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European perspective: a comparison between TENS and MET.

Physical Therapy Products. September 2000

By Patrick De Bock, Physical Therapist
“...physiotherapists already have a better solution—one that is
pleasant and may competently control the pain...”

1.5 Modulation

Another way to avoid adaptation is presented by electronic modulation of intensity, frequency and pulse width. Manual frequency modulation is well-known in the use of interferential current but will not be discussed in this paper. Some patients don’t like the “on-off” burst feeling, which makes modulation a good alternative.

1.6 Electrodes

From a theoretical point of view, three different possibilities can be used in TENS (1.6.1 – 1.6.3). MET probably uses the same three (1.6.4-1.6.6) as well, but they have a different underlying explanation. Cleaning the skin prior to treatment or regularly wetting the probes may be more important than the choice of electrodes. Self-adhesive electrodes, whether they are carbon or silver, usually are the easiest to use. In most cases, silver ones give the best results.

1.6.1 TENS: Local Electrode Placement

Since this paper is about back pain, the real local electrode position isn’t really at stake. Electrodes cannot really be put on the pathologic site. In knee or shoulder problems, where the injury or disease is between the electrodes, the milliampere current could cause side effects. In back problems, the pathology is deeper in the body, at the joint or the disc. However, the possible negative effects from milliampere currents on healing can not be denied (see 2.3). The most suitable electrode types are carbon or silver ones.

1.6.2 TENS: Paravertebral Electrode Placement

If pain decrease is to be achieved on a gate-control basis, a one-inch mistake can cause the treatment to have no effects at all. According to endorphin release theory, any position that stimulates A (- and C –fibers) will do the right thing. From a practical point of view, a vertebral position, counting the spinous process (SP), will always lead to correct electrode placement.



To avoid misplacement, the electrodes can be placed above and under the SP. The stimulus reaches the medial ramus cutaneous of the spinal nerve. In a few occasions, positions 1 or 2 inches lateral of the SP may enhance the results, probably because it causes stretching effects on the capsule of the facet joint. The intervertebral disc may be the subject of comparable effects; i.e. some patients with nerve root compression report more pain relief when electrodes are put on the paravertebral muscles of the opposite side using intensities above motor level. Again carbon or silver electrodes can be used.

1.6.3 TENS: Specific Electrodes Positions

Myofascial trigger points (MTP) and acupuncture points both require specific knowledge. Though literature indicates that TENS can be used on these, MET might be in a better position to treat trigger points. Acupuncture points can also be used, of course, but these shouldn’t be treated in a “cookbook way.” Acupuncture is mostly an art and can not be left to inexperienced therapists. As to the type of electrodes, the same remark can be made.

1.6.4 MET: Probe Electrodes

The electrode type makes a big difference and, as in TENS, specific positions can give very good results. Probes can be used for shorter treatments of two to 10 minutes. If longer treatment is needed, the use of self-adhesive electrodes will be much easier. In MET, it is very important to send the current through the injury site. Therefore, probes should be held dorsal and ventral or left and right of the trunk. Many positions are necessary for all kinds of back pain whether it be an intervertebral disc or a facet joint problem. The probe positions should describe a large “X” through the pathology.

1.7 Treatment Time

1.7.1 TENS

This is a very important parameter. Pain relief through gate-control usually lasts only a few minutes after treatment. This is probably not what the patient came for. Thus repeating the treatment several times a day can solve this problem. Using the TENS device with larger pulse widths to obtain pain relief through endorphin release will not be much different. According to the literature, this effect may last up to 60 minutes. Unless the patient is asked to switch on the machine several times a day, the pain will return after this first hour.

1.7.2 MET

Minor problems or almost cured injuries may need no more than 20 or 30 minutes of treatment. This can be done with the probes. If the patient suffers more pain, a longer treatment will be required. In most cases two to four hours will decrease the pain; and it is best to repeat this every second day. Daily treatments can be used in severe cases, but if side effects such as more pain occur, it is best to switch back to treatment every other day.

1.8 Intensity

1.8.1 TENS

Electrotherapy in the milliampere range can be used at three intensity levels. Depending on the theoretical basis of pain decrease one can use low, moderate or high intensity. Leading to possibilities known as: low intensity/high frequency (enkephalin release), moderate intensity/burst frequency (gate-control), high intensity/low frequency (endorphin release).

Some authors conclude that there is no strict relation between frequency/intensity and the opioid type. Anyway, always give the patient good instructions about this. The effect may be zero if the intensity is set at wrong level. All authors agree that TENS is useless if the patient does not understand the information or if there are sensitivity disturbances at the electrode site(s).

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Physical Therapy Products • Sept. 2000

Used with permission of Electromedical Products International, Inc.

©2006 by

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European perspective: a comparison between TENS and MET