TENS

Notalgia Treatment:  Nerve stimulator uisng TENS:   TENS VIDEO: how to apply pads

 

Give yourself hours of drug-free pain relief with this pain and itch relieving home electrotherapy system. Using revolutionary T.E.N.S. (Transcutaneous Electrical Nerve Stimulation) pain relief therapy, you simply place the self-adhesive electrodes on sore or itchy areas to send harmless low-frequency electrical pulses into the tissue. The electrical stimulation blocks the pain and itch signals and increases blood flow to the area to promote healing and relaxation. Get the pain relief you need without taking prescription drugs or spending excessive time and money on doctors visits.

 

What is TENS ? How does it work?

A relatively new modality is a transcutaneous electrical nerve stimulation
device, hereafter referred to as TENS.

The TENS is a low-voltage electrical impulse generator used as a non-pharmacological pain control
device. It usually looks like a portable transistor radio and can be attached to one
belt. Properly turned, patients are able to use this device as they go about their daily activities.

This special unit for Notalgia has 4 electrodes with removable gel based safety pads.

The electrodes are placed on the patient body at positions selected based on your area of pain or itching. Sometimes moving around the pads may help pinpoint special areas based on on various factors such as the anatomical location of peripheral nerves and/or the ara of gratest pain.

Most Notalgia Paresthetica patients find the ideal placement is as the back of the neck at the base where it joins the upper back. Moest people carry most of their tentsion in their neck and upper shoulders. TENS is most effective in reducing the itching in notalgia (mostly the middle of the back) by having treatment on the neck around levels C4-C7.

However, an element of trial and error is always present when determning individual placement. After the electrodes placed with conducting jelly between them and the patient’s skin, the controls are set, the unit
is turned on, and a pulsating current passes through the area providing a mild-to-moderate
stimulation. Some practitioners prefer low frquency/high intensity stimulation while others
favor high frequency/low intensity application. The literature and clinicians both report variations
in treatment time, ranging from 15 or 20 minutes daily to use throughout the day. They
also stress the importance of evaluating your progress and checkin in with your doctor regularly.

Exactly how relief is achieved is not fully known, but there are two prevalent theories: one,
the Gate’ Control Theory, suggests that the pulsating current overloads the nerve circuit and
blocks pain signals to the brain; another theory says that electrcal stimulation causes the brain
to react by releasing natural pain-suppressing substances called enkephelins and endorphins.

A literature review indicates that TENS does not cure a disease and does not work in all cases,
but may give symptomatic relief of pain. Most clinicians agree that TENS applied properly
can be effective.  Although some clinicians report as much as a 90 percent success rate with TENS in
carefully selected patients, most report about a 40-50 percent success rate.

As with any medical condition, no two individuals are alike and therefore repsonses vary. TENS may not work equally as well for everyone with Notalgia.

 

TENS: the best pain relieving home electrotherapy system

The American Physical Therapy Association acknowledges the value of T.E.N.S. therapy for managing low-intensity discomfort, like back pain and muscle soreness in the extremities. TENS Comes with 4 easy to place electrode pads, adjustable belt for back pain relief, and carrying bag. Includes 1 9 Volt battery. Not for use with pacemakers.

• FDA Class 2 Medical Device

• T.E.N.S pain relief for lower back and extremities

• No costly doctor’s office visits required

• Offers multiple treatment modes

• Includes 4 electrode pads

• Requires  one 9 Volt battery (included)

 

TENS Electrodes should never be placed:
  • On or near the eyes
  • In the mouth
  • Transcerebrally (on each temple)
  • On the front of the neck (due to the risk of acute hypotension through a vasovagal reflex)
  • On areas of numb skin/decreased sensation
  • On broken skin areas or wounds
  • On or near the trigeminal nerve if you have a history of herpes zoster induced trigeminal neuralgia (Postherpetic neuralgia)

Do not turn TENS up too high as this can cause over-stimulation which may make pain worse. There should be no muscle contraction. TENS should also be used with caution in people with epilepsy or pregnant women (do not use over area of the uterus as the effects of electrical stimulation over the developing fetus are not known).

TENS should not be used by people with an artificial cardiac pacemaker due to risk of interference and failure of their implanted device. Possible failure of these warnings can result in a cardiac arrhythmia. In the situation where low frequency (or acupuncture-like) TENS is being used, it is necessary to increase the intensity of the stimulation to the point where a demonstrable muscle twitch is evident. This 2-6Hz (pulses per second) output increases the systemic release of endorphins which in turn cause pain relief.

 


 PER U.S. FDA:

Contraindications

We recommend that the user manual include the following statements:

  • Do not use this device on patients who have a cardiac pacemaker, implanted defibrillator, or other implanted metallic or electronic device, because this may cause electric shock, burns, electrical interference, or death.
  • Do not use this device on patients whose pain syndromes are undiagnosed.

