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An easy guide to TENS pain relief By Dr Gordon Gadsby PhD BA (Hons) RGN RMN DipN (Lord) MISBM DHP DHS Edited by Marilyn Bash and Karen Rubenstein

Easy Guide to Tens

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Page 1: Easy Guide to Tens

An easy guideto TENSpain relief

By Dr Gordon GadsbyPhD BA (Hons) RGN RMN DipN (Lord) MISBM DHP DHS

Edited by Marilyn Bash and Karen Rubenstein

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©Body Clock Healthcare

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system,or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, orotherwise, without the prior permission in writing of the publishers (Body Clock Health CareLimited, 108 George Lane, South Woodford, London E18 1AD)

Note: Although every effort has been made to ensure accuracy, the publishers cannot acceptresponsibility for any errors that may appear. Medical knowledge is constantly changing. Asnew information becomes available, changes in treatment, procedures and equipment maybecome necessary.

First published in June 2000Revised October 2004 and September 2006

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Profile of Dr Gordon Gadsby 2

I IntroductionWhat is TENS all about? 3(a) Gate control theory(b) Acupuncture-like TENS or low frequency TENS

Brief history of electrotherapy and TENS. 3What conditions can be treated with TENS? 4Why should I use a Body Clock TENS? 5How will TENS help my pain ? 5

II Electrode placement and chartsThe importance of accurate electrode placement. 5How to use the electrode placement charts. 5Index to electrode placement charts. 6Electrode placement charts 7-22

III A quick guide to setting up your TENS treatments 23

IV How to use your TENS unit for pain managementGeneral guidelines to help you manage your pain 24Do I need to take any special care of my skin? 25Can I combine TENS with other therapies? 25

V Are there any precautions to be taken with TENS?Under which conditions should I not use a TENS unit? 25

VI Routine maintenanceHow do I care for, clean and store my TENS unit? 26General Precautions 26Tell me about Body Clock’s TENS warranty and servicing 26

VII Troubleshooting 27How to get further supplies of electrodes and accessories. 28What if I need more help? 28

Contents

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Ph.D BA(Hons) RGN RMN DipN(Lond) MISBM DHP DHS

Dr J Gordon Gadsby is a leading clinical specialist in neuro-electric acupuncture andtranscutaneous electrical nerve stimulation. He now practises in the private healthcare sector, following more than thirty years of asuccessful career in psychiatric and general NHShospital nursing.

He has practised in Leicester for the last twenty fiveyears as an electro-acupuncturist, neuro-electricacupuncturist and TENS specialist. He has aBA(Hons) degree in Health Studies and a doctoratein electroanalgesia from the De Montfort University,Leicester. Gordon’s Ph.D researched the historical and contemporary developments ofelectrical treatment of chronic and low-back pain, using transcutaneous electricalnerve stimulation (TENS) and acupuncture-like TENS, within the framework of theCochrane Collaboration.

Gordon was appointed as a consultant to Body Clock Health Care Limited in December1995 to advise on therapeutic applications, research and new product information.

For more information on Dr Gordon Gadsby visit his Internet Website on:[email protected]

Profile of Dr J Gordon Gadsby

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TENS stands for TranscutaneousElectrical Nerve Stimulation. Thetreatment consists of passing mildelectrical impulses through your skin intothe nerve fibres which lie below. Contactis made with your skin via electrodes.TENS electrodes are generally placedaround the painful area, over the painfularea or over acupuncture points.

TENS impulses help your body produceits own pain killing substances. A TENSunit does not provide a direct cure for theproblems responsible for your pain, but italleviates your pain sensation. It alsostimulates various anti-inflammatorysubstances, which help your body withthe healing process. There are twogenerally accepted theories on how TENSworks:

a: The Gate Control TheoryThe TENS message is carried to thespinal cord faster than a pain messageand closes a hypothetical gate, inhibitingthe pain message to the brain. This TENStreatment is also known as “conven-tional” or “high frequency” and applieswhen the Pulse Rate is set at 60-80pulses per second or more. The sensationproduced with this setting can bedescribed as a steady “buzzing” or“tingling” feeling. Many find highfrequency TENS produces the quickestpain relief, often with several hours ofrelief, after a treatment of one hour.

