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to TENS
pain relief
By Dr Gordon Gadsby
PhD BA (Hons) RGN RMN DipN (Lord) MISBM DHP DHS
Edited by Marilyn Bash and Karen Rubenstein
©Body Clock Healthcare
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system,
or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or
otherwise, without the prior permission in writing of the publishers (Body Clock Health Care
Limited, 108 George Lane, South Woodford, London E18 1AD)
Note: Although every effort has been made to ensure accuracy, the publishers cannot accept
responsibility for any errors that may appear. Medical knowledge is constantly changing. As
new information becomes available, changes in treatment, procedures and equipment may
become necessary.
I Introduction
What is TENS all about? 3
(a) Gate control theory
(b) Acupuncture-like TENS or low frequency TENS
Brief history of electrotherapy and TENS. 3
What conditions can be treated with TENS? 4
Why should I use a Body Clock TENS? 5
How will TENS help my pain ? 5
VI Routine maintenance
How do I care for, clean and store my TENS unit? 26
General Precautions 26
Tell me about Body Clock’s TENS warranty and servicing 26
VII Troubleshooting 27
How to get further supplies of electrodes and accessories. 28
What if I need more help? 28
1
Profile of Dr J Gordon Gadsby
Gordon was appointed as a consultant to Body Clock Health Care Limited in December
1995 to advise on therapeutic applications, research and new product information.
For more information on Dr Gordon Gadsby visit his Internet Website on:
www.drgordongadsby@talktalk.net
2
I
Introduction - What is TENS all about?
3
fish being used to treat pain. In AD46 the and general functioning. Acute pain is
Roman physician, Scribonious Largus usually more severe and of shorter
recorded the introduction of the electrical duration, e.g childbirth, trauma or
powers of the fish into clinical medicine surgery. Acute and chronic pain can be
as a cure for headache and gout. In some treated with TENS and some of the more
parts of the world, the electric catfish and common examples are listed below.
electric rays continued to be used for the
treatment of pain and other conditions
up until the end of the nineteenth • Rheumatoid arthritis
century. Electrostimulation, using static • Osteoarthritis of one or several
electrical machines, came into joints
prominence in the mid eighteenth
• Ankylosing spondylosis
century and continued in popularity
through the eighteenth and nineteenth • Neck pain, cervical spondylosis,
centuries. However, it fell out of favour in whiplash injuries
the early part of the twentieth century • Low back pain resulting from strains,
due to the availability of a wider range of prolapsed disc, spondylitis,
analgesic drugs. • Osteoporosis
• Referred pains such as sciatica
The present day use of TENS began after
• Fibrositis/myofascial pain syndromes
the 1965 publication of a landmark paper
by Melzack and Wall entitled “Pain • Acute sprains/strains e.g sports and
Mechanisms: A New Theory”. Its use is occupational injuries
expanding from pain clinics to emergency • Tendonitis/bursitis
departments, operating theatres, labour • Carpal tunnel syndrome
wards, surgeries and self care.
• Migraine and headaches
4
II
However, it may be dangerous to mask
pain associated with an unknown illness Electrode
or a recent uninvestigated injury.
You should check with your health care Placement and
adviser for an accurate diagnosis, before
using TENS. Charts
Why should I use a
Body Clock TENS? The importance of accurate
Body Clock offers a wide range of units, electrode placement
which are fully compliant with current We cannot stress too strongly that correct
medical device regulations. These have electrode placement is vital to obtain the
been tried and tested over many years by best results from your Body Clock TENS.
the author and other practitioners. Body Please see the following charts which
Clock only make the highest quality TENS have been specially prepared to help you.
units known for their ease of use and
latest technology. The most important aspects of TENS
electrode placement is to position them
How will TENS help my pain? so that the current passes through the
The aim of TENS treatment is to promote painful area, or along the nerves leading
pain relief, an increase in movement and from the pain, or over acupuncture
function of the affected area, and to points. If your Body Clock TENS is a dual
decrease pain medication. Good results channel unit, with two sets of leads and
have been obtained over the past twenty- electrodes, then it is possible to treat two
five years in hundreds of studies, surveys different areas of pain at once.
