LIVING WITH THE TENS DEVICE

LONG TERM USE FOR CHRONIC LUMBAR PAIN

I'm a Professional Engineer, Electrical

I make no claim to medical knowledge.

I advise you to consult your Doctor before using TENs.

09/01/11

BACKGROUND

Perhaps TMI, Too Much Info

I've been dealing with very long term Lower Back problems due to misbehaving in youth, a couple injuries and intervening surgeries and finally just plain getting old. Life was getting quite unpleasant and I was seeking help beyond the usual NSAIDs and back braces when I read about the TENS devices Being an electrical engineer, I did some research and then kludged up some tests using homemade electrodes and lab pulse generators. I also had some professinal applications of the TENS and Interferential devices while recovering from shoulder surgery. I was surprised how simple it was and how much TENS helped so I asked our family GP for a prescription so the insurance would pay for the compact battery powered device and I wouldn't have to tote the lab equipment around with extension cords. That was over two years ago and I've rarely been a day without it. I found that interferential current therapy is even better but it's not very portable. It requires four electrodes and the tangle of wires. It eats up small batteries in minutes. Because our goal here is mobility, we'll limit our disussion to the basic TENS device.

LET'S DIGRESS- WHY NOT FIX IT? My trusted neurosurgeon says I have a "terrible back" and he could fix it by fusing L1 thru L5, BUT he observed that I'm still walking, and that there is a significant risk of losing that ability with the surgery. "Come back when your wife pushes you in a wheel chair". He also told me that I'd easily find a doctor that would be pleased to take my money and cut. He sent me to the Pain Management Doctor. I trust this honest and conservative Neurosurgeon, especially as I am acquainted with his local reputation and with people that have been through such surgery by other surgeons.

WHY THE TENS INSTEAD OF PILLS? I was pushing the Ibuprofen to the legal FDA limit and while it seemed to work better than other NSAIDs, it wasn't enough. The next step in the pill department is the narcotics and experiments with them was quite unsatisfactory. I found that Hydrocodone in its various mixes with other NSAIDS dulled my mind and handicapped the thing I value most i.e. analysis and diagnostic abilities. I made a good living with those and the idea of becoming placid, sedate and zombie like didn't set well with me. Later consulting with a pain management doctor, I told him that narcotics was the LAST consideration and he was delighted with my attitude. He done some good with RF ablation and medicated patches, Flector Patch

LINES OF DEFENSE. With judicious use of these therapies, I can continue to be a productive person and enjoy the results of that productivity. I call this my "Lines of Defense".

  1. 32OO mG Ibuprofen daily. A prescription strength 800 mG with each meal and at bedtime. At bedtime, I add 5 or 10 mG Hydrocodone.

  2. Flector Patch, A daytime one and another at night

  3. The TENS electrodes are placed in the morning and the TENS is activated for one hour periods as needed. As soon as I get off the waterbed and load the spine with torso weight, I need the TENS until the first Ibuprofen kicks in. The TENS device can be set to run 30, 60 minutes or continuous and that initial use might, but rarely, be the only use for the day. The TENS has a residual effect that lasts for a while before the need to activate it again.

  4. A high quality back brace prescribed and fitted by a professional therapist. The cheapies from the hardware or safety store were found quite useless . They might help prevent damage but they fail when its too late. I only use this if I'm going to do anything that bends the Lumbar area or even worse applies shear or twist action to the spine. An example of shear action is riding a mower over uneven ground. An example of twist is pushing or pulling a tool i.e vacuum, rake, snow shovel from one side. The belt is of little value for this. For bending, the belt forces more knee and upper back flexure. When work is required at ground level such as gardening, I do it lying down, never bending.

  5. The last line is Vicodin (5mG) or Norco (10mG) or two Norco (20mG). This is only if I've pushed the physical limits too far. I do it too often!