b: Acupuncture-like TENS or lowfrequency TENSAcupuncture-like TENS or low frequencyTENS stimulates the body to releaseendorphins, the body’s own pain killingsubstances. This applies when the PulseRate setting is below 4 pulses per second- and usually at 2 pulses per second.These low frequency treatments areadjusted to an intensity that producesslight muscle twitching and are describedas “tapping” or “pulsating”. Patients findthis type of treatment takes longer, atleast 20-30 minutes to be effective,but the result of a 30-60 minutetreatment can last for a much longerperiod; hours and sometimes days.

The degree of pain relief varies fromperson to person and it is difficult topredict just how effective TENS will beuntil you try it. The best results areobtained by selecting the mostappropriate electrode position andfrequency settings for your particularpain.

A brief history of electrotherapyand TENSAlthough in its present form TENS is ofrelatively recent origin, therapeuticelectrical stimulation of the human bodyhas been employed in various formssince early times. Stone carvings from theEgyptian Fifth Dynasty made inapproximately 2500BC show an electric

Introduction - What is TENS all about?I

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fish being used to treat pain. In AD46 theRoman physician, Scribonious Largusrecorded the introduction of the electricalpowers of the fish into clinical medicineas a cure for headache and gout. In someparts of the world, the electric catfish andelectric rays continued to be used for thetreatment of pain and other conditionsup until the end of the nineteenthcentury. Electrostimulation, using staticelectrical machines, came intoprominence in the mid eighteenthcentury and continued in popularitythrough the eighteenth and nineteenthcenturies. However, it fell out of favour inthe early part of the twentieth centurydue to the availability of a wider range ofanalgesic drugs.

The present day use of TENS began afterthe 1965 publication of a landmark paperby Melzack and Wall entitled “PainMechanisms: A New Theory”. Its use isexpanding from pain clinics to emergencydepartments, operating theatres, labourwards, surgeries and self care.

What conditions can be treatedwith TENS?Many painful conditions (and some non-painful conditions) can be treated withTENS. As with all other forms of therapy,it is essential to have the cause of yourpain diagnosed by your medical adviserbeforehand. Pain can be a warning sign,to alert us that something may be wrong.However, some types of chronic painappear to be of no real value and mayresult in continuous discomfort,depression, restriction in our movements

and general functioning. Acute pain isusually more severe and of shorterduration, e.g childbirth, trauma orsurgery. Acute and chronic pain can betreated with TENS and some of the morecommon examples are listed below.

• Rheumatoid arthritis

• Osteoarthritis of one or severaljoints

• Ankylosing spondylosis

• Neck pain, cervical spondylosis,whiplash injuries

• Low back pain resulting from strains,prolapsed disc, spondylitis,

• Osteoporosis

• Referred pains such as sciatica

• Fibrositis/myofascial pain syndromes

• Acute sprains/strains e.g sports andoccupational injuries

• Tendonitis/bursitis

• Carpal tunnel syndrome

• Migraine and headaches

• Peripheral nerve injuries andneuropathy of various causes

• Phantom limb pain

• Post herpetic (shingles) neuralgia

• Post operative neuralgia and scartissue pain

• Pain in cancer and the terminally ill

• Labour pain

• Nausea and vomiting

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However, it may be dangerous to maskpain associated with an unknown illnessor a recent uninvestigated injury.You should check with your health careadviser for an accurate diagnosis, beforeusing TENS.

Why should I use aBody Clock TENS?Body Clock offers a wide range of units,which are fully compliant with currentmedical device regulations. These havebeen tried and tested over many years bythe author and other practitioners. BodyClock only make the highest quality TENSunits known for their ease of use andlatest technology.

How will TENS help my pain?The aim of TENS treatment is to promotepain relief, an increase in movement andfunction of the affected area, and todecrease pain medication. Good resultshave been obtained over the past twenty-five years in hundreds of studies, surveysand systematic reviews conducted onboth acute and chronic pain patients.By the year 2000 there were nearly 500studies and reviews on electricalstimulation methods recorded in theCochrane Library database alone, themost important source of high qualitymedical research in the world today. Theextensive Medline database listed morethan 800. We can now say that TENSprovides useful relief for most peoplewith acute, subacute or chronic pain. Inaddition TENS is a safe, non invasivetreatment, economical and easy to use.