and systematic reviews conducted on
both acute and chronic pain patients. How to use the electrode
By the year 2000 there were nearly 500 placement charts.
studies and reviews on electrical Check the index on page 6 for the chart
stimulation methods recorded in the most applicable to your own pain
Cochrane Library database alone, the problem. We have selected the easiest
most important source of high quality and most frequently used electrode
medical research in the world today. The placement positions. However there are
extensive Medline database listed more alternatives, which may be advised by
than 800. We can now say that TENS your medical practitioner.
provides useful relief for most people
with acute, subacute or chronic pain. In
addition TENS is a safe, non invasive
treatment, economical and easy to use.
5
Charts
Back Pain Headache and Migraine
Low back pain 7 Classical migraine, headache,
Upper back pain 7 stress, insomnia 18
Back pain with sciatica 8 Pre-menstrual migraine
and tension (PMT) 18
Ankylosing spondylitis 8
Neuralgia Pain
Neck and Shoulder pain
Trigeminal neuralgia 19
Neck pain and whiplash 9
Post shingles neuralgia
Shoulder pain and (ophthalmic shingles) pain 19
frozen shoulder 9 - 10
Post shingles pain 19
Post operative neuralgia 20
Leg pain
Hip pain 10 - 11
Nausea and Vomiting
Knee pain 11
Nausea associated with
Ankle pain 12 pregnancy, chemotherapy,
Achilles tendon problem 12 travel sickness etc 21
Foot pain 12
Phantom limb pain both Labour and delivery
below and above the knee 13 - 14 Labour pains 21
6
Low back Low back
pain pain
chart 1 chart 2
Low Back pain is shown by the red Low Back pain is shown by the red “pain
“pain zone”. The black squares inside zone”. The black and white squares
the “pain zone” represent a pair of inside the “pain zone” represent two
electrodes. Each electrode is placed on pairs of electrodes, placed on the lower
the lower back as shown above. back as shown above.
Upper back pain is shown by the red Upper back pain is shown by the red
“pain zone”. The black squares inside “pain zone”. The black and white
the “pain zone” represent a pair of squares inside the “pain zone”
electrodes. Each electrode is placed on represent two pairs of electrodes,
the back as shown above. placed on the back as shown above.
7
Back pain Back pain
with with
sciatica sciatica
chart 1 chart 2
Back pain with Sciatica is shown by the Back pain with Sciatica is shown by the
red “pain zone”. The black squares red “pain zone”. The black and white
inside the “pain zone” represent a pair squares inside the “pain zone” represent
of electrodes. Each electrode is placed two pairs of electrodes. Each electrode is
on the body as shown above. placed on the body as shown above.
8
Neck pain/whiplash is shown by the
Neck pain and whiplash
red “pain zone”. The black squares
chart 1
inside the “pain zone” represent a pair
of electrodes. Each electrode is placed
either side of the spine as shown in the
diagram to the left.
9
Shoulder pain and frozen shoulder
Shoulder pain and frozen shoulder are shown by the red “pain zone” above.
The black and white squares inside the “pain zone” represent two pairs of electrodes.
Two electrodes are placed on the front of the shoulder and the other two on the back
of the shoulder as shown in the diagrams.
Hip pain is shown by the red “pain zone” above. The black squares represent a set of
two electrodes. Both electrodes are placed within the “pain zone” - one at the front
and one at the back.
10
Hip pain chart 2
Hip pain is shown by the red “pain zone” above. The black and white squares inside
the “pain zone” represent two pairs of electrodes.
a. The white set is placed within the “pain zone” - one at the front and one at the
back of the hip.
b. The black set is placed on opposite hips to allow the current to pass straight
through the body.
