A herniated disc occurs when the soft, jelly-like center of a spinal disc pushes through a tear in the exterior, resulting in pressure on nearby nerves. This nerve compression causes localized back pain and discomfort radiating into the extremities, such as the leg (sciatica). Transcutaneous Electrical Nerve Stimulation (TENS) offers a non-invasive option for managing this pain by delivering mild electrical currents through electrode pads. Correct pad placement is key to achieving effective pain relief.
Understanding TENS Therapy
TENS therapy works to alleviate pain through two primary mechanisms. The first is the Gate Control Theory, which suggests the electrical current stimulates large, non-pain-carrying nerve fibers. This stimulation effectively “closes the gate” in the spinal cord, preventing pain signals from reaching the brain.
The second mechanism involves the body’s natural pain-relieving system. TENS stimulation encourages the release of endogenous opioids, commonly known as endorphins, which are the body’s natural painkillers. The release of these chemicals helps to reduce the overall perception of discomfort. The effect is temporary, but it provides relief.
Pad Placement Techniques for Herniated Discs
The effectiveness of TENS for herniated disc pain hinges on placing the electrodes to target the painful area and the affected nerve pathways. A fundamental strategy involves placing the pads to “surround the pain” without placing them directly over the spine itself. For a localized herniation, one pad should be positioned just above the area of maximum pain, and the second pad should be placed below it, keeping them at least one inch apart.
Bracket Method for Spinal Pain
A highly effective technique for spinal pain is the “bracket” method, which places the pads laterally on either side of the spine. This creates an electrical field that surrounds the nerve roots at the level of the disc issue, targeting the compressed area without risking direct stimulation of the vertebrae. The pads should be positioned parallel to each other and the spine for the current to flow across the affected region.
Targeting Radiating Pain (Sciatica)
When a herniated disc causes radiculopathy, such as sciatica, the pain radiates down the buttocks and leg. Placement should follow the path of the radiating nerve pain. One common approach is to place one pad on the lower back near the origin of the sciatic nerve and the second pad further down the leg, along the back of the thigh, where the symptoms are most intense. This configuration ensures the electrical current travels along the irritated nerve pathway, providing relief to the extremity. Experimenting with slightly different placements can help the user find the configuration that provides the most optimal sensation and pain relief.
Safe Operation and Treatment Duration
Once the electrode pads are correctly positioned on clean, dry skin, the device settings must be carefully selected for optimal results. For acute pain associated with an initial flare-up, a high-frequency setting (80 to 120 Hertz) is recommended. This high-frequency stimulation activates the fast-acting pain-gating mechanism for quick, temporary relief.
For persistent or chronic pain, a low-frequency setting (2 to 10 Hz) is beneficial. Low-frequency stimulation is associated with the release of endorphins, which provides a longer-lasting pain-relief effect. Intensity should be increased slowly until a strong but comfortable tingling sensation is felt, without causing any muscle contraction or twitching.
Treatment sessions commonly last between 15 to 60 minutes. TENS can be used multiple times a day, often up to four times, as needed for pain management.
There are important safety considerations:
- Never place electrodes over broken or infected skin.
- Avoid placement near the eyes, mouth, or on the front of the neck.
- TENS is contraindicated for individuals with pacemakers, implanted electronic devices, or metal implants.
- Safety during pregnancy has not been definitively established.