Electrical therapy is a pain management technique that uses mild electrical currents to stimulate nerves and muscles.

Some electrical therapy techniques may alleviate pain by blocking the transmission of pain signals along nerves. Others may work by promoting the release of endorphins (hormones in the brain that reduce pain sensations). Electrical therapy may be offered in settings including physical therapy, occupational therapy or chiropractic. It is sometimes used in conjunction with other types of pain treatments, such as medications or biofeedback.

Electrical therapy is used to treat a wide variety of acute and chronic pain conditions, including back pain, headaches and arthritis.

There are many types of electrical therapy, including transcutaneous electrical nerve stimulation (TENS), electroacupuncture and spinal cord stimulation.

Before treatment, a physician may review the patient’s medical history, perform a physical examination and conduct a pain assessment. If the physician determines that electrical stimulation can help a patient, the physician will recommend or prescribe the treatment.

Depending on the treatment technique, there are a variety of ways electrical therapy can be administered. Many techniques involve the placement of electrodes (small, flat adhesive discs) or wires over the body part to be stimulated. The electrodes are connected to a machine that serves as the power source for the electrical current. Patients usually receive several treatments over a period of time. The treatments may be performed by a healthcare professional or in some cases may be self-administered after training.

Benefits of electrical therapy can include:

• Pain relief
• Increased function, mobility and range of motion
• Ease of use and administration
• Possible decreased need for medications

Potential  side effects of electrical stimulation include irritation of skin at the site of the electrode and vasodilation (widening of the blood vessels).

Electrical therapy, also known as electrical stimulation or e-stim, is a pain management technique that uses mild electrical currents to stimulate nerves and muscles. The electrical current may be administered with the use of devices such as electrodes (small, flat rubber adhesive discs) or felt pads, which are placed on the body part to be stimulated. The electrical current used during therapy is similar to the electrical impulses the brain sends to the muscles to cause movement.

Scientists are still researching how electrical therapy alleviates pain. One theory is that electrical stimulation blocks the transmission of pain signals along nerves. Another is that electrical stimulation promotes the release of endorphins (hormones in the brain that reduce pain sensations and affect emotions).

Electrical therapy may be offered in healthcare settings such as physical therapy, manipulation therapy (e.g., chiropractic) or occupational therapy. Many researchers, physicians and patients have found it to be useful in easing some types of pain, but, as with any form of treatment for pain, it does not help everyone.

Electrical therapy may be harmful to certain patients, including:

• Pregnant women. Little research has been conducted on how the treatment affects a developing fetus.
  
  
• Patients with implanted devices such as pacemakers, defibrillators, pain pumps, artificial joints and bone screws.
  
  
• Patients with hemophilia (hereditary disorder in which blood fails to clot normally) or thrombosis (blood clots in the arms or legs). Some devices cause vasodilation (widening of the blood vessels), which could aggravate these conditions.

Other potential conditions of concern include epilepsy, other seizure disorders and certain heart conditions. All patients are advised to consult their physician before trying electrical therapy.

Electrical therapy is used to treat a variety of acute (short-term) and chronic (long-term) pain conditions. They include:

• Back pain. Back pain is one of the most common medical conditions in the United States. Pain due to conditions such as back sprain or strain, degenerative disc disease, sciatica and scoliosis are sometimes treated with electrical therapy. Techniques such as transcutaneous electrical nerve stimulation (TENS) can ease spasms and pain resulting from vertebral fractures caused by osteoporosis.

• Neck pain. Most conditions affecting the neck, such as whiplash, cause pain and stiffness along the base and sides of the neck. However, problems with the structures of the neck can also cause pain over the top of the head (tension headache), pain over the upper back (neck strain and fibromyalgia) or pain over the shoulder (neck strain or a pinched nerve in the neck).
  
  
• Joint pain. Most people experience joint pain at some time during their lives. Pain can be the result of a short-term injury or condition, but can also be chronic. Some examples of joint pain that may be treated with electrical therapy include:
  
  
• Arthritis (inflammation of the joints). Common types of arthritis include osteoarthritis and rheumatoid arthritis.

• TMJ disorder. The temporomandibular joints (jaw joints) connect the lower jawbone (mandible) to the skull. Many people experience pain and dysfunction in these joints at some point in their lives. This can affect the jaw and jaw joint as well as muscles in the face, shoulder, head and neck.
  
  
• Tendinitis (inflammation of a tendon). The most common cause of tendinitis is overuse, frequently from a sports activity.
  
  
• Bursitis (inflammation of a bursa). A bursa is a fluid-filled sac that functions as a gliding surface to reduce friction between the tissues of the body. The body has 160 bursae, located in areas such as shoulders, elbows, hips and knees.
  
  
• Nerve pain. Electrical therapy may benefit people with conditions including peripheral neuropathy, complex regional pain syndrome, cranial neuralgias, postherpetic neuralgia or phantom limb pain.

• Headaches. Headaches affect millions of Americans. The three most common types are tension headaches (sometimes described as a tight band around the head), migraines (characterized by throbbing pain and other symptoms, such as nausea) and cluster headaches (marked by excruciating, piercing pain on one side of the head).
  