The importance of accurateelectrode placementWe cannot stress too strongly that correctelectrode placement is vital to obtain thebest results from your Body Clock TENS.Please see the following charts whichhave been specially prepared to help you.

The most important aspects of TENSelectrode placement is to position themso that the current passes through thepainful area, or along the nerves leadingfrom the pain, or over acupuncturepoints. If your Body Clock TENS is a dualchannel unit, with two sets of leads andelectrodes, then it is possible to treat twodifferent areas of pain at once.

How to use the electrodeplacement charts.Check the index on page 6 for the chartmost applicable to your own painproblem. We have selected the easiestand most frequently used electrodeplacement positions. However there arealternatives, which may be advised byyour medical practitioner.

IIElectrodePlacement andCharts

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ChartsBack PainLow back pain 7Upper back pain 7Back pain with sciatica 8Ankylosing spondylitis 8

Neck and Shoulder painNeck pain and whiplash 9Shoulder pain andfrozen shoulder 9 - 10

Leg painHip pain 10 - 11Knee pain 11Ankle pain 12Achilles tendon problem 12Foot pain 12Phantom limb pain bothbelow and above the knee 13 - 14

Arm and shoulder painTennis elbow 14Golfer’s elbow 15Wrist pain and carpal tunnelsyndrome 15Hand and finger pain 15Phantom limb pain bothbelow and above the elbow 16

Abdominal PainPeriod pain or dysmenorrhoea 17Irritable bowel syndrome 17

Headache and MigraineClassical migraine, headache,stress, insomnia 18Pre-menstrual migraineand tension (PMT) 18

Neuralgia PainTrigeminal neuralgia 19Post shingles neuralgia(ophthalmic shingles) pain 19Post shingles pain 19Post operative neuralgia 20

Nausea and VomitingNausea associated withpregnancy, chemotherapy,travel sickness etc 21

Labour and deliveryLabour pains 21

Peripheral NeuropathyPeripheral neuropathy associatedwith chemotherapy and diabetes 22

Wound healing and leg ulcersWound healing associated withdiabetes, varicose, ulcer, postoperative pain etc 22

Key: = 1st pair of electrodes= 2nd pair of electrodes -if using a dual channel TENS

= pain zone

Electrodes supplied are single colour.Black and white squares are for indicating electrodeplacement only.

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Low Back pain is shown by the red“pain zone”. The black squares insidethe “pain zone” represent a pair ofelectrodes. Each electrode is placed onthe lower back as shown above.

Low backpainchart 1

Low Back pain is shown by the red “painzone”. The black and white squaresinside the “pain zone” represent twopairs of electrodes, placed on the lowerback as shown above.

Low backpainchart 2

Upper back pain is shown by the red“pain zone”. The black squares insidethe “pain zone” represent a pair ofelectrodes. Each electrode is placed onthe back as shown above.

Upper backpainchart 1

Upper back pain is shown by the red“pain zone”. The black and whitesquares inside the “pain zone”represent two pairs of electrodes,placed on the back as shown above.

Upper backpainchart 2

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Back pain with Sciatica is shown by thered “pain zone”. The black squaresinside the “pain zone” represent a pairof electrodes. Each electrode is placedon the body as shown above.

Back painwithsciaticachart 1

Ankylosing Spondylitis is shown by thered “pain zone”. The black and whitesquares inside the “pain zone”represent two pairs of electrodes.The electrodes are placed on the backas shown in the diagram.

Ankylosing Spondylitis

Back pain with Sciatica is shown by thered “pain zone”. The black and whitesquares inside the “pain zone” representtwo pairs of electrodes. Each electrode isplaced on the body as shown above.

Back painwithsciaticachart 2

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Neck pain/whiplash is shown by thered “pain zone”. The black squaresinside the “pain zone” represent a pairof electrodes. Each electrode is placedeither side of the spine as shown in thediagram to the left.

