The TENS Blog

It would be a wonderful thing to be able to say there are no politics behind the use of such versatile and useful equipment as Sustained Mobile TENS therapy devices.

Unfortunately, its simply not the case.

Year after year, for what’s now approaching several decades, manufacturers of electrical therapy devices have watched on as less effective, more expensive and potentially dangerous therapies have taken favour amongst health care providers.

Year after year, advocates of Sustained Mobile TENS have had to sit back and watch, while giant pharmaceutical companies with hundred million dollar marketing budgets “educate” doctors about their wonderful new (and potentially lethal) “medications”. Vioxx anyone?

Year after year, the question continues to be asked:–

Why is Sustained Mobile TENS (or even TENS in general) still not considered a treatment of choice for pain relief, healing and rehabilitation when there is so much evidence to support it? If it is used, why is the last choice?

Reliance on health care providers for guidance

Australia’s Health and Pharmaceutical Benefits Schemes are formulated on the advice of our medical providers, legislators and health care administrators. With the exception of doctors, legislators and administrators mostly have no medical training, so fairly, they have no knowledge on which to base decisions than that of their “advisers”.

In the main, legislation is reliant on the advice provided by doctors – advice that has a vested interest in maintaining the status quo. Advice that directs funds into the provision of ever more expensive techniques, resulting in escalating costs that have no end in sight. Advice that apparently has no opinion about Sustained Mobile TENS and other cost-cutting self care measures.

The escalating cost of health care has long been a major concern to many of Australia’s leaders. However, the policy advisers are also the primary recipients of these tax-payer dollars. So asking them, the service providers, to endorse measures that reduce costs is asking them to endorse a pay cut. End result – no such advice or endorsement is forthcoming.

Lopsided funding of Health Care

The political consequences of an entrenched system, perceived cost savings and lack of knowledge has resulted in a lopsided allocation of health care funding.

Funding benefits are directed to health care providers who treat the sick and injured – resulting in the proliferation of ‘fee for service’ health care providers. These fees are expected to be reimbursed by the government, or by those who are able to insure against the cost.

There is practically no incentive in Australia’s health care system for the provision of funding directed to individuals who wish to take positive action in caring for their own state of health.

Until the government and insurers realize personal health care should be promoted and funded appropriately, the cost of our national health care system will continue to rise. And all the while, those that need it will be unknowingly denied access to a form of self-care therapy that could significantly ease their burden.

Adoption of Sustained Mobile TENS

Imagine the savings if GP’s were to embrace and encourage the use of intensively applied Sustained Mobile TENS instead of automatically prescribing analgesics, anti-inflammatories and sedative medication for relief of arthritic and musculoskeletal pain.

Imagine the savings if GP’s were to embrace and encourage the use of intensively applied Sustained Mobile TENS instead of prescribing multiple pharmaceuticals, having patients attend for intensive physiotherapy, risk an Investigative - Consultancy - Treatment - Roundabout and undergo what may well be unnecessary surgery.

Savings

While governments and health care insurers are saying they need to reduce the high costs of our present health care system, they’re simply not adopting the measures to obtain the substantial potential savings achievable with the use of Sustained Mobile TENS.

The reasons and evidence is everywhere.

The Commonwealth Pharmaceuticals Benefits Scheme has no provision to subsidize the cost of advanced TENS or Sustained Mobile TENS systems, even though pharmaceuticals are now costing the Federal Government billions of dollars per year.

Community health care centres and state hospitals have minimal provisions to make advanced Sustained Mobile TENS systems available, although the cost of providing a system to a patient may be far less than a single hospital outpatient visit (orthopaedics department).

The provision of Sustained Mobile TENS may be in many cases all the patient requires and could negate the need for multiple return visits.

I feel this point’s very clearly illustrated in my recent four year study of Sustained Mobile TENS users; 67.1% belived they had reduced their need for medical services (doctors, physiotherapists & chiropractors) as well as hospitalisation. This is a staggering figure if you think about what it means when applied in terms of whole country. Or the world.

Compulsory and private health care insurers are generally not aware of the substantial savings available to themselves and to their contributors with the use of multiple modality Sustained Mobile TENS devices.

Many private health insurance funds are now offering refunds on the purchase of TENS, but only as part of their top extras cover. This is great news, but it still doesn’t address the problem of people actually knowing what TENS, or Sustained Mobile TENS actually is, and how it can help them.

Is the Adoption of Sustained Mobile TENS expecting too much?

Is it asking too much of the professional health care provider to champion the cause of TENS for personal health care? It would seem the answer is yes…

The practice of medicine is largely involved in consulting, counseling, drug prescription, performing surgery, etc.. Medical practice isn’t involved in patient self care, therefore the self care nature of TENS is of minor interest.