TENS PROBLEMS

The people that designed this system must have had in mind that the user would be a sedate, chair bound person in a controlled environment. The electodes are "supposed" to last for fifteen uses, so the insurance folks figure that you are only allowed two pair in a month. BIG JOKE! I've had new ones fail in an hour or two when outdoors in warm sweaty weather. They would fall off and end up pasted to my underwear. The first Summer I made an electrode system with sanitary pads wetted with salt water and assembled to a wide belt with duct tape. Later, I'd learn how to extend the life by keeping them pressed in place and this is what I want to share with you. The other major problem is BURNS! The TENS has to deliver a high voltage pulse to overcome the skin resistance. Typically 100 volt pulse across 500 ohms. Now that works just fine if the current is evenly distributed over the surface of the stick-on electrode, about 23 to 43 sq cm, but if that electrode comes loose then the current density can encrease hundreds of times and you are dancing like Hell trying to get the @#%# thing turned off. Even worse is when the stranded wire gets pulled out of the electrode cause it got caught around the cheek of your butt, then the fine little wires burn little spots that itch for days and keep you from putting an electrode in that place. As if those risks weren't enough, the makers violated the fundamentals of connector design by putting the male connector on the energy source and the female on the electrode DUH! When you squirm around and pull the connection apart then you get to do the dance and burn again. I can imagine they figured some stupid clod might plug himself into the 120 Volt outlet if they done it right. Considering the energy limits of the TENS, the "BURN" may not be a thermal burn such as you'd get from a hot object but the result is the same, red angry and sensitive spots that inhibits the use of the electrodes on top of them.

LETS OVERCOME THE TENS PROBLEMS

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Toughen up the electrode wire so it won't pull out so easily. I fold it over, hold it down with some duct tape and smear some Urethane (Gorilla) glue on the wire.

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Find some sleeving and cement it to the wire pin plug so it will cover the pin but leave room for the electrode socket. I used a scrap of coax wire insulation as shown on the upper pix.

Now the BIGGIE! Keeping the electrodes (and medicated patches) in place when you sweat. After numerous failures, one day I was helping my wife hook up her bra and realized that those bra designers had their act together. They hold a heavy load firmly in place with a reasonably comfortable structure that has been engineered to the Nth degree. I cannibalized some old bras and went to work. Like the bra, you want a non-stretching material to hold things in place with a short elastic connection. The over-the shoulder straps also have only a short piece of elastic. No way would I have the seamstress skills to assemble this without the bra salvage. I used real simple zig-zag straight stitching on everything. Thanks to the ladies at Jo-Ann fabrics for their patient advice. After several iterations I think I got it right. It works, It's comfortable. It washes and dries quickly. I call my design the LUMBRA.



And finally, where do you carry the little electronic box? It has a belt clip so intuitively you'll clip it on your belt. Makes sense until you are not wearing a belt or you sit down and it pushes off and falls away. Also makes sense until the fragile plastic clip snaps off. It makes sense until the hanging wires snag on something and you destroy them or pull them out of the electrodes and enjoy a burning dance.

Ok, lets get it somewhere where the wires won't snag on something. I bought a fabric under-the-shoulder gun holster like 007 might use. Worked, but what a daily hassle. Careful when you reach to adjust it. Someone might think you are drawing on them VBG. If you're a well endowed female then you know the obvious safe place. A lanyard around your neck works nicely to hang it in the midchest depression under your shirt for the rest of us. The dirty detail is you need as many lanyards as you do underware between washings 'cause like a shirt collar, they get grundgy every day. Finally, I made a non-absorbant lanyard from thin salvaged IV tubing. You clip the wires in the belt hanger for strain relief else they soon fail at the plug.

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The ugly black thing is an elastic to hold the front sliding door in place, else you'll likely lose it in the first few days or weeks.

One final thought- If someone sees the power-on LED glowing through your thin shirt, and asks about it- Like look around and see if some jealous husband has a lasar target on you, or apologize to the store clerk admitting you are from Corporate and are "wired".

WHAT YOU DON'T NEED TO KNOW

As you search the internet for info on TENS you'll soon come up on the kinky use of electro stimulation. Unless you are a sexual weirdo, ignore it all. Did I explore it a bit? sure-I'm human. It's a way to ruin a good thing. Like pain, it works by overcoming and suppressing natural responses. DUH-

Have Fun and I hope I've helped you to stay active.

Wayne in Idaho