Knee pain Knee pain is Knee pain The black and white
chart 1 shown by the red chart 2 squares inside the
“pain zone”. “pain zone” represent
The black squares two pairs of
inside the “pain electrodes. The black
zone” represent a electrodes are placed
pair of electrodes. as in chart 1. The
These should be white electrodes are
placed either side placed at the back
of the knee as and front of the knee
shown. allowing the current
to pass through.
11
Ankle and foot pain is shown by the red
Ankle pain
“pain zone”. The black squares inside
Inside Outside the “pain zone’ represent a pair of
leg leg
electrodes. These are placed either side
of the ankle as shown in the diagrams
to the left.
12
Below the knee phantom
Phantom limb pain below the knee limb pain is shown by the
red “pain zone”. The
black squares inside the
”pain zone” represent a
pair of electrodes. One
electrode is placed on the
front of the leg and the
other on the back as shown
in the diagrams.
13
Above the knee phantom
Phantom limb pain above the knee limb pain is shown by the
chart 2 red “pain zone”. The black
and white squares inside
the ”pain zone” represent
two pairs of electrodes. Two
electrodes are placed on the
front of the leg and the
other two on the back of the
leg as shown in the
diagrams.
14
Golfer’s elbow pain is
Golfer’s elbow shown by the red “pain
zone”. The black squares
Outer Inner
aspect of aspect of inside the ”pain zone”
arm arm represent a pair of
electrodes. One electrode is
placed over the area of pain
and the other on the outer
aspect of the arm allowing
the current to pass through
the arm.
15
Phantom arm pain is shown
Phantom limb pain below the elbow by the red “pain zone”.
The black and white squares
inside the ”pain zone”
represent two pairs
of electrodes.
16
Period pain or
Period pain or dysmenorrhoea dysmenorrhoea is shown
by the red “pain zone”.
The black and white squares
inside the ”pain zone”
represent two pairs of
electrodes. One set of
electrodes is placed on the
front of the body and the
other set is placed on the
back of the body as shown
in the diagrams.
17
Classical migraine, headache, stress,
Classical migraine, headache, insomnia are shown by the red “pain
stress, insomnia zone”. The black and white squares
represent two pairs of electrodes.
The electrodes on the back of the neck
should border the hairline and be
placed either side of the spine with
5cm (2”) between them.
18
Trigeminal neuralgia pain is
Trigeminal neuralgia pain shown by the red “pain zone”.
The black squares represent a
pair of electrodes. The electrodes
are placed on the face as shown
in the diagram. Stimulate very
gently to begin with and stop if
the pain worsens. Then try again,
applying the electrodes to the
opposite side of the face without
the pain.
Post shingles ophthalmic pain is shown by the red “pain zone”. The black squares
represent a pair of electrodes. One electrode is placed on the forehead in the “pain
zone”, and the other on the back of the neck bordering the hairline as shown in the
diagrams above.
19
Post-operative neuralgia chart 1
Post-operative neuralgia
An example is shown by the red “pain zone” but the scar could be sited anywhere on
the body. One electrode should be placed over the scar and the other placed in the
same position on the other side of the body, as shown in the diagrams above.
20
Nausea and vomiting
Nausea and vomiting associated with The black squares represent
pregnancy, chemotherapy travel a pair of electrodes. Use a
sickness, post operative, inner ear low frequency pulse rate for
problems etc. thirty minutes as needed.
The electrodes should be
placed on the inner aspect
of both wrists, 2.5cm (1”)
Inner Inner from the wrist crease as
aspect of aspect of shown.
arm arm
21
Peripheral Neuropathy
Peripheral Neuropathy - associated The black and white squares
with diabetes, chemotherapy, inside the “pain zone”
represent two pairs of
electrodes. Place the
electrodes on the leg as
shown in the diagram.
Wound/ulcer healing
Wound/ulcer healing - associated with The black and white squares
diabetes, varicose ulcer, post operative inside the “pain zone”
pain etc represent two pairs of
electrodes. An example of
how to treat this pain is
shown, but the area of pain
could be sited anywhere on
the body.
