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 two 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 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.

Call to Schedule an appointment at (949) 582-SKIN
Dr. Gary Cole and Dr. Nili Alai are Board-Certified Dermatologists.
For more information, please call (949) 582-7699 or visit the practice website at

Information in this publication and site is not intended to serve as medical advice. Individuals may use the information as a guide to discuss their treatments with their own physicians. This site does not promote nor endorse the unauthorized practice of medicine by non-physicians or state licensed health care providers.
Medicine is a constantly changing science and not all therapies are clearly established. New research changes drug and treatment therapies daily. The authors, editors, and publisher of these artciles have used their best efforts to provide information that is up-to-date and accurate and is generally accepted within medical standards at the time of publication. However, as medical science is constantly changing and human error is always possible, the authors, editors, and publisher or any other party involved with the publication of this article do not warrant the information in this article is accurate or complete, nor are they responsible for omissions or errors in the article or for the results of using this information. The reader should confirm the information in this article from other sources prior to use. In particular, all drug doses, indications, and contraindications should be confirmed in the package insert.


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