 

Warnings

We recommend that the user manual advise users of the following:

  • Do not apply stimulation over the patient’s neck because this could cause severe muscle spasms resulting in closure of the airway, difficulty in breathing, or adverse effects on heart rhythm or blood pressure;
  • Do not apply stimulation across the patient’s chest, because the introduction of electrical current into the chest may cause rhythm disturbances to the patient’s heart, which could be lethal;
  • Do not apply stimulation over open wounds or rashes, or over swollen, red, infected, or inflamed areas or skin eruptions (e.g., phlebitis, thrombophlebitis, varicose veins);
  • Do not apply stimulation over, or in proximity to, cancerous lesions;
  • Do not apply stimulation in the presence of electronic monitoring equipment (e.g., cardiac monitors, ECG alarms), which may not operate properly when the electrical stimulation device is in use;
  • Do not apply stimulation when the patient is in the bath or shower;
  • Do not apply stimulation while the patient is sleeping; and
  • Do not apply stimulation while the patient is driving, operating machinery, or during any activity in which electrical stimulation can put the patient at risk of injury.

 

We also recommend that the user manual advise users of the following:

  • Consult with the patient’s physician before using this device, because the device may cause lethal rhythm disturbances to the heart in susceptible individuals; and
  • Apply stimulation only to normal, intact, clean, healthy skin.

 

Precautions

We recommend that the user manual advise users of the following:

  • TENS is not effective for pain of central origin, including headache;
  • TENS is not a substitute for pain medications and other pain management therapies;
  • TENS devices have no curative value;
  • TENS is a symptomatic treatment and, as such, suppresses the sensation of pain that would otherwise serve as a protective mechanism;
  • Effectiveness is highly dependent upon patient selection by a practitioner qualified in the management of pain patients;
  • The long-term effects of electrical stimulation are unknown;
  • Since the effects of stimulation of the brain are unknown, stimulation should not be applied across the head, and electrodes should not be placed on opposite sides of the head;
  • The safety of electrical stimulation during pregnancy has not been established;
  • Some patients may experience skin irritation or hypersensitivity due to the electrical stimulation or electrical conductive medium (gel);
  • Patients with suspected or diagnosed heart disease should follow precautions recommended by their physicians; and
  • Patients with suspected or diagnosed epilepsy should follow precautions recommended by their physicians.

 

We also recommend that the user manual advise users of the following:

  • Use caution when the patient has a tendency to bleed internally, such as following an injury or fracture;
  • Use caution following recent surgical procedures when stimulation may disrupt the patient’s healing process;
  • Use caution if stimulation is applied over the menstruating or pregnant uterus; and
  • Use caution if stimulation is applied over areas of skin that lack normal sensation.

 

The user manual also should advise users of the following:

  • Keep this device out of the reach of children;
  • Use this device only with the leads, electrodes, and accessories recommended by the manufacturer; and
  • Use this device only under the continued supervision of a licensed practitioner.

 

Adverse Reactions

We recommend that the user manual include known adverse reactions as in the examples below:

  • Patients may experience skin irritation and burns beneath the stimulation electrodes applied to the skin;
  • Patients may experience headache and other painful sensations during or following the application of electrical stimulation near the eyes and to the head and face; and
  • Patients should stop using the device and should consult with their physicians if they experience adverse reactions from the device.




 

An  2009 article by Wang et al at Stanford University showed evidence of effective treatment of Notalgia Paresthetica in 4 patients using EMS technology. The Case Report entitled “Serratus muscle stimulation effectively treats notalgia paresthetica caused by long thoracic nerve dysfunction: a case series” depicts placement of two electrodes from the electrical unit placed on the serratus muscle just below the underarm area. The electrodes are placed about an inch apart on the skin.

 

Full article

Abstract
Currently, notalgia paresthetica (NP) is a poorly-understood condition diagnosed on the basis of
pruritus, pain, or both, in the area medial to the scapula and lateral to the thoracic spine. It has been
proposed that NP is caused by degenerative changes to the T2-T6 vertebrae, genetic disposition,
or nerve entrapment of the posterior rami of spinal nerves arising at T2-T6. Despite considerable
research, the etiology of NP remains unclear, and a multitude of different treatment modalities have
correspondingly met with varying degrees of success. Here we demonstrate that NP can be caused
by long thoracic nerve injury leading to serratus anterior dysfunction, and that electrical muscle
stimulation (EMS) of the serratus anterior can successfully and conservatively treat NP. In four
cases of NP with known injury to the long thoracic nerve we performed transcutaneous EMS to
the serratus anterior in an area far lateral to the site of pain and pruritus, resulting in significant and
rapid pain relief. These findings are the first to identify long thoracic nerve injury as a cause for
notalgia paresthetica and electrical muscle stimulation of the serratus anterior as a possible
treatment, and we discuss the implications of these findings on better diagnosing and treating
notalgia paresthetica.


 

A study by Wallengren et al from Sweden published in the Archives of Dermatology in 2001 demosntrated the effectiveness  of cutaneous field stimulation in NP and BRP patients. Their study showed a reduction in itching accompanied by degeneration of the epidermal nerve fibers, as evidenced by the loss of protein gene product 9.5 immunoreactivity.. 23

 


A 201 Case Report on Notalgia Paresthetica by Alai et al published in Cutis outlined the association of Notalgia with spinal cervical disc disease and osteophytes.

 

NOTALGIA PARESTHETICA( NP)

At a Glance

  • sensory neuropathic syndrome of the back skin
  • may include localized burning, pain, tenderness, hyperalgesia, or dysesthesiason a small patch of the mid back
  • associated with a poorly circumscribed tan or hyperpigmented patch
  • chronic condition
  • causes discomfort and nuisance to affected patients
  • not life threatening
  • common disorder which remains largely underdiagnosed
  • no uniformly effective treatment available

Synonyms, Key Words, and Related Terms

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