NeuroTalk Support Groups - Update and TENS question

NeuroTalk Support Groups (https://www.neurotalk.org/)

- Reflex Sympathetic Dystrophy (RSD and CRPS) (https://www.neurotalk.org/reflex-sympathetic-dystrophy-rsd-and-crps-/)

- - Update and TENS question (https://www.neurotalk.org/reflex-sympathetic-dystrophy-rsd-and-crps-/77142-update-tens-question.html)

Quote:

Originally Posted by Imahotep (Post 464429)

The tens helps me to get distracted from the pain but it's a little like sending a bee to kill an elephant. I have been using it a little more recently though.

The biggest problem is that it worsens my tremor that keeps me awake. I can't use it more than about twenty minutes a day because of this.

Can you adjust the modulation on your unit? The TENS that I bought on my physiotherapists recommendation has different programs that I can change it to. On days when I'm really sensitive I switch it to a different program and turn it down.

MsL

Quote:

Originally Posted by Mslday (Post 464665)

It has a lot of adjustments on it and a thirty page instruction manual I haven't read. Most of these are utterly incomprehensible and just make you angry if you try to read them. They're written by computer geeks to satisfy lawyers and legal requirements. It's no wonder they don't help. ;)

I just play with it until something seems to help. The default setting seems to be among the best.

Yes your right, the instructions totally confused me too LOL... so I had my physio pick the different program numbers for me asked her to write it down for me. I change to different program setting when I find it doesn't help. The concept being that our brains get used to one setting so we need to shake things up a bit in order to close the pain gate again.

MsL

Quote:

Originally Posted by ali12 (Post 462954)

Hi Lorie,

I can't tell you how happy I am to hear that you are finally getting some much-needed pain relief and seeing some improvements - that is GREAT and you SO deserve it after everything you have been through!!:hug: I really hope that the improvements continue and that you are in remission very soon!!

I tried a TENS Machine before I was diagnosed with RSD and it didn't work at all for me. If anything, I think it probably made the spasms worse as my muscles just couldn't cope with the stimulation from the electrodes. I also noticed that I was having quite a bit more cramp after the treatment. The TENS didn't work at all for ME although everyone is different and it really is a matter of trial and error - as I am sure you know already, no two people are the same when dealing with this illness!!

Here is an article that my Physical Therapist gave me when I first tried the TENS machine that you might find useful - it tells you what to expect, how the TENS works etc:

Facts about TENS
Technically, it is low voltage and hence safe. It uses a biphasic alternating current so as to avoid tetany and to prevent the increase of ionic concentrations under the electrode surfaces). It can be used as “high” frequency (greater than 50 HZ) or “low” frequency (less than 10 Hz). It is typically battery operated for portability, compact and discreet for the user.

The author’s prescription for TENS:
CRPS pain and changes to that area of your body are like scrambled signals going to your brain. This has resulted in the brain putting that area on the highest alarm status. All signals coming from your area of pain are amplified as a result. Even normal signals are translated by the brain as painful. This has become a vicious cycle. The treatment is aimed at reversing this cycle.

5 Application of TENS to CRPS

Settings
High frequencies (200 Hz) and low intensity (50 to 100 us) have been shown to be the most beneficial for persistent pain conditions [16]. A low pulse width is used usually 75 us. A constant or modulation mode is better tolerated. Few enjoy the “burst” mode. In clinical practice, the constant mode is always used.

Duration
Research into duration of use is scanty. Our current thinking of 20 minutes once during therapy day may not be effective simply because it is not long enough. The longer duration of use is useful. This means using it for up to 8 hours a day.

When can’t TENS be used?
There are several situations where TENS cannot be used:
• TENS cannot be used on the site when the skin sensation is decreased due to sensory nerve damage, or when there is hyperalgesia or allodynia. However it can be used further up from that site to access the nerve or dorsal column.
• Patients who have a high tolerance for opioids and are taking large opioid doses for their pain cannot use TENS, as the opioid receptors in the brain may appear to be the same as the TENS sites.
• If the patient has a pace maker-check safety with the Cardiologist first.
• If someone has severely sensitive thin skin, prone to rashes it cannot be used.

What should the patient feel?
No muscle contraction should be felt. it is not the strength of the sensation that is important. It is simply that there is a pleasant sensation all the time. Remember, we are distracting the brain’s radar from the pain and closing the gate to the nociception. As the skin accommodates the current, the intensity can slowly be increased over the day. What is “started” with is not what will be “finished” with. The first sensation is typically felt around 11 ma and then still comfortable around 30 ma after eight hours.

