A to Z of MS TENS (Transcutaneous electrical nerve stimulation)

Transcutaneous electrical nerve stimulation (TENS) is the application of a small electric current to relieve pain and can be a useful tool in the management of pain in multiple sclerosis. Whilst TENS can reduce pain in the short-term, it does not get rid of the pain or the underlying problem permanently. Often TENS is something that needs to be used on a long-term basis.

TENS is recommended in the NICE Guideline for people with musculoskeletal pain that has not responded to medication. However, it can be used in conjunction with medication and also for some types of neuropathic pain. TENS is not beneficial for acute pain syndromes such as trigeminal neuralgia or L'hermitte's sign. It is most useful for alleviating chronic pain, for example:

• dysasthetic extremity pain - the pain that is described as burning, tingling or shooting in nature;
• back pain - often caused by reduced mobility, poor posture and the use of wheelchairs and other aids;
• painful leg spasms - TENS may be useful where anti-spasmodic medications are not tolerated.

How TENS works

A TENS machine is a small battery operated unit that delivers a small current through electrically conductive pads that are applied to the skin. A buzzing, prickling or tingling sensation is felt when the TENS machine is switched on. It is portable and should not restrict a person's activity in any way except when showering, swimming and in some instances, when driving.

TENS machines typically have two modes, a continuous mode and a burst mode (also known as acupuncture TENS). In the constant mode a continuous tingling sensation is felt, whilst in the burst mode a pulsing sensation is experienced.

Although there are TENS machines that can be bought from high street chemists, ideally the machine should be demonstrated by a trained healthcare professional to determine its suitability, as well as to get the most benefit for the user. The healthcare professional will be able to advise on the most appropriate settings to use for the type of pain experienced, as well as the best position for the pads. Many pain clinics, physiotherapy departments and some GP surgeries have TENS machines that can be borrowed or hired to determine whether TENS works for the individual before buying their own machine.

References

Chitsaz A, et al.
Sensory complaints of the upper extremities in multiple sclerosis: Relative efficacy of nortriptyline and transcutaneous electrical nerve stimulation.
Clinical Journal of Pain 2009;25(4):281-285.
abstract

Miller L, et al.
The effects of transcutaneous electrical nerve stimulation (TENS) on spasticity in multiple sclerosis.
Multiple Sclerosis 2007;13(4):527-533.
abstract

Warke K, et al.
Efficacy of transcutaneous electrical nerve stimulation (TENS) for chronic low-back pain in a multiple sclerosis population: a randomized, placebo-controlled clinical trial.
Clinical Journal of Pain 2006;22(9):812-819.
abstract

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