Neck pain and whiplashchart 1

Neck pain/whiplash is shown by thered “pain zone”. The black and whitesquares inside the “pain zone”represent two pairs of electrodes.Each electrode is placed either side ofthe spine as shown in the diagram tothe left.

Neck pain and whiplashchart 2

Shoulder pain and frozen shoulderare shown by the red “pain zone”.The black squares inside the “painzone” represent a pair of electrodes.One electrode is placed on the front ofthe shoulder and the other on the backof the shoulder as shown in thediagrams to the left.

Shoulder pain andfrozen shoulder

Outeraspect ofarm

Inneraspect ofarm

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Shoulder pain and frozen shoulder are shown by the red “pain zone” above.The black and white squares inside the “pain zone” represent two pairs of electrodes.Two electrodes are placed on the front of the shoulder and the other two on the backof the shoulder as shown in the diagrams.

Shoulder pain and frozen shoulder

Hip pain is shown by the red “pain zone” above. The black squares represent a set oftwo electrodes. Both electrodes are placed within the “pain zone” - one at the frontand one at the back.

Hip pain chart 1

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Hip pain is shown by the red “pain zone” above. The black and white squares insidethe “pain zone” represent two pairs of electrodes.a. The white set is placed within the “pain zone” - one at the front and one at the

back of the hip.b. The black set is placed on opposite hips to allow the current to pass straight

through the body.

Hip pain chart 2

Knee painchart 1

Knee pain isshown by the red“pain zone”.The black squaresinside the “painzone” represent apair of electrodes.These should beplaced either sideof the knee asshown.

Knee painchart 2

The black and whitesquares inside the“pain zone” representtwo pairs ofelectrodes. The blackelectrodes are placedas in chart 1. Thewhite electrodes areplaced at the backand front of the kneeallowing the currentto pass through.

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Ankle and foot pain is shown by the red“pain zone”. The black squares insidethe “pain zone’ represent a pair ofelectrodes. These are placed either sideof the ankle as shown in the diagramsto the left.

Ankle pain

Achilles tendon pain is shown by thered “pain zone”. The black squaresinside the “pain zone’ represent a pairof electrodes. These are placed eitherside of the leg as shown in thediagrams to the left.

Achilles tendon pain

Foot pain is shown by the red “painzone”. The black squares inside the“pain zone’ represent a pair ofelectrodes. These are placed either sideof the foot as shown in the diagrams, orone on the sole and one on the top ofthe foot.

Foot pain

Insideleg

Outsideleg

Inneraspect ofarm

Insideleg

Outsideleg

Insideleg

Outsideleg

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Below the knee phantomlimb pain is shown by thered “pain zone”. Theblack squares inside the”pain zone” represent apair of electrodes. Oneelectrode is placed on thefront of the leg and theother on the back as shownin the diagrams.

Above the knee phantomlimb pain is shown by thered “pain zone”. The blacksquares inside the ”painzone” represent a pair ofelectrodes. One electrodeis placed on the front of theleg and the other on theback as shown in thediagrams.

Phantom limb pain below the knee

Phantom limb pain above the kneechart 1

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Above the knee phantomlimb pain is shown by thered “pain zone”. The blackand white squares insidethe ”pain zone” representtwo pairs of electrodes. Twoelectrodes are placed on thefront of the leg and theother two on the back of theleg as shown in thediagrams.

Phantom limb pain above the kneechart 2

Tennis elbow pain is shownby the red “pain zone”.The black squares inside the”pain zone” represent a pairof electrodes. One electrodeis placed over the area ofpain and the other on theinner aspect of the armallowing the current to passthrough the arm.

Tennis elbow

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Golfer’s elbow pain isshown by the red “painzone”. The black squaresinside the ”pain zone”represent a pair ofelectrodes. One electrode isplaced over the area of painand the other on the outeraspect of the arm allowingthe current to pass throughthe arm.

Golfer’s elbow

Outeraspect ofarm

Inneraspect ofarm

Wrist pain and carpaltunnel syndrome are shownby the red “pain zone”.The black squares inside the”pain zone” represent a pairof electrodes. One electrodeis placed over the area ofpain and the other on theouter aspect of the armallowing the current to passthrough the arm.

