Update and TENS question

Imahotep · 02-12-2009, 06:08 PM

Quote:

Originally Posted by Mslday

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.

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.

Mslday · 02-13-2009, 11:56 AM

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

02-13-2009, 05:41 PM

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

MominPainRSD · 02-13-2009, 05:48 PM

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.

Alessea · 02-13-2009, 08:49 PM

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.

MominPainRSD · 02-13-2009, 05:36 PM

Quote:

Originally Posted by ali12

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!!

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!!

nancyinLA · 07-27-2009, 10:43 AM

Quote:

Originally Posted by llrn7470

I have actually been having a run of good luck with my RSD. There is a big improvement in the sensitivity and my mobility is very good. I am still off work trying to get some strength back. Still have discoloration at times and still have areas of patchy numbness and burning. I took myself off of MSContin (WOW did that suck) and am decreasing my Lyrica and so far so good.

Now my concern is pain control for my eventual return to work. I know that once I get back into the ICU my sympathetic will be firing like crazy, but I don't want to do a SCS since I am improving and it's too soon. My pain doc thinks that a TENS unit might be helpful. Anyone have any experience with TENS units and RSD pain?
Lori Lee

yep, w.c. bought my TENS.... again, temporary relief, but hey, ok. my pain's gone 2 my foot! (from hand & wrist) good luck!

Greedy · 07-27-2009, 12:32 PM

I suffer from CRPS and use a tens unit myself. I do like the feeling of what it does to massage the back in a setting that pulsates in and out. I have had this tens for a long time and now it is getting to be less productive but I will use it all the time.
Take care and remember pain free days ahead.

loretta · 07-27-2009, 02:05 PM

Hi Lori Lee,
I'm so excited for you. I'm sure that was rough-MSContin strong stuff. I asked my Dr. to go off 3200 mg of neurotin. I had gainsed so much weight. Was on 400 mg. of Lyrica after the neurotin. We gradually went off, and I didn't get the electric shocks, jolts, spasms back. I've had a couple in 7 months. Lost 30 lbs and working on my 2nd 30 lbs.
After having RSD 4 years and not being diagnosed, I flew back to Oregon to orthopedic sports injury Dr. and was diagnosed in 1 minute. He ordered Tens Unit and P.T. The Physical Therapy lasted 100 treatments. I liked the Tens Unit. It has batteries and can be controled as to strength of vibrations and length of vibratons. It has two lead wires with patches on the end. Your can choose where to put the patches. Insurances pays for the unit and also replacement patches. I liked it, took my mind off pain.
I have recently been going thru horrific lack of sleep. Wouldn't get to sleep until 5-6 a.m. then sleep till afternoon. My life was passing me by. My Dr. took me off Ambien CR, which obviously wasn't working and started 300 mg. of seroquel. He is just finishing up a 200 person study of seroquel. It's a low dose and for fibromyalgia patients. High doses of seroquel is for bi-polar and schezophrenia.
Had to stay in bed 3 days. It's a miracle drug for me. I take it at 7 p.m. and sleeping by 10 pm Get up at 8 a.m. feeling absolutely great with restorative sleep. My pain level is way down. Dr. left it up to me. I used to take 6 vicodin a day. Now I take 2-3. Lorazepam, an anti-anxiety med had gone down from 6 pills a day to 2-3. I feel like I'm going into remission. When he writes regarding his trial, I'll let you know. I just can't believe it- I feel like a new person. I am gradually getting my strength built up and energy level is going up.
So I guess what I'm saying is yes, to the tens unit. and sleep is imperative-keeps the pain level down. I believe in anti-anxiety meds- it keeps the sympathetic nervous system calmed down. Also anti-depressent meds work well on nerve pain. I'm on cymbalta.
That's exciting going back to work. Low dose seroquel was a miracle worker for me.
Hope all works out for you going back to work. Take care, loretta

Smoke_666 · 07-28-2009, 12:46 AM

Before I was diagnosed, and we all thought I simply had a badly sprained knee, I had TENS therapy and ultrasound. The ultrasound (I guess it was) heated my knee up, and it helped a little bit. Very little. Ok, straight up, it felt good while it was being run, as soon as it was turned off, it was as if it nothing had been done. But the TENS deal, well, I didn't know why, but it did work, nothing like a total recovery, of course, but it knocked the pain down probly by half for at least half the day, and sometimes I was 'cured' for the whole day, into the next. Frankly, I had forgotten all about it until I read this thread. I cannot thank you enough, a good friend of mine has one I can try out, so fingers crossed, I pray it helps. RSD's spreading down my leg, every now and then it's popped over to the opposite leg, so I am really hoping this stops it. Thank you. Later, Smoke

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