Place electrodes
surrounding the pain, not
over broken or damaged
skin. Use a high frequency
(pulse rate) and stimulate
gently.
22
III
A quick guide to setting up your
TENS treatment
1. First - read this book and the level now. Is it better or the same?
“Instructions for Use” booklet which Again, try scoring the level of pain
accompanies your Body Clock TENS. on a scale of 0-100.
2. Set up your unit in accordance with 7. The next time you set up your TENS
the “Instructions for Use” booklet. treatment it will be much easier.
Deciding on the length of your next
3. Wash and dry around the area of pain, treatment, e.g. 30 mins, one hour oror
ensuring there is no grease or longer depends on the response you
powder on your skin. had with your first treatment, whether
you are going to rest or continue
4. Apply self-adhesive electrodes to your activities. You score the level of pain,
skin. If using carbon rubber before and after each treatment, over
electrodes, use a small amount of gel the next few days and weeks, as to
and affix with surgical tape. how effective treatment has been in
reducing your pain level.
5. Make yourself comfortable for an hour
or so while the treatment is working 8. You may prefer to begin with just one
and re-read the instructions again treatment a day, or even three or four
until you are familiar with them. Take treatments, or use TENS continuously
note of your pain level before the for a while, depending on
treatment. Try scoring the level of the severity of your pain.
pain on a scale of 0-100, where 0 is no
pain and 100 is the worst pain you 9. You may then wish to adjust your
have ever had. Record it on paper. TENS unit settings using a different
mode, or different treatment times to
6. At the end of an hour switch the TENS gain more effective pain
unit off. If you want to begin management, in line with the
treatment again within a few hours, recommendations on page 24.
you may leave the self-adhesive
electrodes in position for the next
treatment. If using non-adhesive
electrodes remove them and wipe off
the gel. Take note of your pain
23
IV
How to use your TENS unit
for pain management
TENS treatment can provide useful relief 5. For “conventional” high frequency
for both acute and chronic pain. TENS is TENS there are no recommendations
self-administered, non-invasive and concerning total treatment time.
simple to use once you have mastered a Some find that short periods of 30-60
few easy techniques. minutes can provide them with
several hours of pain relief. Others
General guidelines to help you find that they require longer
manage your pain treatment periods, perhaps for several
hours or all day in order to achieve
1. Place electrodes over the painful area satisfactory pain relief.
and stimulate. If this does not help
then move the electrodes to either 6. Some patients find that one particular
side of the pain, as shown on the setting gives them the best pain
Body Clock Electrode Placement relief. Others find it more comfortable
Charts. Pages 7 - 22. to vary the settings.
24
V
Do I need to take any special
care of my skin? Are there any
1. TENS treatment produces very few
side effects. Occasionally mild precautions to be
irritation at the electrode site may
occur. This can usually be remedied by taken with TENS?
replacing the electrodes, gel or tape
with alternative products.
2. When using carbon rubber electrodes Under which conditions should I not
and conductive gel, ensure the gel use a TENS unit?
does not dry out. Add more if 1. To treat pain not diagnosed by your
necessary to protect your skin. medical adviser.
3. Trim any excess body hair, which 2. If you have a demand-type cardiac
could interfere with smooth electrode pacemaker, serious or unstable heart
contact with the skin, but do not condition or have had a recent heart
shave it. attack.
25
VI
TENS Leads
7. If driving or operating potentially Do NOT yank or twist the leadwires - treat
dangerous machinery. them gently for a long life. They are
made from fine wire to be flexible and
8. Your TENS unit should be kept out of lightweight.
the reach of children.
General Precautions.
