Transcutaneous Electrical Nerve Stimulation (TENS) is an effective, evidence based method to manage pain. Modern devices are small and portable, making the tool very appropriate for use in the home.
Physicians prescribe the use of TENS based on the patient’s signs and symptoms, after which therapy staff select the appropriate parameters and instruct the patient and/or caregiver how to use the device.
Two protocols are commonly utilized: the Gate Control protocol and the Endogenous Opiates protocol.
The Gate Control Theory is indicated to produce immediate analgesic effect. The analgesia may allow for functional exercise that would otherwise have been difficult to perform because of the pain. Analgesia only occurs as long as stimulation is delivered. This protocol is often used in the presence of acute, present pain.
Pain is perceived when noxious stimuli enter the spinal cord via A-delta (fast pain) and/or C (slow pain) fibers. According to the Gate Control theory, these signals can be blocked in the spinal cord by sensory information entering the same spinal cord level through fast conducting sensory neurons (A-beta).
The Endogenous Opiates protocol is used to produce a lasting analgesic effect to facilitate functional movement during ADL’s. In this case, the pain is blocked in the spinal cord by chemicals released in the brain (endogenous opioids). The analgesia may allow for functional use during ADL’s that would otherwise have been difficult because of the pain. Analgesia may last for several hours after stimulation. This protocol is often used to manage chronic pain.
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