Physical therapists and other para-medical practitioners are unable to provide the space or time required for extended therapy, or treatment out of office hours, that’s so vital to the success of electrotherapy treatment.

Professionals do not see any advantage for themselves in a patient self-treatment system.

The very nature of self care Sustained Mobile TENS is against the interests of health care providers. Imagine a therapist recommending a piece of equipment for a patient that would reduce the need for the therapist who made the recommendation – both for the current ailment and any future physical problems.

It appears the therapeutic effectiveness, ease of use and low cost is a stumbling block to the recommendation of TENS by health professionals. Those professionals that do use electrical stimulation as a treatment method, usually use very bulky and expensive equipment. Not only does this equipment offer no significant advantage over Sustained Mobile TENS, but the high price tag imparts on them an ‘exclusivity’ that precludes patients from obtaining that equipment for themselves.

Where Sustained Mobile TENS is having success

Not surprisingly, Sustained Mobile TENS has been accepted, but only by specific groups of people:

• By those who have been taken in circles by the current medical system, without getting closer to a solution.
• By those who cannot physically tolerate the use of analgesics or anti-inflammatories, and by those who wish to reduce their intake of medications.
• By those in remote regions without easy access to a range of health professionals.
• By those who wish to save money, time and travel going to and from health professionals.

Denial of Human Rights

I’m not familiar with the systems of other countries, but all Australians must pay compulsory levies for their health care – but due to the nature of the system as it is today, they’re restricted in their access to Sustained Mobile TENS.

This is a gross denial of very basic human rights – the right to free and accurate information, freedom of choice and the freedom to be self reliant.

Frankly, there are people who are missing out on adequate health care, and for a range of reasons:

• There are those who are unable to tolerate the adverse side effects of anti-inflammatory medication and opiate based pain medication – and are being offered no recourse such as the use of Sustained Mobile TENS.
• There are those who simply don’t wish to take medication, or as much as may be prescribed by their physicians.
• There are those who need physical therapy, but just can’t afford to spend the money or the time to get the level of treatment they require – or the level they deserve.

All this is a sad and seemingly hopeless state of affairs. And after struggling with it for so long, there are times when I feel it’s all too much myself.

But there is an answer.

There is a way the minds and hearts of people in decision making positions can be swayed. And that is, quite simply, the power of personal experience and proof.

As time goes on, more and more people come across Sustained Mobile TENS and see it for what it is. They tell their friends. And their friends tell more friends.

As time goes on, more and more research evidence accumulates as to the effectiveness of this therapy. Members of the scientific community read these papers. And they pass these papers onto their friends. And their friends tell more friends.

I am a firm believer that there will come a time when politicians and policy advisers can no longer ignore the weight of all these voices. At that time, walls that were once only cracked, will crumble and allow the flood waters of truth to spill forth. In all honesty, I can’t say when that day will come. But it will. And then everyone will benefit from the knowledge we now take for granted.

Independence is a word we can easily take for granted. Those of us with it don’t give it a second thought. Indeed, why should we? Since we could walk, we’ve come to expect it as our natural right.

Its only when its taken away from us that we understand its worth. Self reliance is a part of who we are. Independence is central to the formation of our self image and whether we hold ourselves in a positive or negative light. Its easy to understand why those with very little control over their personal environment can often be anxious, angry, depressed, or worse.

And it seems nothing is more disempowering than being forced to rely on others when it comes to health. Much like our finances, this is one area of our lives over which we can ill afford to be giving control away to others – and yet it happens on a daily basis.

Its not a rare occurrence to hear of people with physical ailments who have been attended to by a stream of professionals. They’ve seen doctors, physical therapists, chiropractors, surgeons and consultant physicians. They’ve used anything from one to a dozen different drugs, often several concurrently. They’ve been subject to all manner of investigations – from blood tests, to x-rays and CAT scans. And in some cases, when the cause of the pain couldn’t be isolated, the individual’s been sent for psychiatric assessment!

This is not a one-in-a-million story. If it only were. I don’t believe there is a single general practitioner who doesn’t have at least one of these cases on their books. And we can only sympathize, both with the individual and the practitioner.

Medicine is an investigative process; this is a fact I understand well. Its probably the closest most of us will come to true detective work. There are often cases where a conclusive diagnosis can be elusive, to say the least. Clearly, in-depth investigations are indicated and necessary.

Having said that, however, I think it timely to look at the basics of what medicine is all about. The cornerstone of the Hippocratic Oath is: first, do no harm. To the medical practitioner, this is self evident. But there are many types of harm, not just physical injury. And amongst them, one must surely rate taking away someone’s control amongst the worst.

