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#362706 - 10/27/09 11:43 AM Re: TENS unit for nerve pain anyone? [Re: Megan]
Sue22 Offline
Very_Addicted_to_AS_Kickin

Registered: 01/13/08
Posts: 21346
Loc: Upstate NY
megan,

i'm so sorry you've tried so many things and they've all failed you so miserably.

i like dow's explanation of how the TENS machine can work. maybe this will help?

maybe a biologic would help again. really the only way to find out is to try it.

and i'm with you, if a drug's side effects are worse than the symptoms i had to start with, i don't take it.

hate to hear when doctors have run out of ideas and kind of given up.

hang in there the best you can, you have been incredibly strong through all of this, through my eyes at least. all i know is that in my darkest days, its hard to imagine that the cloud will lift and that i will ever get any relief, but eventually i do. so i guess, deep down inside, i do feel like if you just hang in there long enough, someone will be able to figure it out.

hope the TENS works at least some for you. i know for me, sometimes even a little is just enough for the time.

_________________________

sue

Spondyloarthropathy, HLAB27 negative
Humira (still methylprednisone for flares, just not as often. Aleve if needed, rarely.)
LDN/zanaflex/flector patches over SI/ice
vits C, D. probiotics. hyaluronic acid. CoQ, Mg, Ca, K.
chiro
walk, bike
no dairy (casein sensitivity), limited eggs, limited yeast (bread)

Top
#362707 - 10/27/09 02:20 PM Re: TENS unit for nerve pain anyone? [Re: Megan]
Farinelli Offline
Silver_AS_Kicker

Registered: 08/14/07
Posts: 1489
Loc: Pennsylvania
Hey Megan!! My cousin obtained great relief from low back pain using a tens unit. He has a herniated lumbar disc.

Craig

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#362708 - 10/27/09 08:50 PM Re: TENS unit for nerve pain anyone? [Re: Dow]
inkyfingers Offline
Gold_AS_Kicker

Registered: 04/08/09
Posts: 1595
Loc: Melbourne, Australia
Yep, yep & yep!

That's exactly what the TENS should be doing... This is the basis of the 'counter irritant' theory of pain blocking. You know if you have a really itchy mosquito bite - how you get your fingernail and push a big 'X' into the area of the bite - you no longer feel the itching! Your brain (especially Dow's - being a mere male - yes, Dow, you can spank me now...) can't take in both signals from the same area, so it registers the more intense sensation.

Hallelujah for another physio who knows what they're talking about! Megan - I think that you *seriously* need to find yourself a more knowledgeable PT!!!

I have one of those vibrating and heating massage machines. I use it quite a lot on my upper back, SIJs and thighs. I get so tender to touch, as well as deep aching, but I find that if I crank up the vibration to 'supersonic' and apply it over the tender bits (a bit like trigger point therapy, acupressure etc) whilst it hurts like he11 initially, after a few minutes the deep ache is much less. Same nerve pathway being bombarded with a sensation that is transmitted through a bigger diameter fibre than the tiny "C" or pain fibres. Messages travel faster (and therefore more efficiently) through a bigger fibre. A bit like me driving my Ferrari and passing Dow in that little blue thing he drove in Daytona...

Eventually, if you have a high enough intensity for long enough, you can get the added effect of temporarily exhausting the supply of transmitter substance at the end-plate too.
_________________________
Louise

Happy to be a physio by day, not happy to be a Spondy 24/7! wink3

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#362709 - 10/27/09 09:15 PM Re: TENS unit for nerve pain anyone? [Re: Megan]
inkyfingers Offline
Gold_AS_Kicker

Registered: 04/08/09
Posts: 1595
Loc: Melbourne, Australia
Quote:

OMG Louise, I'm so sorry about misspelling your name! Please don't hold it against me. Can you tell I was typing waaay too late last night without my contacts in.... oh dear. I'm very sorry!





If it was *me* who was typing without my contacts/glasses you would think that I had momentarily stepped away from the keyboard, and that Coco (my beautiful kitty who is hurting and has a fever today) had taken a walk across it!!!

You could try treating one thigh at a time.

