On the Wire: TENS Unit Controversy

A recent headline on WebMD, a popular source for online medical information, states that TENS is no longer recommended for chronic low back pain.  The article quotes Richard M. Dubinsky, MD, MPH, of Kansas University Medical Center, “from the systematic review of the literature, based on the strength of the studies, we can say that TENS does not work for low back pain.”  TENS stands for transcutaneous electrical nerve stimulation.  This means it applies electrical current through the skin (via electrodes) for pain control.  Most sources consider the use of TENS to be a non-invasive safe treatment that has very few side effects when used as directed (not over the eyes, broken skin, pregnant uterus, etc.).

TENS is often confused with Electric Muscle Stimulation (EMS).  The confusion is understandable as they both are electrical devices applied using two or four electrodes to the affected area.   TENS is for blocking pain pathways while EMS is for stimulating muscles to relieve muscle spasm, hence reducing pain and improving function.

Here lies the problem with this headline.  Dubinsky is also quoted as saying, “We can’t say that TENS will not work in any patient with chronic low back pain.  We can say there is proof it doesn’t work in groups of patients with chronic low back pain.”   So, it probably works for some patients but not a large enough proportion to be recommended.  Why not?  Here is a safe non-invasive treatment with very few side effects that may work for some patients.  If there was a long, scary list of side effects it wouldn’t be worth the risk.  For patients that have back pain, a treatment that doesn’t require drugs or surgery and could make them more comfortable is an important tool to have in the physician‘s toolbox.  Patients will know immediately if they get any relief.  If they do, great.  If not, stop using it.

A TENS unit is inexpensive (well under $100) and doesn’t require refills other than changing the electrodes and batteries once in a while.  It can be used right before driving or handling heavy machinery.  It doesn’t cause stomach upset or make you feel “loopy” like some of the commonly prescribed pain meds.  Does it fix your back? No.  Could it make you more comfortable? Maybe. Does it deserve to be crossed off the list?  Certainly not.

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1 Comment

  1. George said,

    April 15, 2010 at 7:33 am

    Thank you for the interesting post!


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