I believe every practitioner would agree the aim of medicine is to make the ailing person independent of the need for external medical measures. So why does the healthcare industry systematically goes about disenfranchising the very people it says it serves!

I must hasten to add that I’m not at odds with the medical profession as such; I’ve spent over 50 years as part of it. I’m simply asking why it is that healthcare practitioners aren’t advocating systems of therapy that give individuals a greater role in therapeutic decision making and the opportunity to take control of their pain. After all, its their physical health that’s central to the entire discourse.

Why are patients asked to take drugs with unwanted and potentially hazardous side-effects when alternatives exist? Why aren’t patients informed of the full range of options from the outset of their physical ailment? Why are certain measures tried only as a last resort, despite their proven effectiveness?

And so we come to one of the most maligned, misunderstood and ignored therapeutic tools in history. Electrical therapy.

The use of electricity in medicine dates back to ancient Rome, when the discharge of the electrical eel was used to ease the pains of various physical ailments.

Through the centuries, dozens of investigators have experimented with, refined and improved hundreds of therapeutic electrical devices. Electricity has been used primarily for its ability to reduce pain, but also to speed the rate of healing of physical injuries, to induce relaxation and sleep, to exercise and strengthen muscles and more.

Literally thousands of scientific and medical research articles exist verifying the effectiveness of electrical stimulation for use in such widely ranging presentations as arthritis, muscle strain, child birth, joint sprain, orthopaedic surgery, broken bones and much, much more.

The main difference in the devices available today to those of five or more years ago, is the vast improvement in safety and the significant reduction in size. A device that could once only fit on a table top and needed years of training to use safely, now comes in a matchbox-sized enclosure that can be operated by almost anyone of any age with the guidance of a simple instruction manual.

Imagine the implications for patient independence. A person with a physical injury or ailment, most often under professional supervision, can actually treat themselves. They can have treatment as often as they like. Even up to 24 hours per day if necessary. Professional physical therapists simply cannot offer anywhere near this intensity of treatment. So not only is the person empowered by electrical therapy, but in many instances the quality of the overall treatment is improved.

Lets look at a typical example of someone who sustains a lower back injury while lifting a heavy object.

While it may be a very common injury, such cases can be quite difficult to diagnose. It could be an injury of the disc, bone, ligaments, muscles or nerves – but normally, it will be several of these at once. And naturally, the diagnosis guides the therapy. So if it is unclear exactly which structures are affected, treatment can be somewhat in the dark.

What eventuates from here is a medical roundabout, as mentioned above. The patient ends up frustrated and disenchanted because they’re in pain, and seemingly no closer to knowing why. If portable electrotherapy is used at all, it is most commonly a last resort. Even so, it still works in around 30% of cases in which every other single therapy has failed!

On the other hand, were the patient given a portable electrotherapy device, or Sustained Mobile TENS on day one of the injury, a world of difference could be made.

From the outset, the patient would have a means of reducing pain that would cause them no side-effects (unlike prescribed pain killers). For those experiencing the harmful secondary effects of medications, this in itself is a leap in the right direction.

Another advance on the ‘old’ system is the fact the treatment is within the patient’s own control. This is frequently commented upon, by actual users of the equipment, as being a remarkably liberating experience that gives them satisfaction and peace of mind.

And very importantly, should a diagnosis be a long time coming, it won’t change the fact the person can actually do something about their own pain, whenever they need to, and for as long as they need to.

This simple and effective technique has prevented countless surgical procedures from taking place, incurring significant financial and emotional savings.

Portable electrical stimulators have ‘caught’ those people the current system would otherwise have failed. What’s more, its done all this by increasing the independence of the person with the physical pain condition. In no uncertain terms, this is a win for the public and a win for modern medicine. What do you think?

More information about quality electrotherapy TENS equipment is available.

TENS and electrical acupuncture both provide therapy for pain management by electrically stimulating the same body structures, but they use a differing way to explain the manner in which they work. Acupuncture uses an ancient Chinese theory, while TENS uses modern anatomical, physiological and pharmaceutical knowledge.

The machines that apply pulsed electrical potential therapy vary in the way they are applied to the body.

Acupuncture

With acupuncture, needles are used to pass the electrical stimulus through the skin. Because the stimulating electrical charges are delivered via a needle, there is no resistance to their passage to the nerve, allowing higher potentials to be delivered.

Acupuncture equipment does not require a high level of electrical circuitry design. TENS equipment may be used for acupuncture, but it must be applied at very low voltage, and generally they do not provide enough active leads. “Split” leads can be purchased from some TENS suppliers however.