Channel 1 for the front (femoral N). Red electrode just above your knee on the front (if you put it towards the inside, you will most likely get it over the quadriceps 'motor point' and will get twitching - not harmful, unless you are super sensitive, like Sue) and the black one up the top slightly lateral to the midpoint.

Channel 2 for the sciatic N at the back. Red electrode behind knee (or a bit up from it) and the other over your butt(central, lower 1/2)

Try the different modes (start with Burst) and experiment with it.

Honestly, that PT of yours must be a bit of a donkey. Any PT worth their salt will have a big IFT (Interferential Therapy) unit in their rooms. It *IS* often great for neurogenic pain, because as Sue explained, you cross the 2 currents, getting 'interference' deep in the tissues where their paths intersect.

IFT uses a high frequency current, and as the 2 intersect, you get a nodal pattern of much lower frequency waves happening as the 2 'line up'. Can't think how to explain IFT in layman's terms, sorry.

I would be very careful of the electrode placement of IFT on SUE, as the freq of current used (at the skin)is right in the range for stimulating muscle contraction, so you would need to avoid the specific motor points, Sue. For everybody else, moving TENS or IFT electrodes just an inch in any other direction should eliminate/reduce the 'annoying' contraction. You are more likely to get twitching with the TENS, but can get a full-on tetanic muscle contraction with IFT. (A nasty trick PTs play on each other... )

Stop me if I get too involved with the physiology of electrotherapy, but I figure you guys have uni degrees, and I know for a fact that Sue has a Very Inquiring Mind and loves this degree of technobabble!
_________________________
Louise

Happy to be a physio by day, not happy to be a Spondy 24/7! wink3

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#362710 - 10/28/09 12:24 PM Re: TENS unit for nerve pain anyone? [Re: inkyfingers]
Sue22 Offline
Very_Addicted_to_AS_Kickin

Registered: 01/13/08
Posts: 21346
Loc: Upstate NY
thanks louise for all the information, i think we all appreciate it.

as for that all out "tetanic muscle contraction", yes, that's what happened with the neck when we tried it there. but since the neck only spasms "in response" to what is happening in the upper back anyway, we just treat the back with IF stim and ultrasound, and just use heat when the neck won't be quiet, and that seems to help.

have found electrode placement to be very important, know how to avoid TPs and spasming muscles, but how do you know where those motor points are, except by trial and error?

thanks,
_________________________

sue

Spondyloarthropathy, HLAB27 negative
Humira (still methylprednisone for flares, just not as often. Aleve if needed, rarely.)
LDN/zanaflex/flector patches over SI/ice
vits C, D. probiotics. hyaluronic acid. CoQ, Mg, Ca, K.
chiro
walk, bike
no dairy (casein sensitivity), limited eggs, limited yeast (bread)

Top
#362711 - 10/28/09 01:43 PM Re: TENS unit for nerve pain anyone? [Re: inkyfingers]
Dow Offline
Imperial_AS_Kicker

Registered: 03/11/08
Posts: 3231
Loc: Valley Cottage, NY
Thanks, Loo-ease, great stuff! (and love the way you explain things, I don't have a UNI degree, didn't even finish college, but you are still making sense to me!)

Had another discussion with my PT, she is so great, and also at a great time at her career, young enough to still have an open mind to listen to whatever crazy theories I walk in with each week, (not just dismiss them with a wave of a hand, like an older "expert" might do) and educated & smart enough to find a way to put them in perspective from a medical viewpoint

She clarified the the theory that over time, a stimulus such as a TENS unit might make changes to the neural network, by transmitting non-pain messages from a particular site that is normally sending pain messages-

Not so much that it could change the width and efficiency of a neural path, that's how I was picturing it. She said that the thing that can change was the receptors, the receiving units that "catch" the electrical impulses that travel through the body. Explained that they don't change in number, but more like the threshold number of how many of them need to be activated before a message is sent to the brain as pain

like while before it might need like 100 receptors, but with now constant pain messages being sent, it might now only need only 80 receptors for the brain to get that unpleasant experience. Of course, I'm just making up those numbers, have no idea of what the actual numbers of receptors might be, just understood the idea of it

It made me think of a project we did years ago, doing the sound effects for a documentary series called "The Secret Life Of The Brain" that through animation, they showed what the synapses in the brain "looked" like, as they were going about their electrical activity, in this particular example, showing how dopamine acts as a neural lubricant (my word not theirs) and when the levels of dopamine get out of control, trouble follows..