Wrist pain and carpal tunnel syndrome

Outeraspect ofarm

Inneraspect ofarm

Hand and finger pain isshown by the red “painzone”. The black squaresinside the ”pain zone”represent a pair ofelectrodes. These are placedin the pain zone” onopposite sides of the hand.They can also be wrappedaround two fingers in painand secured with tape, ifnecessary.

Hand and finger pain

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Phantom arm pain is shownby the red “pain zone”.The black and white squaresinside the ”pain zone”represent two pairsof electrodes.

Two electrodes are placedon the front of the arm andthe other two on the backas shown in the diagrams. Ifyou are using only one pairof electrodes, apply eachpad centrally to the frontand back of the stump.

Phantom arm pain is shownby the red “pain zone”.The black and white squaresinside the ”pain zone”represent two pairsof electrodes.

Two electrodes are placedon the front of the arm andthe other two on the backas shown in the diagrams.If you are using only onepair of electrodes, applyeach pad centrally to thefront and back of the stump.

Phantom limb pain below the elbow

Phantom limb pain above the elbow

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Period pain ordysmenorrhoea is shownby the red “pain zone”.The black and white squaresinside the ”pain zone”represent two pairs ofelectrodes. One set ofelectrodes is placed on thefront of the body and theother set is placed on theback of the body as shownin the diagrams.

Irritable bowel syndrome isshown by the red “painzone”. The black and whitesquares inside the ”painzone” represent two pairs ofelectrodes. One set ofelectrodes is placed on thefront of the body and theother set is placed on theback of the body as shownin the diagrams. The greyelectrodes show analternative placementposition.

Period pain or dysmenorrhoea

Irritable bowel syndrome

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Classical migraine, headache, stress,insomnia are shown by the red “painzone”. The black and white squaresrepresent two pairs of electrodes.The electrodes on the back of the neckshould border the hairline and beplaced either side of the spine with5cm (2”) between them.

The electrodes on the hands shouldbe positioned on the web spacebetween the first finger and thumb.If nausea and vomiting occur placeelectrodes on the inner arm 2.5cm (1”)from wrist crease.

Classical migraine, headache,stress, insomnia

Pre-menstrual migraine and tension(PMT) are shown by the red “painzone”. The black and white squaresrepresent two pairs of electrodes.The electrodes on the back of the neckshould border the hairline and beplaced either side of the spine with5cm (2”) between them.

One electrode should be placed oneach inside leg as shown in thediagrams.

Pre-menstrual migraine andtension (PMT)

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Post shingles ophthalmic pain is shown by the red “pain zone”. The black squaresrepresent a pair of electrodes. One electrode is placed on the forehead in the “painzone”, and the other on the back of the neck bordering the hairline as shown in thediagrams above.

Post shingles ophthalmic pain

Trigeminal neuralgia pain isshown by the red “pain zone”.The black squares represent apair of electrodes. The electrodesare placed on the face as shownin the diagram. Stimulate verygently to begin with and stop ifthe pain worsens. Then try again,applying the electrodes to theopposite side of the face withoutthe pain.

Trigeminal neuralgia pain

Post shingles pain is shown bythe red “pain zone”. The blackand white squares inside the“pain zone” represent two pairsof electrodes. Place theelectrodes on either side of theshingles scar wherever it is foundon the body.

Post shingles pain

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Post-operative neuralgiaAn example is shown by the red “pain zone” but the scar could be sited anywhere onthe body. One electrode should be placed over the scar and the other placed in thesame position on the other side of the body, as shown in the diagrams above.

Post-operative neuralgia chart 1

Post-operative neuralgiachart 2

Post-operative neuralgia painThe black and white squares inside the“pain zone” represent two pairs ofelectrodes. An example of how to treatthis pain is shown but the scar couldbe sited anywhere on the body. Theelectrodes should be placed aroundthe scar as shown in the diagram.

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Nausea and vomitingThe black squares representa pair of electrodes. Use alow frequency pulse rate forthirty minutes as needed.The electrodes should beplaced on the inner aspectof both wrists, 2.5cm (1”)from the wrist crease asshown.