9. Turn off your TENS unit while
operating a microwave oven. • Do not immerse your TENS unit in
water or any other liquid
10. If you are in any doubt, contact your • Do not place it close to any source of
usual medical adviser. excess heat
• Do not operate your unit in the
26
VII
Troubleshooting
If you are still having difficulty obtaining (b) Low pulse rate settings: Set the pulse
pain relief, carefully re-read this book and rate below 10 and usually
the “instructions for use” supplied. They between 2-3 in continuous mode (C).
contain all the information needed for This should be felt quite firmly.
success. Many people experience almost A treatment period of 30 minutes
instant pain relief after following these once or twice a day is usually
instructions. Are you following all the sufficient once the pain is under
instructions suggested? If so, and if you control. You may also repeat the
are still having difficulty in controlling treatment 90 minutes later for an
your pain, try the following tips - one at a improved analgesic effect.
time.
(c) Try pulse burst treatment (if this is
available on your TENS model) by
1. You may need two or more treatments selecting B on your TENS and 100 on
a day, sometimes for several hours, both the pulse rate and the pulse
over several days. Even professionals width for 30 minutes each treatment
do not always achieve instant relief and repeat as required.
for their patients: so do not abandon
your TENS after just a few treatments. (d) If your TENS unit has an M setting
Continue use for two or more weeks (Pulse Modulation) then you can also
at least, as the effects tend to be try this setting again for 30 minutes
cumulative i.e. each treatment builds each treatment, or longer if necessary.
upon the last. Some patients find this setting most
helpful and soothing.
2. Experiment with different frequency
settings bearing in mind the following 4. Make sure the electrodes are firmly in
guidelines: place at all times, in good condition
and well-gelled. TENS electrodes are
(a) High pulse rate settings: Set the pulse generally placed around the painful
rate above 10 and usually between area, over the painful area, or over the
80-100 or more in continuous mode acupuncture points in order to
(C). This should be felt as a tingling increase the effectiveness of TENS
sensation. Recommended treatment treatment.
period is at least one hour, or for
several hours continuously, for at 5. If you are treating back pain try
least 2 or more weeks. placing one electrode over the most
painful area and the other on the
27
opposite side of the spine. Also try 11. Enthusiastic tea or coffee drinking
placing the electrodes 2.5cm (1”) may reduce the analgesic effect of
either side of the spine, in line with TENS - try cutting your intake down
the area of pain - i.e. 5cm (2”) apart. by half and drink water and fruit
juices instead.
6. Try using different pulse rates during
each treatment e.g 30 minutes on a 12. If your pain becomes worse, either
high rate and 30 minutes on a low during or after treatment, then it is
rate. usually due to applying the incorrect
pulse rate for your problem. Try a
7. Try gently exercising the painful area different setting and if this does not help
while you are using your TENS unit try moving the electrodes to another
and then applying a cold pack (from position and repeat until you achieve the
the fridge NOT out of the freezer) to pain relief you are looking for.
the area for 10 minutes at the end of
the treatment. 13. Remember: TENS treatment benefits
most people but you have to give it a
8. The most common cause of failure to chance to work by ensuring an
achieve pain relief from TENS is too adequate trial i.e. treatments once or
few treatments, so make sure you twice daily, or more, for at least 2-3
have given the treatment a really weeks, plus it may be necessary to
good trial and remember, the longer adjust the pulse rate and/or the
you have had your pain the longer it electrode placement to achieve the
may take to reduce it and the more best effect.
treatment you need.
9. Do not stop taking your usual pain Where can I find further
killing drugs when you begin your supplies of accessories?
pain treatment, but discuss reducing Call Body Clock Health Care on
the dosage with your medical (+44) 020 8532 9595 for:-
practitioner as your pain decreases. electrodes, batteries, gel, leads,
sticky fixers, pouches, battery
10. Do not be afraid to experiment with chargers and rechargeable batteries
different pulse rate settings to find and much more, or order online at
the treatment which gives you the www.bodyclock.co.uk
best result but give each change
several days to work before switching What if I need more help?
to another one. Call us at Body Clock on
(+44) 020 8532 9595 and we will do
our best to assist.
28
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