"Secret Life Of The Brain" clip

helped me get a mental picture about what goes on in there, anyway!

(And also gives credence to a popular theory, that we are all within "Six Degrees of Separation from Kevin Bacon", because the music in this show was written by his brother, Michael Bacon!)
_________________________
Dow

Top
#362712 - 10/28/09 05:11 PM Re: TENS unit for nerve pain anyone? [Re: Sue22]
inkyfingers Offline
Gold_AS_Kicker

Registered: 04/08/09
Posts: 1595
Loc: Melbourne, Australia
Quote:

but how do you know where those motor points are, except by trial and error?





Sue,

There are books out there with pics, but I don't think you need to go that far! They are for PTs doing musc stim after injury... We usually use a little round-ended tool and run it over the muscle we want to stim - it has a pulsed current running through it, and we find the point of maximal contraction.

A motor point is the point close to the skin where you can get the best result. It is where the motor neuron bundle goes into the muscle. Usually about the mid point of a muscle belly, but since there are so many muscles, I wouldn't suggest you get anxious about identifying which one you are looking to *avoid*!

Just put the electrodes where you think, and turn it up slowly - if you're getting muscle contraction *turn it OFF before removing the electrodes*, move them a bit (an inch...) and try again. Practice will tell you where to avoid.
_________________________
Louise

Happy to be a physio by day, not happy to be a Spondy 24/7! wink3

Top
#362713 - 11/05/09 12:35 AM Re: TENS unit for nerve pain anyone? [Re: Dow]
Dow Offline
Imperial_AS_Kicker

Registered: 03/11/08
Posts: 3231
Loc: Valley Cottage, NY
Talked again with my PT about the whole neural network thing

I think I'd better amend what I wrote earlier a bit

She said that regarding the situation that I previously described, where the receptors change their threshold numbers so that they need a higher number of units to be triggered before they send a message of pain up to the brain- what she was really talking about was a chemical process, that could be achieved by a neural inhibitor drug, such as Lyrica, Neurontin or Cymbalta

And she immediately concurred about the way that Louise and I were discussing how a TENS unit could reduce pain, by sending a DIFFERENT type of message other than pain, helping the brain refocus on the new sensation, which can distract it from the more unpleasant ones

which can and does have longer term effects, whenever the cycle of pain is broken, always a good thing, even if only temporarily ending the feedback loop between the nerves and the brain, can gradually diminish the way they feed off each other

Emphasizing that it is a two-way transmission, not just from the place that is hurting to the brain, with those little glowing electrons zapping up through the neural train tracks, but that the brain also sends messages back, the same way that it tells a muscle to tighten, or perhaps go into spasm-

-still learning-
_________________________
Dow

Top
#362714 - 11/05/09 02:09 AM Re: TENS unit for nerve pain anyone? [Re: Dow]
Sue22 Offline
Very_Addicted_to_AS_Kickin

Registered: 01/13/08
Posts: 21346
Loc: Upstate NY
thanks dow,
_________________________

sue

Spondyloarthropathy, HLAB27 negative
Humira (still methylprednisone for flares, just not as often. Aleve if needed, rarely.)
LDN/zanaflex/flector patches over SI/ice
vits C, D. probiotics. hyaluronic acid. CoQ, Mg, Ca, K.
chiro
walk, bike
no dairy (casein sensitivity), limited eggs, limited yeast (bread)

Top
#362715 - 11/05/09 04:37 AM Re: TENS unit for nerve pain anyone? [Re: Dow]
Megan Offline


Registered: 04/11/02
Posts: 3607
Loc: Canada
THanks Dow. I'm just catching up on my thread now.
For the life of me, I just can't get this tens to help me out at all. You were describing (very well, I might add) on how the tens modulates the nerve impulses.... I can't help but wonder why my nerves are sending so many pain signals to begin with. That really bugs me. I know it's neuropathy... but that's just a symptom. Not a diagnosis. Makes me think that a tens unit might work better on neuropathies with different causes? If this IS an autoimmune neuropathy then..? (Fragmented thinking at 4:30am here... )

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