  
• Fibromyalgia. A chronic pain condition characterized by musculoskeletal aches, pain and stiffness, tenderness in soft tissues, general fatigue and sleep disturbances.
  
  
• Pelvic pain. Electrical therapy may be recommended for conditions including interstitial cystitis, prostatitis and menstrual pain.
  
  
• Chest pain. Conditions such as costochondritis and heartburn have been treated with electrical therapy.
  
  
• Post-surgical pain. A patient-controlled device uses iontophoresis to deliver an opioid for relief of post-operative pain.
  
  
• Cancer pain. Techniques such as electrical acupuncture have been studied in relieving nausea and other side effects of chemotherapy. TENS may help cancer patients with mild to moderate pain, according to the National Cancer Institute.

Forms of electrical therapy have also been used or studied on conditions including depression, obesity, wound care, edema reduction, stroke rehabilitation, multiple sclerosis and prevention of premature birth.

There are many types of electrical therapy to treat pain and other conditions. Most incorporate the use of electrical currents to stimulate muscles or nerves and cause little or no discomfort. They include:

• Transcutaneous electrical nerve stimulation (TENS). A small, battery-operated device sends low-voltage electrical current through the skin, with electrodes (small, flat adhesive discs) placed near the source of the pain. The electricity stimulates the nerves in the affected area and sends signals to the brain that distort normal pain signals. TENS, the most common type of electrical therapy, can sometimes be performed at home by patients who have received training from a physical therapist or other healthcare professional.
  
  
• Percutaneous neuromodulation therapy (PNT). Also known as percutaneous electrical nerve stimulation (PENS), PNT is similar to TENS except that needles are inserted in the area where pain is being experienced before stimulation occurs. This may be used with patients who have difficulty getting adequate electrical stimulation with TENS because of obesity, scar tissue or other issues.
  
  
• Electroacupuncture. This treatment is sometimes described as a variation of PNT and sometimes as a separate therapy. It incorporates techniques of acupuncture with needles that are inserted on specific points in the body. The needles are then attached to a device that generates electrical pulses. This technique has been used to treat a wide variety of chronic pain conditions, including heartburn, a common cause of chest pain. Auriculotherapy is a type of electroacupuncture in which the external ear is stimulated with electrical currents.
  
  
• Microcurrent electrical therapy (MET). Electrodes are placed on opposite sides of the body so that the electrical current flows through the injured or diseased part of the body and speeds healing.
  
  
• Iontophoresis. Electrical current delivers medication through the skin. This method is sometimes used to treat conditions such as neck pain, back pain, arthritic conditions, rotator cuff injuries, bursitis, tendinitis and other joint pain. (A similar technique called phonophoresis uses ultrasound instead of electricity to introduce medication through the skin.)
  
  
• Intradiscal electrothermal therapy (IDET). A wire is placed into an injured intervertebral disc. The wire is then electrically heated to seal and toughen the tissue. It is often used to treat lower back pain.
  
  
• Spinal cord stimulation (SCS). Electrical impulses are used to block pain from being perceived in the brain. A small wire connected to a power source is surgically implanted under the skin. Low-level electrical signals are transmitted to the spinal cord. This is sometimes used to treat chronic back pain.
  
  
• Occipital neurostimulation (ONS). Minimally invasive surgery inserts electrodes beneath the skin at the base of the skull. ONS has been used to treated severe head pains including migraines and neuralgias.
  
  
• Galvanic stimulation (GS). This is used to treat acute injuries. Unlike other types of electrical therapy that use alternating currents, GS uses direct current, which changes blood flow and speeds healing.
  
  
• Russian stimulation. This type of electrical muscle stimulation provides deep penetration and intense contraction. This method is most often used to treat spinal cord injuries, scoliosis and chronic muscular pain conditions.

• Shortwave diathermy. A high-frequency electrical current raises the temperature in body tissues. This increases elasticity in connective tissue (particularly skin), muscles, ligaments and joint capsules. Conditions it is used to treat include arthritis, bursitis, sinusitis, tendinitis, contusions, ruptures and fractures.

• Transcutaneous electrical joint stimulation (TEJS). Electricity is delivered through electrodes worn for hours a day in an effort to ease knee osteoarthritis.
  
  
• Interferential electrical stimulation (IFC). This can be used on deep tissues, such as the pelvic floor muscles, that do not respond to other types of electrical therapy. It may require using a greater number of electrodes and take longer to perform than other types of electrical therapy.
  
  
• Sympathetic therapy. This technique attempts to ease widespread chronic pain by stimulating the sympathetic nervous system and returning the autonomic nervous system to normal.
  
  
• Cranial electrotherapy stimulation (CES). Electrodes are placed behind the ear or clipped to the upper portion of the earlobe, near the face. CES works by increasing the production of endorphins (hormones found mainly in the brain that reduce pain and affect emotion). It is used in the treatment of anxiety, depression, insomnia and drug addition.
  