TENS

Contrastingly, TENS therapy is applied by using skin surface TENS electrodes that pass the electrical stimulus via the skin to the nerves. With skin contact electrodes there’s a high level of skin resistance during the passage into the body, so the pulse charges delivered have to be at a higher voltage potential in order to pass through the skin.

Skin contact electrodes with large surface areas are required with TENS equipment to prevent the dispersion of the energy deep within the body and to ensure the stimulation remains comfortable.

When small electrodes are used, the user will often find sensation caused by the stimulation to be uncomfortable and “prickly”.

Much higher levels of microelectronics design is required for Sustained Mobile TENS units to ensure a compact and unobtrusive size for carrying around and still have the therapeutic efficacy of clinical models, so they’re suitable for home and mobile use.

The smaller and more comfortable the TENS unit, the longer the treatment can be sustained over extended periods and the better the results for the user. So in this way, Sustained Mobile TENS is exactly like acupuncture, but instead of needles, you use stick on electrodes.

Nothing could be simpler and you don’t need someone else to do it for you. So it begs the question – why on earth would anyone want to lay around with needles stuck in them when they can use stick on electrodes and go about their day while treating themselves?

Which one would you choose?

Does electrical stimulation (or TENS) relieve pain?

The answer has, and always will be, yes. But how does it work? Well, that’s a bit more involved, so lets explain in a bit more detail…

The pain relieving mechanism of TENS and electrical stimulation in general, is multi-factorial. All sorts of issues factor in – including the type of stimulus, its frequency and duration. The acceptance of the technology by the user plays no small part either, meaning there’s a strong psychological component to any pain experienced; so how one interprets pain and the choice of analgesia for that pain can be very important. Having said all that, the three most important physiological factors are an endorphin release, pain ‘gating’ and the ‘unlearning’ of pain.

The Endorphin Effect

Endorphins are hormones that occur naturally in the body that reduce pain and promote a feeling of wellbeing. Endorphins are released in response to injury and physical stress. Morphine, and related medications, have a similar chemical structure to endorphins – which explains their strong pain-killing effects. (In fact, ‘endorphin’ is made up of two words: Endogenous – native to the body, and Morphine – opiate like substance.)

Runners (and other athletes), experience a natural ‘high’ after about half an hour of sustained physical exertion. This is attributed to the steady release of endorphins during exercise – which reach a threshold point within an hour, below which their effect is unlikely to be noticed.

TENS is a well accepted medium for inducing a release of endorphins – and much like exercise, may take 30 minutes or more to take a noticeable effect. However, once the pain relief is evident, the effect may last for several hours before endorphin levels in the body need to be increased again.

The body will release endorphins if the rate of electrical stimulation is low – less than 7 pulses per second (14Hz).

On a BioStim® TENS unit, this is the ‘L’ setting on the rate control.

On an EziStim® TENS unit, you can use either the ‘PainEze’ mode, ‘Mild’ or ‘Sustained’ modes.

The Gating Effect

The absolute simplest way to describe this pain relieving effect is to use the example of a person who stubs their toe, then rubs it to ease the pain (after they’ve finished cursing up a storm, of course).

When the toe is stubbed, the pain messages travel in the nerves to the brain – where the messages are interpreted and tell the person that they actually ‘feel‘ the pain.

However, when the toe is subsequently rubbed vigorously, these new, ‘non-painful’ messages also travel to the brain where they compete for attention. The brain processes these new non-painful message in favour of the pain messages and subsequently we feel less pain. In other words, the rubbing sensation has ‘closed the gate’, so that painful messages cannot get through. And we know from personal experience that the faster we rub our stubbed toe, the better the results. When we stop rubbing the toe, often the pain begins to return.

When set to a pulse rate or frequency above 35Hz, TENS works in just the same way. It generates electrical impulses which block the pain. The faster the pulses, the better the pain blocking effect.

On a BioStim® TENS unit, this is the ‘H’ setting on the rate control.

On an EziStim® TENS unit, you can use either the ‘PainEze’ mode, ‘Strong’ or ‘Gating’ modes.

Here’s where it gets really good. By modulating the pulse rate from high to low (or fast to slow), you can actually achieve both pain relief effects of an endorphin release and pain gating at the same time.

Unlearning Pain

After a course of treatment with TENS, the body will often reprogram itself so that pain is no longer perceived. It has been taught to ‘unlearn’ the pain.

If, during a course of treatment, the pain messages are switched off or broken often enough (through the above effects), this new state of reduced pain can slowly become the norm.

This may produce prolonged relief lasting weeks, months or more. This is a complex mechanism, and is poorly understood – although it does appear to have something to do with the pain messages as they travel in the spinal column to the brain. It seems the body ‘learns’ new neural pathways to exclude pain.