Labour and deliveryThe black and white squaresinside the “pain zone”represent two pairs of largeobstetric electrodes. Placethe electrodes on the lowerback and mid back asshown in the diagram.

Please note that a BabycareTENS should be used forlabour (supplied by BodyClock). These are speciallydesigned units forchildbirth.

Nausea and vomiting associated withpregnancy, chemotherapy travelsickness, post operative, inner earproblems etc.

Labour pains

Inneraspect ofarm

Inneraspect ofarm

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Peripheral NeuropathyThe black and white squaresinside the “pain zone”represent two pairs ofelectrodes. Place theelectrodes on the leg asshown in the diagram.

Use a high frequency (pulserate) and stimulate gently.

Wound/ulcer healingThe black and white squaresinside the “pain zone”represent two pairs ofelectrodes. An example ofhow to treat this pain isshown, but the area of paincould be sited anywhere onthe body.

Place electrodessurrounding the pain, notover broken or damagedskin. Use a high frequency(pulse rate) and stimulategently.

Peripheral Neuropathy - associatedwith diabetes, chemotherapy,

Wound/ulcer healing - associated withdiabetes, varicose ulcer, post operativepain etc

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III

1. First - read this book and the“Instructions for Use” booklet whichaccompanies your Body Clock TENS.

2. Set up your unit in accordance withthe “Instructions for Use” booklet.

3. Wash and dry around the area of pain,ensuring there is no grease orpowder on your skin.

4. Apply self-adhesive electrodes to yourskin. If using carbon rubberelectrodes, use a small amount of geland affix with surgical tape.

5. Make yourself comfortable for an houror so while the treatment is workingand re-read the instructions againuntil you are familiar with them. Takenote of your pain level before thetreatment. Try scoring the level ofpain on a scale of 0-100, where 0 is nopain and 100 is the worst pain youhave ever had. Record it on paper.

6. At the end of an hour switch the TENSunit off. If you want to begintreatment again within a few hours,you may leave the self-adhesiveelectrodes in position for the nexttreatment. If using non-adhesiveelectrodes remove them and wipe offthe gel. Take note of your pain

level now. Is it better or the same?Again, try scoring the level of painon a scale of 0-100.

7. The next time you set up your TENStreatment it will be much easier.Deciding on the length of your nexttreatment, e.g. 30 mins, one hour ororlonger depends on the response youhad with your first treatment, whetheryou are going to rest or continueactivities. You score the level of pain,before and after each treatment, overthe next few days and weeks, as tohow effective treatment has been inreducing your pain level.

8. You may prefer to begin with just onetreatment a day, or even three or fourtreatments, or use TENS continuouslyfor a while, depending onthe severity of your pain.

9. You may then wish to adjust yourTENS unit settings using a differentmode, or different treatment times togain more effective painmanagement, in line with therecommendations on page 24.

A quick guide to setting up yourTENS treatment

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IV

TENS treatment can provide useful relieffor both acute and chronic pain. TENS isself-administered, non-invasive andsimple to use once you have mastered afew easy techniques.

General guidelines to help youmanage your pain

1. Place electrodes over the painful areaand stimulate. If this does not helpthen move the electrodes to eitherside of the pain, as shown on theBody Clock Electrode PlacementCharts. Pages 7 - 22.

2. The sensation should feelcomfortable. Low frequency TENSshould produce a firm muscletwitching sensation. Your TENS unitmust be set to a tolerable level.

3. As your TENS unit battery begins todrain, you may need to graduallyincrease the intensity to maintain thesame level of stimulation output.

4. Research studies have shown that atleast 30-60 minutes is needed for aconventional or burst mode TENStreatment to be effective. When usinglow frequency (acupuncture-likeTENS) then 30 minutes is therecommended treatment time, whichcan be repeated after 90 minutesonce or twice a day.

5. For “conventional” high frequencyTENS there are no recommendationsconcerning total treatment time.Some find that short periods of 30-60minutes can provide them withseveral hours of pain relief. Othersfind that they require longertreatment periods, perhaps for severalhours or all day in order to achievesatisfactory pain relief.

