TENS, Back Pain, and Recipes
Posted on September 11, 2013
Does TENS therapy really work for lower back pain?
Before answering this question, let’s first understand exactly what causes back pain, how to treat back pain, and how TENS can be used to treat lower back pain.
I. Causes of back pain
There are four basic groups of causes of lower back pain:
Injury or overuse of the muscles, ligaments, and joints - This is especially true with former athletes, or with folks who have repetitive motion injuries due to work. But this is not exclusively to former athletes. Weekend golfers and bowlers, for example, often struggle with back pain due to the repetitive (and sudden) motions associated with their sports. Stretching prior to weekend athletic events can be a big help in preventing back injury and pain.
Conversely, the weakening of muscles in the back from underuse (such as a lack of exercise, or from remaining in a seated position for extended periods of time) can increase the chance of an injury which is both painful and difficult to treat effectively.
Pressure on nerves - There are a number of acute and chronic conditions that can create pressure on the nerves. Examples include herniated discs, fractures, osteoarthritis, other forms of inflammation (like arthritis), and various deformities, such as scoliosis. Sciatica can also be included in this category. In fact, when the nerves start to get involved, the pain can travel down the back through the buttocks, and into the legs. As a result, the broad area that is painful can make back pain due to pressure exceedingly difficult to treat.
Compression fractures - A compression fracture is typically seen in women with osteoporosis, where bones are weakened over time. A fall, a bump, or even a strong sneeze can cause the brittle bones in the back to compress and fracture, resulting in a tremendous amount of pain.
Rare causes - Much rarer causes of lower back pain include ankylosing spondylitis (a form of arthritis), infections, or tumors.
As you can see, there are a wide variety of possible causes of back pain. This is why it’s so important to talk to your doctor and have a thorough physical history and examination before deciding on a course of treatment.
And, if you doctor says something like “Oh, it’s just arthritis.” without a thorough examination, then it may be time to get a second opinion from a back pain specialist.
II. How to treat lower back pain
With so many causes of back pain, finding the right treatment can be difficult. Ironically, the rarer causes can be “easier” to treat because the treatment protocols are well-established. For example, back pain caused by infections can be cured by lengthy courses of antibiotics. Surgical procedures, can also sometimes bring permanent relief to certain back pain conditions.
The real challenge lies with the chronic causes, such as chronic arthritis, or longer-term injuries caused by repetitive motion. There are several categories of therapies for chronic lower back pain, including:
A. Oral pain relievers - This would include over the counter drugs, like ibuprofen and naprosyn, plus the prescription ones, like diclofenac. These drugs are excellent pain relievers, but they can have side effects, especially stomach upset, pain, and even bleeding. These drugs work primarily as anti-inflammatories, so they are perfect for arthritis and other inflammation.
Stronger pain relievers, such as the narcotics, are sometimes used for severe pain, such as severe chronic osteoarthritis pain. These are not recommended for long-term use due to their side effects (such as constipation), and their potential for abuse.
Fortunately, some of the narcotic pain relievers are available in a patch form that is placed on the skin. This is a good way to receive chronic pain relief, but the side effects will persist.
Some natural pain relievers, like Traumeel, are available which are excellent supplements to the prescription pain relievers.
B. Topical pain relievers - Pain relievers that are applied directly to the skin are an excellent approach for dealing with chronic pain. While some of these products may not completely eliminate pain, they are an excellent way to reduce pain, and perhaps even reduce the amount of prescription pain reliever taken.
Topical pain relievers can be a confusing array of brands and active ingredients. Basically, there are three kinds of topical pain relievers:
Aromatics, such as menthol and camphor, are incredibly safe, and are available in patches, gels, lotions, and roll ons (such as BioFreeze and Sombra Cool) . While very effective, some people may object to their strong odor. These products will give a cold sensation to the skin.
Patches such as Imbue which contain menthol or camphor tend to have a lot less odor, and may be preferred. Other products, such as Old Goat, provide all-natural herbal sources of these aromatics, and can be effective as well.
