TENS is a non-invasive, safe nerve stimulation intended to reduce pain, both acute and

chronic. While controversy exists as to its effectiveness in the treatment of chronic pain, a
number of systematic reviews or meta-analyses have confirmed its effectiveness for
postoperative pain, osteoarthritis, and chronic musculoskeletal pain.[6] A January 2010,
systematic literature search published in the journal Neurology,[8] advised against
recommending TENS for chronic low back pain since evidence is controversial for that type
of pain. However, other reputable neurologists wrote in the same issue of the journal:
"Absence of evidence is not evidence of absence," and although the research on TENS may
be thin, "there seems to be considerable empirical evidence that, at least in some patients,
TENS is useful."[9] Recent clinical studies and meta-analysis suggest that having an adequate
intensity of stimulation is necessary to achieve pain relief with TENS.[10][11]

Scientific studies show that high and low frequency TENS produce their effects by activation
of opioid receptors in the central nervous system[citation needed]. Specifically, high frequency
TENS activates delta-opioid receptors both in the spinal cord and supraspinally (in the
medulla) while low frequency TENS activates beta-opioid receptors both in the spinal cord
and supraspinally[citation needed]. Further high frequency TENS reduces excitation of central
neurons[citation needed] that transmit nociceptive information, reduces release of excitatory
neurotransmitters (glutamate) and increases the release of inhibitory neurotransmitters
(GABA) in the spinal cord, and activates muscarinic receptors centrally to produce analgesia
(in effect, temporarily blocking the pain gate)[citation needed]. Low frequency TENS also releases
serotonin and activates serotonin receptors in the spinal cord, releases GABA, and activates
muscarinic receptors to reduce excitability of nociceptive neurons in the spinal cord[citation
needed]
.

http://www.scribd.com/doc/6133274/Tens
TENS
What is it?
It is a form of electrical stimulation with surface electrodes to
modulate pain perception.
Why do physical therapist use it?
To reduce pain perception
To reduce spasticity
To reduce nausea and vomiting (cancer patients or post-op)
What stages of healing can we use TENS?
1. acute stage
2. sub-acute
3. chronic

1. Gate control theory (Melzack and Wall, 1985)

Neurophysiology background: the CNS can only interpret and transmit one form of sensory
stimulus at a time. There a two sets of afferent (incoming) nerve fibers that enter the spinal
cord:
A-beta fibers – larger diameter (faster) – carry touch sensation
C and A-delta fibers – smaller diameter (slower) carry pain sensation
Theory: When an electrical current is applied to a painful area, transmission of the
perception of pain (via small diameter fibers) to the brain in inhibited by the
activity of the large diameter, fast-conducting highly myelinated, proprioceptive
sensory nerve fibers --- closing the gate to the pain perception to the brain.
2. Opiate-mediated control theory
Neurophysiology background:
The brain can secrete its own analgesic substance such as endorphins to
modulate pain.
Endorphins are neuropeptides that act on the CNS and peripheral nervous
system to reduce pain. They have the similar pharmacological effect as
morphine.
ES is thought to relieve pain to some degree by promoting endorphin release.

How does TENS reduce spasticity?

Neurophysiology background:
A normal stretch reflex is modulated, inhibited or facilitate by the higher centers of
the brain; but if this connection is damaged, spasticity is the result. Spasticity is
therefore mostly due to an excess of impulses from a -motor neurons due to a SCI
or brain injury.
TENS is thought to reduce spasticity by reducing / inhibiting excessive a-motor
neuron activity. (Goulet e al, 1996; Joodaki et al, 2001)
This inhibition is accomplished by stimulating the Ia afferent nerve of the muscle
that is antagonist to the spastic muscle.
For example, stimulate the peroneal nerve to inhibit soleus/gastrochnemius
spasticity

Parameters used are that of conventional TENS.

SMALL
FIBERS

Placebo effect

• depends on the patients belief that they will work.

• process in the patient trigger the release of endogenous opiods in the body thereby inhibit
the transmission of pain signals.