6. Some patients find that one particularsetting gives them the best painrelief. Others find it more comfortableto vary the settings.

It is recommended that you consultyour usual healthcare adviser toobtain the most effective pain reliefadvice. If this is not possible then thisbook may help you achieve the mosteffective response.

7. It is not usually recommended to useyour Body Clock TENS during nighttime sleep, the reason being that ifyou roll over on to your electrodes,they may come off or be damaged.

8. All electrodes should be removedfrom the skin every day, and thesurrounding area should be carefullywashed and dried. Electrodes shouldshould not be applied to exactly thesame area every day. Move themaround slightly within the area ofpain.

How to use your TENS unitfor pain management

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Do I need to take any specialcare of my skin?1. TENS treatment produces very few

side effects. Occasionally mildirritation at the electrode site mayoccur. This can usually be remedied byreplacing the electrodes, gel or tapewith alternative products.

2. When using carbon rubber electrodesand conductive gel, ensure the geldoes not dry out. Add more ifnecessary to protect your skin.

3. Trim any excess body hair, whichcould interfere with smooth electrodecontact with the skin, but do notshave it.

4. Do not place electrodes on cut,broken or irritated skin.

5. Moisturising cream may be appliedafter treatment, NOT before.

6. If irritation still occurs, discontinueuse and consult your health careadviser.

Can I combine TENS with othertherapies?Yes - It can be combined with most othertherapies such as conventionalmedication, physiotherapy, acupuncture,exercise, massage, homeopathy, herbalmedicine, chiropractic and osteopathicmanipulation, and hot and cold packs.However, if you have more than onetreatment at a time, it may be difficult toknow which treatment is helping you.

Under which conditions should I notuse a TENS unit?1. To treat pain not diagnosed by your

medical adviser.

2. If you have a demand-type cardiacpacemaker, serious or unstable heartcondition or have had a recent heartattack.

3. Do NOT place electrodes on or nearthe eyes, in the mouth, over the frontor sides of the neck, across the head,heart, or an area of broken, infected,or numb skin. Electrodes shouldgenerally only be applied to skin withnormal sensation unless undermedical supervision.

4. Do not use TENS during pregnancyunless under medical supervision.

5. Do not use in the presence oftuberculosis, malignant tumours, highor low blood pressure, epilepsy, highfever or acute inflammatory diseaseunless under medical supervision.

6. If an allergic reaction develops toadhesive tape or electrodes.

VAre there anyprecautions to betaken with TENS?

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VI7. If driving or operating potentially

dangerous machinery.

8. Your TENS unit should be kept out ofthe reach of children.

9. Turn off your TENS unit whileoperating a microwave oven.

10. If you are in any doubt, contact yourusual medical adviser.

How do I care for,clean and storemy TENS unit?

How do I care for, clean and store myTENS unit?Your TENS unit requires no maintenanceother than regular gentle cleaning.Using a soft cloth, slightly moistenedwith warm water, to clean the case, andleads. A mild soap may also be used butDO NOT apply solvents.

ElectrodesStore self-adhesive electrodes inpackaging provided in a cool, dry place.Follow instructions supplied to maintainadherence. Carbon rubber electrodesshould be cleaned to remove conductivegel after use.

BatteriesThe unit must be switched off whenchanging the battery.

TENS LeadsDo NOT yank or twist the leadwires - treatthem gently for a long life. They aremade from fine wire to be flexible andlightweight.

General Precautions.• Do not immerse your TENS unit in

water or any other liquid• Do not place it close to any source of

excess heat• Do not operate your unit in the

presence of flammable gases• Do not attempt to open the TENS unit• Do not use battery or power sources

other than those specified• Do not drop this unit onto a hard

surface

Tell me about the Body ClockWarranty and Servicing1. Body Clock TENS should be repaired

by qualified technical personnel.

2. Body Clock TENS units are guaranteedfor a period of 5 years againstmanufacturer’s defects. Leads andcarbon rubber electrodes areguaranteed for a period of threemonths.

