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Chronic pain and disabling muscles aches is one of the most common reasons why most people seek physical therapy. Although the history of physical therapy is as old as almost 140 years, in the last few decades a lot of machines and devices are also constructed on the physical therapy principles and techniques that are of great help in managing chronic pain symptoms in office and home based settings. TENS (Transcutaneous electrical nerve stimulation) is perhaps one of the most effective physical therapy technique used in alternative medicine today. TENS refers to the transcutaneous passage of electric currents in a pre-determined frequency across peripheral nerves. A current of a particular wavelength and intensity is delivered via electrodes that are attached to the skin. The frequency or intensity can be controlled manually. TENS are broadly classified as conventional TENS and low-frequency TENS on the basis of the frequency used in the procedure. Conventional therapy uses a current frequency of 50Hz or above; whereas in low- frequency TENS, a much lower frequency is used (less than 10Hz). Different frequencies have different effects on the physiological perception of pain by modulation of electric nerve signaling across nerve fibers. The working principle deals with excitation of peripheral nerves in an attempt to suppress the nerves that carry pain signals to the brain. This can be achieved if the device stimulates nerve fibers with a higher frequency in comparison to pain nerve fibers. Transcutaneous electrical nerve stimulation is widely used in managing acute pain at home or in a clinical setting. The most preferred use is in labor pain. Although not very effective, TENS is one of the preferred pain management techniques used during the later stages of labor and women who prefer to give vaginal birth without anesthesia can get benefits from TENS. TENS is one of the safest and most risk-free methods available today to treat chronic pain of diabetic neuropathy and musculo-skeletal injuries refractory versus ordinary pain medications. TENS is also used in the management of osteoarthritis pain by physical therapists. TENS is very effective in the management of acute pain soon after major surgeries and accidents to reduce the dose of morphine or other prescription pain-killers. Chronic pain may be functional, post-surgical or neuro-muscular in origin. Unfortunately, there are limited options for the management of pain in most cases. Traditionally, the most popular management strategy adopted by most physicians and general public is OTC pain killers. For moderate to severe pain, over-the-counter NSAIDs (Non- steroidal anti- inflammatory drugs) are ineffective and more potent opoids are needed for relief; however, opoids and other pain medications have a number of complications including addiction potential, phenomena of tolerance and multi- organ damage. Use of TENS provides long lasting pain relief that is free from complications. A Meta-analysis suggested that TENS provides a 43% reduction in chronic pain cases as opposed to just 23% reduction with opoid use. For safety and optimal benefits, it is important to consider these points: Do not put TENS electrodes directly onto eyes or around peri-orbital region due to substantial risk of an alarming rise in intra- ocular pressure that may lead to pain or even damage to visual apparatus. It is contraindicated to apply electrodes over a tumor or malignancy as the electric current may stimulate the growth of the tumor. Never put electrodes on the anterior aspect of the neck as the risk of vaso-vagal reflex is very high that may culminate in hypotension, cerebral ischemia and other complications. Putting electrodes on wounds, open or abraded skin or abscess should also be avoided. For best results, always consult a physical therapist about the proper use of TENS devices for individual or home use. TENS can be given as an adjuvant therapy with other pain medications in patients with chronic pain (in terminal stages of cancer, chemotherapy induced pain and neuromuscular abnormalities) along with potent pain killers. This helps in reducing the dose required to produce pain-relief while decreasing the risk of addiction or tolerance. For optimal benefits, it is mandatory to consider the etiology of pain and accordingly other interventions should also be considered simultaneously (since TENS work best as an adjuvant therapy). 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physical therapy, TENS, transcutaneous electrical nerve stimulation, technique, alternative medicine, treatment,
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