Electricity has been used to manage pain for many decades. We can actually go back many centuries to the repeated use of electric eels to relieve gout pain. The patient would place the painful area in a bucket with eels to receive pain relief from the shocks of the eels. This is the first time electricity has been used for pain control. It doesn’t matter if the pain is acute or chronic, the process of the sensory input for the sensation of pain is almost identical. Tens units were used in the past outside of the clinic to allow patients to adjust their daily activities to compensate for the pain. Intermittential is used in clinical settings when the pain is severe or acute. In very rare cases, a dorsal columns stimulator (DCS), and in the most severe cases, a deep brain stimulation (DBS) may be used.
Pain is a sign of a problem in your body. Your brain responds to pain signals by quickly withdrawing your hand from a hot pan or touching it. If the hand is damaged or the tissue is damaged, the brain will start a new process to ensure there are no infectious agents like germs, bacteria, etc. The area where the pain was felt. The brain will release T-cells (natural antibiotics) to the area and will precede the cells with histamines to break through the capillaries and kill the bacteria. The brain will make many physiological and biological changes, with the latter two only being a small part. The spinal column sends the pain stimulus to the brain. It is an electrical signal which causes nerves to be inflamed. The nerves then take the appropriate actions to ensure that the pain message is received and no further damage is done.
All this is fine until the message reaching the brain is constant or more frequently than necessary. The patient is in trouble when the message is persistent. The problem is not preserving the body, but preventing further injury by the constant pain message that limits the patient’s ability to function. The pain impulse can become a barrier to health. You will hear the phrase “all in your head” a lot. This is a very accurate statement. All pain is felt in the head so it is not surprising that this is what you hear most often.
Patients with diabetes neuropathy or other diseases that reduce sensory input are at greatest risk of the pain not being in their heads. A patient might have a cut or burn on their foot/legs and not realize it until infection has developed. A patient may suffer from a more severe injury if their brain’s sensory input is impaired. This can lead to amputation, systemic infection, and even death. The lack of pain in the patient’s “head” can lead to serious consequences. Chronic pain can cause nerves that transmit the pain signal to be activated by very little input. The spinal cord can only receive and transmit a small number of messages to the brain when the pain nerve that goes to the spinal chord is stimulated.
Different types of nerves send messages to the brain, referred to as “A”, B”, and “C” fibers. These fibers transmit different messages, such as heat and pressure. The fibers perform different jobs (jobs) to keep our brain informed about what is happening in our bodies. Some messages are not transmitted because there are more nerve fibers reaching the spine than the pathways to the brain. If that message is the C fiber’s pain message, it will not be transmitted. There is no pain if it is not in the brain. We use electric stimulation to stimulate the “non-pain” fibers in chronic pain patients. This process can be compared to an old-fashioned telephone system, where the operator physically routed calls to their destination.
To prioritize non-pain messages so that the spinal cord will transmit them, we use electricity. The electrical impulse stimulates the nerve fibers, causing chemical and physical changes. Therefore, the input from the non-pain fibers is transmitted while the pain message is not. The patient does not feel pain when using electrical inputs. This is because the sensation is what is being transmitted from the brain to our perception. The pain signal is not transmitted or disappears, so there is no pain. A clarification is needed on the “blocking” the pain signal. One would expect that a patient would feel real injury if they blocked the pain message. However, it would not be felt. This is not true with controlled electrical input from devices.
The level of pain in the area where the electrical stimulus is applied is a factor. The patient will feel pain if the electrical stimulus is too strong. The patient would simply respond by saying that the electric current is painful. If the intensity of the stimulation is too high, the patient would feel no pain. If the electrical stimulus has been set up and the patient is now suffering from a new injury, the new pain stimulus will override them. The new injury will be a stronger stimulus that is transmitted to his brain. The body will then react accordingly. This is especially true for athletes who use electrical devices. A football player who has been injured by an electrical device during a game would still feel any stimulus or injury, such as a re-injury to the ankle.
The electrical device does not override the pain from the injury.
- TENS (Transcutaneous Electrical Nerve Stimulator) – A small, portable device that is worn by the patient and operates from a generally 9 volt battery. The device can be worn continuously or whenever pain is present. It can also be worn 24/7 if needed. The range of 1 to 150 pulses per second (PPS) of electricity is what makes the device electrically. PPS simply refers to the machine being turned on and off 150 times per second. Tens do not have carryover pain relief, so if the unit turns off, the pain will immediately return. TENS are covered by most insurance companies including Medicare.
- Interferential Unit ( IF/IFC ) – This unit is slightly larger than a tens unit, and uses electricity from an AC adaptor plug. The pulses per second range from 8,000 to 8,150. An Interferential Unit cannot be worn or used for extended periods of time if it has a battery system. It must be plugged into the wall. Interferential provides significant carryover pain relief. Often, after a 20-30 minute treatment, the pain will cease to return for days, weeks or hours. Some insurance companies cover Interferential when it is billed as durable medical gear ( DME). Medicare considers it experimental.
- This implant requires surgical intervention. In some cases, the stimulus can provide immediate pain relief and carryover to other patients. The insurance company must approve the surgery and verify that no external devices have failed before the DCS can be inserted.
- Deep Brain Simulator ( DBS ) – This is similar to the DCS, except that wires are inserted into the brain. A neurosurgeon usually performs the implant. This is often used as a last resort treatment for patients who are likely to commit suicide due to their chronic pain.