TENS and electrothermal therapy for pain management

The most common form of electrical stimulation used for pain management is transcutaneous electrical nerve stimulation (TENS) therapy, which provides short-term pain relief. Electrical nerve stimulation and electrothermal therapy are used to relieve pain associated with various conditions. Intradiscal electrothermal therapy (IDET) is a treatment option for people with low back pain resulting from intervertebral disc problems.

TENS therapy for pain management

In TENS therapy for pain management, a small, battery-operated device delivers low-voltage electrical current through the skin via electrodes placed near the source of pain. The electricity from the electrodes stimulates nerves in the affected area and sends signals to the brain that "scramble" normal pain perception. TENS is not painful and has proven to be an effective therapy to mask pain.

Intradiscal electrothermal therapy (IDET)

Intervertebral discs act as cushions between the vertebrae. Sometimes the discs can become damaged and cause pain. IDET uses heat to modify the nerve fibres of a spinal disc and to destroy pain receptors in the area. In this procedure, a wire called an electrothermal catheter is placed through an incision in the disc. An electrical current passes through the wire, heating a small outer portion of the disc to a temperature of 90°C.

IDET is performed as an outpatient procedure while the patient is awake and under a local anesthetic. Early studies indicate that some patients may have continued pain relief for up to six months or longer. The long-term effects of this procedure on the disc have not been determined.The National Institute Of Clinical Excellence (NICE) only recommends this procedure under special arrangements for consent and for research or audit.

Radiofrequency discal nucleoplasty

Radiofrequency discal nucleoplasty is a newer procedure which utilises a radio frequency probe instead of heating wire to disintegrate a small portion of the central disc material. The result of this intervention is partial decompression of the disc, which may help relieve pain caused by bulging discs pressing on nearby spinal nerve roots. NICE suggests this should only be used where there is no other cause for pain and the problem appears to be “discoid pain”.