Topical anti-inflammatories, such as methyl salicylate, are an excellent option for those who respond well to pain relievers like ibuprofen, but who want to avoid the stomach and intestinal side effects. Methyl salicylate-containing patches (such as Imbue) are perfect for this.
Capsaicin is a substance extracted from hot peppers. When applied to the skin, capsaicin provides a warming sensation similar to a heating pad. Capsaicin is perfect for muscle pain that responds well to heating pads. Capsaicin is available in lower strengths in lotions (Epsom It) and roll ons (Sombra Warm). But it’s also available in an over-the-counter patch (Salonpas HOT).
C. Back Supports - Having a good back support is a must, especially for folks who develop back trouble from remaining seated for extended periods of time. Lumbar supports are inexpensive, and highly effective for maintaining the proper back position and avoiding back problems.
We generally recommend not using chairs with built-in lumbar supports, as these supports are not easy to adjust. Our recommendation is to use a straight-back chair, then to attach an adjustable lumbar support that better suits your needs.
More recently, the ProBack support was introduced. This is a wearable back support that can offer quick relief for tight muscles in the lower back. A ProBack is perfect for commuters, or for folks who need back support but who are not in a seated position. One nice thing about the ProBack is that it is very light, and can be easily worn underneath the clothes.
All of these product ideas (pain relievers, back supports) may or may not work for your particular type of pain. In fact, it is nearly impossible to say this particular brand will definitely work for you. Why? Because not only are we all different, but the cause and severity of the back pain can differ quite a lot from person to person.
Thus, the best thing to do over the long term is to experiment a bit with different product ideas. Try one product for at least 2-3 weeks. If it doesn’t provide some level of pain relief, then try another.
But, it’s important to remember that these products may not completely remove the pain. If they reduce the pain by 25-50%, then they are doing their job, especially if you feel more comfortable, if you are more active, and if you find yourself taking less oral pain relieving drugs.
III. A role for TENS?
TENS, or transcutaneous electrical nerve stimulation) is a well-established method for reducing pain. There are many TENS units available for use by physicians, physical therapists, and chiropractors for in-office use. More recently, several companies have developed TENS units for use in the home.
But does it work? As discussed above, it really depends on the individual and the severity of the pain. However, some of the clinical research performed using TENS is compelling. For example, in a study recently published in the European Journal of Pain, physicians found that:
An improvement of at least 50% in lumbar pain between the first and last assessments was achieved by 25% of the patients in the active TENS group compared with 6.7% in the sham TENS group...
In other words, many patients who used TENS were able to reduce their lower back pain by at least half! This is a great result, since it shows that TENS in combination with oral pain relievers can reduce pain.
Some of the older TENS units are big, bulky, and inconvenient to use. Plus, some have long wires from the pads to/from the unit which provides the actual electricity. Some also have a separate controller which is also attached to the unit which provides the electricity.
Fortunately, there are now available wireless TENS units which are simpler and easier to use. Plus, the newer units are much smaller, and designed specifically for the lower back. So they can be worn discretely while controlled with a wireless remote.
As we said earlier. With any form of treatment for back pain, it should be understood that no single approach will completely eliminate back pain. It may take a combination of two or three approaches to relieve the pain. So, for example, one “recipe” for back pain management might look like this:
- Adjustable lumbar support at work
- One oral pain reliever in the morning
- One methyl salicylate back pain patch worn all day during work
- One capsaicin patch at bedtime
For another person, the back pain recipe might look like this:
- Wearable back support all day while at work
- One oral pain reliever in the morning, one at night
- Topical pain reliever at bedtime
Here is one last one:
- One oral pain reliever in the morning
- Wearable TENS unit while at work
- Evening yoga, stretching, or other mild exercise
- Application of topical pain reliever at bedtime
These are examples of “recipes” that you can think about for dealing with lower back pain.
So experiment a bit and find your own recipe!