I'm thinking about you and please keep us updated when you can!

Hi all!! I'm sorry I just posted this whole thing again. I couldn't figure out how to multi quote it!! :)

I am seeing my Pain Doc next week due to a quick spread of my RSD symptoms to the bottoms of my feet (as opposed to just the tops) and I am getting some symptoms in my hands. I found the above information that Ali posted very informative, but I noticed the highlighted parts where it suggests reasons why someone would NOT be a candidate for the TENS Unit.

My Pain Doc wants to put a SCS in me (I've posted about this) but I am NOT comfortable with that at this point. I am rather certain that I have nerve damage in my left foot from my surgery. Would that preclude me from being able to get a TENS?? Does the PT prescribe it??? Or the doc??? Is the sensation the same as the SCS???

They hooked me up to one on my TMJD (in another thread) and I did NOT like it. It was on pulse and would contract the whole side of my face every 2 seconds for an hour. It was HORRIBLE and it didn't help. The above article from Ali's PT suggests that a constant mode is used for RSD.

Any further information about this would be appreciated before I go in to the doctor. I am alarmed at the rate of my spread (all four quadrants of my body in 2 months). I am desperate to try anything I can that is on the conservative side. Thanks in advance for any input!!

Hello
I agree with Ali, I also had one and it did not work , it made my RSD worse

best of luck to you

peace
Kelly

Ugghhhh.....I am so discouraged......I just don't know what to do???? Can they give me nerve blocks in all four quadrants??? Maybe two by two??? I just want for the pain on the bottoms of my feet to go away so I can walk normally again. I am resisting the urge to walk on my tiptoes because I know that is bad body mechanics.

Hi there, I'm new but I know Ali ;)

The information Ali provided was actually what I sent her , its part of a presentation handout my physio gives to teach other physio's here about CRPS and TENS :)

They have done research that shows that most TENS machines do not go up to the required frequencies so are usually a waste of time, for the people they may help, they are not getting the right settings to try.

200Hz and 75 us pulse width is the usual settings they use here, the ones they have found work the best. I had to get a specific TENS machine that went up to 200Hz.

TENS can upset some people with RSD but if you havent tried it, it is worth a shot especially if you are not sure about the SCS, TENS is a non invasive treatment.
You have to remember that with a TENS, you are in control, the first settings you dont even feel anything as the current intensity is so small, if you find you cant tollerate it, the first thing to look into is what intensity you have the machine set to (some days I can feel it at about 8ma and others I have it over 14 before I feel anything). Now I'm not saying this is the only reason, your body may not tollerate it at all like some of the people on here but its important to make sure its not just because you have it on the wrong setting first.

I use my TENS sometimes for over 8 hours a day as I find it helps with my pain coupled with meds etc.

For starting to use the TENS, you may not notice any pain relief for a while, for me it took a couple of weeks to notice the pain relief but I could see how I was coping with my uni day much better rather than notice less pain.

If you are going to try out the TENS, make sure you start out slow, and dont put the electrode pads on or close to your pain areas. Also just use it for an hour the first day, 2 the next, 3 the next see what I'm saying. Your body needs to feel ok about the machine or else it will reject it. Play with where you place the electrode pads, maybe you will place them either side of your spinal canal you may need to place them higher or lower, it all depends on your pain and how they feel, it may take a couple of trials before you find the comfortable places.

I use mine a couple of times a week a the moment since I'm on summer break but when I go back to uni I will probably use it most days. It just fits in my pocket and I can turn it up when I need to and I find it a great help.

If you have any specific questions just ask, I'm more than happy to try and help if I can.

Thank you so much for your input. I will mention the possibility of the TENS unit to my doctor to see what he says. Can it be used for both feet?? I want to start as conservatively as possible, in medications and in treatments and procedures.

My unit has two sets of electrodes that work independently.

I am purchasing one off of the internet as I refuse to have my insurance company dictate how long they will pay for it. If you look up TENS units, you will see that there are tons of options for not only the amount of stim, but the number of electrodes (mine can hold eight), and the programs it can do. I keep thinking that it's worth a try to get back to work without being on anyting narcotic. I also am now really scared of any surgical procedure, so I am holding SCS as a very very last resort. Hey, I figure this is non-invasive and I can play with it to try and get some relief.
I'm thinking that the number of electrodes might be the key for multiple sites, so searching that way might be an option.