  
• Functional electrical stimulation (FES). This technique is used to produce movement in paralyzed muscles. Electrodes are placed on muscles and contracted in a controlled manner. It is used to treat spinal cord injury, stroke, multiple sclerosis and cerebral palsy. This is also called peripheral nerve stimulation (PNS).
  
  
• Neuromuscular electrical stimulation (NMES). A device sends electrical impulses via electrodes to activate underused muscles.
  
  
• Vagus nerve stimulation (VNS). A surgically implanted device delivers electrical impulses to the brain. VNS has been studied in addressing conditions including hard-to-treat major depression.
  
  
• Deep brain stimulation (DBS). An electrode is inserted into the brain to stimulate a region called the thalamus. DBS has been used to treat movement disorders such as Parkinson’s disease, essential tremor and dystonia.
  
  
• Gastric pacemakers. Similar in some ways to cardiac pacemakers, these surgically implanted devices are being developed as a way of making obese people feel full and eat less. obesity contributes to many pain conditions including abdominal pain, chest pain, back pain and osteoarthritis.

Before treatment, a physician obtains a medical history and performs a physical examination with specific focus on the area of pain. A pain assessment may be conducted. The patient may be asked to describe the frequency, duration and intensity of the pain being experienced. The patient may also be asked whether pain has resulted in limited movement in any body part and whether certain movements increase or decrease pain.

The patient may also be asked to rate the pain on a scale of 0 (no pain) to 10 (excruciating or debilitating pain). Because treatment can result in immediate pain relief, a pain rating scale provides physicians with an easy way to quantify the effectiveness of treatment while it is being administered.

The physician or healthcare professional will determine the appropriate electrical stimulation procedure for the patient. The schedule and duration of the therapy will depend on the type and severity of pain. Electrical stimulation will be  part of physical therapy in many cases, or sometimes occupational therapy. It also can be part of chiropractic or other manipulation therapy. The treatment will be incorporated into a therapy plan aimed at decreasing the patient’s pain.

Some forms of electrical therapy involve spinal surgery or other surgery. The risks and benefits of surgery will be discussed with the patient. Any needs, such as fasting, adjusting medication or arranging hospitalization, will be reviewed.

The process by which patients are treated is dependent upon the type of treatment technique used. A trained healthcare professional will provide the electrical stimulation.

In general, electrodes (small, flat adhesive discs), rubber suction cups (vaso pneumatic devices) or wires are placed over the skin of the body part to be stimulated. During some techniques, devices are surgically implanted.

The electrodes or other devices are hooked up to a computer, which is programmed to deliver an appropriate amount of electricity determined by the healthcare provider. The currents move through the skin and other body parts to the muscles or nerves to be stimulated. The computer may measure the patient’s response to the electrical treatment.

Electrical therapy usually does not cause pain or discomfort. Patients may feel a mild, vibrating or tingling sensation when electricity is applied. With many treatment techniques, patients experience pain relief shortly after receiving treatment.

With most types of treatment, patients will require numerous treatment sessions over a period of time. With certain treatment techniques, the pain relief experienced is cumulative.

Some treatment techniques, such as transcutaneous electrical nerve stimulation (TENS), can be administered at home by a patient who has received training. This allows the patient to alleviate pain when necessary without relying on a visit to a medical facility.

There are many potential benefits to electrical therapy. They include:

• It is easy to administer.
  
  
• It may increase range of motion, mobility and function.
  
  
• It may reduce or eliminate the need for pain medication.
  
  
• Some types may be administered by patients at home.
  
  
• It is cost-effective compared to many other types of treatments.
  
  
• Some types produce cumulative effects over successive sessions.

There are also some possible side effects associated with electrical therapy. They include:

• Some patients experience skin irritation and redness under the electrodes or other devices placed on the skin.
  
  
• Electrical currents can cause chemical burns or cardiac fibrillation (twitching of the heart muscle fibers).
  
  
• Some devices can raise or lower blood pressure or cause headaches, vertigo or nausea.
  
  
• Some devices may cause vasodilation (widening of blood vessels), which can worsen conditions such as blood clots and hemophilia.
  
  
• Excessive stimulation can cause muscle soreness or spasm.
  
  
• Patients may become tolerant to the therapy, meaning more treatment is needed over time to produce the same level of pain relief.

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about electrical therapy:

1. How does electrical therapy work? Could it be painful to me?
   
   
2. Is electrical therapy an appropriate method for treating my condition?
   
   
3. Which form of electrical therapy is recommended for me? What exactly does it involve? Is any surgery required, or is it noninvasive?
   
   
4. Should I still take medication while being treated with electrical therapy?
   
   
5. Will I receive other treatments, such as physical therapy, with electrical stimulation?
   
   
6. What are the benefits and drawbacks of receiving electrical therapy?
   
   
7. How many times must I be treated with electrical therapy to see results?
   
   
8. Can I administer electrical therapy at home?
   
   
9. How can I buy my own TENS unit?
   
   
10. Do I need a prescription for electrical stimulation treatments?