3. Note: the guarantee is null and void ifany attempt is made to open the unitby unauthorised personnel.In the event of a fault please contactBody Clock, 108 George Lane,South Woodford, E18 1AD.Tel: (+44) 020 8532 9595Fax: (+44) 020 8532 [email protected]

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VII

If you are still having difficulty obtainingpain relief, carefully re-read this book andthe “instructions for use” supplied. Theycontain all the information needed forsuccess. Many people experience almostinstant pain relief after following theseinstructions. Are you following all theinstructions suggested? If so, and if youare still having difficulty in controllingyour pain, try the following tips - one at atime.

1. You may need two or more treatmentsa day, sometimes for several hours,over several days. Even professionalsdo not always achieve instant relieffor their patients: so do not abandonyour TENS after just a few treatments.Continue use for two or more weeksat least, as the effects tend to becumulative i.e. each treatment buildsupon the last.

2. Experiment with different frequencysettings bearing in mind the followingguidelines:

(a) High pulse rate settings: Set the pulserate above 10 and usually between80-100 or more in continuous mode(C). This should be felt as a tinglingsensation. Recommended treatmentperiod is at least one hour, or forseveral hours continuously, for atleast 2 or more weeks.

(b) Low pulse rate settings: Set the pulserate below 10 and usuallybetween 2-3 in continuous mode (C).This should be felt quite firmly.A treatment period of 30 minutesonce or twice a day is usuallysufficient once the pain is undercontrol. You may also repeat thetreatment 90 minutes later for animproved analgesic effect.

(c) Try pulse burst treatment (if this isavailable on your TENS model) byselecting B on your TENS and 100 onboth the pulse rate and the pulsewidth for 30 minutes each treatmentand repeat as required.

(d) If your TENS unit has an M setting(Pulse Modulation) then you can alsotry this setting again for 30 minuteseach treatment, or longer if necessary.Some patients find this setting mosthelpful and soothing.

4. Make sure the electrodes are firmly inplace at all times, in good conditionand well-gelled. TENS electrodes aregenerally placed around the painfularea, over the painful area, or over theacupuncture points in order toincrease the effectiveness of TENStreatment.

5. If you are treating back pain tryplacing one electrode over the mostpainful area and the other on the

Troubleshooting

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opposite side of the spine. Also tryplacing the electrodes 2.5cm (1”)either side of the spine, in line withthe area of pain - i.e. 5cm (2”) apart.

6. Try using different pulse rates duringeach treatment e.g 30 minutes on ahigh rate and 30 minutes on a lowrate.

7. Try gently exercising the painful areawhile you are using your TENS unitand then applying a cold pack (fromthe fridge NOT out of the freezer) tothe area for 10 minutes at the end ofthe treatment.

8. The most common cause of failure toachieve pain relief from TENS is toofew treatments, so make sure youhave given the treatment a reallygood trial and remember, the longeryou have had your pain the longer itmay take to reduce it and the moretreatment you need.

9. Do not stop taking your usual painkilling drugs when you begin yourpain treatment, but discuss reducingthe dosage with your medicalpractitioner as your pain decreases.

10. Do not be afraid to experiment withdifferent pulse rate settings to findthe treatment which gives you thebest result but give each changeseveral days to work before switchingto another one.

11. Enthusiastic tea or coffee drinkingmay reduce the analgesic effect ofTENS - try cutting your intake downby half and drink water and fruitjuices instead.

12. If your pain becomes worse, eitherduring or after treatment, then it isusually due to applying the incorrectpulse rate for your problem. Try adifferent setting and if this does not helptry moving the electrodes to anotherposition and repeat until you achieve thepain relief you are looking for.

13. Remember: TENS treatment benefitsmost people but you have to give it achance to work by ensuring anadequate trial i.e. treatments once ortwice daily, or more, for at least 2-3weeks, plus it may be necessary toadjust the pulse rate and/or theelectrode placement to achieve thebest effect.

Where can I find furthersupplies of accessories?Call Body Clock Health Care on(+44) 020 8532 9595 for:-electrodes, batteries, gel, leads,sticky fixers, pouches, batterychargers and rechargeable batteriesand much more, or order online atwww.bodyclock.co.uk

What if I need more help?Call us at Body Clock on(+44) 020 8532 9595 and we will doour best to assist.

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Version (2) Sept 2006