthesia without muscle contractions. Overall, the concept of TENS throughout history has been the topic of vigorous debate within scientific circles in regards to efficacy. However, while this modality of pain management has proven itself in clinical investigations, there remains to this day disagreement over which pain syndromes and conditions TENS is appropriate. TENS, in its earliest conceptual form, is believed to date back to approximately 60 A.D. The Roman physician Scribonius Largus proposed symptomatic relief to patients by having the patient be exposed and in contact with an "electric fish" from the ocean. There are also ancient records of the use of electric eels for their pain management benefits — the use of electricity in managing human ailments propagated over time. By the 18th century, there were numerous devices developed to deliver electrostatic exposures with the belief of treating a wide array of conditions, from headaches to cancer, with even Benjamin Franklin being an eventual supporter. The 19th century started with one particular machine, the "Electreat," leading the way in clinical therapeutic usage of electricity in managing patient disease. However, it had several constraints including large size and limited adjustments. It has been long since abandoned. The TENS units and functionality as we think of it today are credited to American neurosurgeon Dr. C. Norman Shealy. After completing medical school at Duke University in North Carolina, he had additional training out of Barnes-Jewish Hospital and Massachusetts General Hospital. He spent several years subsequently researching spinal cord stimulators and transcutaneous electrical nerve stimulation, developing what developed into today's TENS units. His early work was an effort to arrive at an impactful therapy for several types of pain including migraines, back pain, and gout. As the study of transcutaneous electrical nerve stimulation advanced, there came new techniques inherent to the modality, such as intense TENS, acupuncture TENS, and conventional TENS.[1][2][3][4]
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Indications
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Complications
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PMID: 30725873
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