Pain relief programs – which one for what?
Most people take medication to reduce pain. But what about those for whom drug side effects make that impossible? For them I recommend drug- and side-effect-free nerve stimulation pain relief methods, i.e. TENS and MENS treatments. Both are based on electrically stimulating nerves with impulses. Devices can offer several different programs with differing effects. Some are suitable for acute pain and are worth using for a few days only because they lose effectiveness if used longer. Others, conversely, can be used for chronic pain for years without tolerance or loss of effect. In this article I show when to choose which pain relief program.
The aim of TENS treatment is to reduce joint and muscle pain, and to relieve other complaints and pains of endogenous origin.
You can read detailed practical instructions about the treatment here.
Pain relief impulses
Most TENS devices offer general-purpose programs that manufacturers name similarly. For example: conventional (or high-frequency) TENS, endorphin (or low-frequency) TENS, BURST TENS, modulated TENS, etc. Their common feature is that they can be used on any painful point of your body.
Some devices also offer programs named after a specific condition or symptom — for example neck pain, disc herniation, lumbago, tennis elbow, knee pain, etc. These provide impulses "fine-tuned" for that problem and are most suitable for treating conditions matching the program name.
TENS devices typically provide the following programs. You won't find every program on every device — for example the most modern and effective modulated TENS is still only available in a few devices! Check before buying a device.
Conventional TENS
A 20–30 minute program consisting of high-frequency impulses. Its pain-relieving effect can last for a few hours. The stimulation causes the gates of the pain-transmitting nerve pathways to "close," so the pain signal does not reach your brain and you do not perceive the pain.
The stimulation feels pleasant and tingling. You should not experience muscle twitching.
Strength: you can use it to relieve any type of pain, on any part of your body (except the skull and the front of the neck).
Drawback: conventional TENS is effective for most people only for a few days, then its effect diminishes. This is because the regular, evenly spaced impulses are quickly "gotten used to" by your nervous system.
You will notice that the pain relief that was good at the beginning diminishes after a few days of treatment or even disappears completely.
When to use it: use it for complaints that have arisen suddenly and where you want the fastest possible pain relief because of the intensity of the pain. Examples: toothache, muscle contusion, strain, sprain, nerve compression, lumbago, sciatica, disc herniation, etc. — these are conditions where the first days are the most painful and the natural healing process will then reduce the complaints.
When not to use it: this program is not ideal if you want to treat long-lasting, daily pain. For example osteoarthritis (joint wear), arthritis (joint inflammations), rheumatism, tendon degeneration, tendonitis, disc herniation, sciatica, chronic back pain. These conditions usually cause persistent pain that recurs for weeks, months or even years. In such cases I recommend the modulated TENS program instead.
Endorphin TENS
A 30–40 minute program consisting of low-frequency impulses. The impulses last longer than those of conventional TENS, so you may feel subtle twitching in the muscles of the treated area. This is normal and nothing to be alarmed about. Its pain-relieving effect lasts longer, even 5–8 hours or more.
This stimulation promotes the production of your body's own pain-relieving substances (so-called endorphins).
Strength: particularly effective for muscle-origin pain (strain, sprain, stiff neck upon waking, lumbago, lower back pain, a neck stiffened after a stressful day, etc.). Its effect lasts longer than conventional TENS.
Drawback: during the endorphin TENS program the device delivers impulses at regular intervals and rarely. The impulse shape and duration are also identical, so your nervous system "gets used to" them after a few days. You will notice that the initially good pain relief diminishes after a few treatments or even disappears completely.
When to use it: mainly for acute muscle-related complaints. The endorphin effect develops more slowly but lasts longer than conventional TENS.
When not to use it: this program is also not ideal for long-standing, daily pain. For persistent pain I recommend the modulated TENS program instead.
Burst TENS
Designed to prevent habituation to conventional and endorphin TENS. During the treatment the device emits sequences of low- and high-frequency impulses every few seconds, interspersed with pauses. Because of the two types of impulses, the pain relief is twofold: on the one hand it blocks pain signal transmission, and on the other it stimulates your body's endorphin production.
Strength: you can use it to relieve any type of pain, on any part of your body. Its effect is lasting. Habituation can occur only in the long term (after 4–6 weeks of regular use), so it is excellent for complaints expected to resolve in a shorter time.
Drawback: due to the "jumping" frequency the treatment produces a tingling, sometimes disturbing sensation and some patients find BURST less comfortable than the conventional or endorphin programs. Since these are variable but still regular impulses, your nervous system can "get used to" them after a few weeks of treatment, and the initially good pain relief may diminish or disappear after several weeks.
When to use it: use it when you will need pain relief for a longer period — typically 4–5 weeks. Examples: shingles, joint inflammation, neuralgia, tennis elbow, golfer's elbow, back pain, etc. You can also use it for chronic pain such as osteoarthritis or rheumatoid joint pain. These conditions usually cause persistent pain that recurs for weeks, months or even years. However, Burst TENS loses effectiveness for these complaints after a few weeks.
Modulated TENS
Modulated TENS is the most modern TENS algorithm. During treatment the pulse duration, amplitude and frequency continuously change — in other words, they are modulated. There is no habituation to the treatment and the discomfort associated with electrical therapy is minimized.
Strength: you can use it for any type of pain, on any part of your body, even for years. Its effect is long-lasting. No habituation, no treatment discomfort, no side effects.
Drawback: only more modern devices provide this feature, and their price is higher (look for these in devices typically priced above 20,000 HUF).
When to use it: for any acute or chronic pain, anywhere on your body. Especially suitable for persistent, long-standing complaints (osteoarthritis, brachialgia, carpal tunnel syndrome, neuralgia, etc.).
Microcurrent treatments (MENS)
Microcurrent (MENS) is the newest form of transcutaneous nerve stimulation.
The biggest difference between TENS and microcurrent (MENS) is the strength of the current used. TENS programs use milliampere current strengths, so the impulses during treatment are easily perceived, producing a prickly, stinging sensation that more sensitive people find hard to tolerate.
Microcurrent programs use currents an order of magnitude smaller — microampere currents. 1 milliampere = 1000 microamperes, meaning TENS uses a current a thousand times stronger than MENS. The microcurrent is so mild that most people do not even feel the treatment.
Studies show that the pain-relieving effect of microcurrent treatment is stronger than that of TENS. Microcurrent treatment produces pain reduction in more than 90% of patients.
An additional advantage is that while other TENS programs are purely symptomatic, microcurrent treatment can be healing — it can address the cause of the pain as well. In Western countries microcurrent treatment has already become the most commonly used physiotherapeutic pain relief method.
Strength: you can use it for any type of pain, on any part of your body, even for years. Its effect is long-lasting. No habituation, no treatment discomfort, no side effects. It has a healing effect!
Drawback: only the most modern electrotherapy devices provide microcurrent, and they are more expensive (generally above 100,000 HUF).
When to use it: for any pain, inflammation or chronic complaint, anywhere on your body.
There are many types of TENS devices
To choose the device most suitable for you, consider the following aspects.
- the size of the area affected by the pain,
- the intensity of the pain,
- the number of channels of the device. The more channels a device has, the larger the area it can treat simultaneously,
- the programs provided by the device (cheaper devices in the 11–15k HUF range typically offer only conventional and endorphin TENS, to which you will habituate in a few days and whose effect then ceases, so they are suitable only for short treatments),
- the presence of modulated TENS and microcurrent programs (these are more effective and do not cause habituation even with long-term use),
- the presence of other functions: muscle stimulation, incontinence treatment, beauty-care programs, etc.
