Percutaneous Electrical Nerve Stimulation

Percutaneous electrical nerve stimulation (PENS) is a form of electrical muscle stimulation (EMS) therapy that uses low-frequency electrical impulses to relieve pain, improve muscle strength and endurance, and promote healing in conditions such as muscle strains, sprains, and injuries. PENS is a percutaneous, or non-invasive, form of therapy, which means it does not require the use of needles or other invasive techniques.

PENS therapy works by delivering low-frequency electrical impulses to the nerves through electrodes placed on the skin near the affected area. The electrical impulses stimulate the nerves, which in turn sends signals to the brain to block pain signals, and activate the body’s natural pain-relieving mechanisms. PENS therapy can also help to improve muscle strength and endurance by stimulating the muscles to contract and relax. The therapy is particularly effective in treating chronic pain conditions, such as neuropathic pain, as well as musculoskeletal conditions, such as lower back pain, neck pain, and osteoarthritis. It can also be used to treat headaches, such as migraines and tension headaches.

PENS therapy is a non-invasive and drug-free alternative to traditional pain management methods, such as medication, injections, and surgery. It is also considered to be a safe treatment option, with few side effects and no significant risks. The most common side effects are mild skin irritation and muscle soreness, which are typically temporary and go away shortly after the therapy is discontinued.

PENS therapy is typically administered by a healthcare provider, such as a physical therapist, chiropractor, or physician. The therapy can be delivered in a variety of ways, such as through a handheld device, a pad that is placed on the skin, or a mat that the patient lies on. The intensity of the electrical impulses can be adjusted to suit the individual needs of the patient, and the therapy can be used to target specific areas or to stimulate the entire body.

It is important to note that PENS therapy should not be used in people with certain medical conditions, such as heart problems, pacemakers, or metal implants, without consulting with a healthcare provider. Pregnant women, or those who have had recent surgery, should also avoid PENS therapy.

In the United States there are over fifty acupuncture training schools, which require approximately 3000 credit hours of study and offer the equivalent of a Master’s Degree. The training regimen over time is close to the same as for an internship and residency for a MD certificate of practice States have different requirements for acupuncturists, since it deals with pain relief and associated cures but all must take a state examinations and/ or a national exam in order to be licensed to practice. To find an acupuncturist, contact the American Academy of Medical Acupuncture, pick three and conduct sufficient research to determine the qualifications and credentials of you acupuncturist particularly in the area of pain relief in general and specifically for back pain or any particular painful condition.

Don’t be surprised if the practitioner treats your back pain by putting needles in your ankles, knees, or fingers. This is a technique called percutaneous electrical nerve stimulation (PENS),where needles are inserted into nerve centers and electrically stimulated. You can expect to feel pain relief for chronic pain in about ten to fifteen treatments and sooner for acute or sudden pain.

Other things an acupuncturist may do:
• Use moxibustion, an herb that is burned onto the needle before insertion to stimulate the area being treated;
• Cupping: burn cotton in a glass cup, which is then placed on the skin to create a vacuum
• Prescribe herbal supplements in addition to physical treatment.

Electrotherapy involves the use of electrical energy in treatment of various diseases. Electrical therapy includes various modalities for a variety of diseases, however in patients with neuropathies, the electrotherapies mainly used are electrical muscle stimulation and electroanalgesia.

The form of electrotherapy, called electroanalgesia specifically deals with use of electricity to provide relief from pain. The nerves carry the pain signals as electrical signals, and electrotherapy provides symptomatic relief by interfering with these electrical currents of the nerve fibers. There are numerous techniques for providing electroanalgesia and the ones most commonly used in treatment of pain associated with peripheral neuropathy are peripheral nerve stimulation, percutaneous electrical nerve stimulation (PENS) and transcutaneous electrical nerve stimulation (TENS). The techniques that can be used in pains associated with neuropathies, like diabetic neuropathy, are Peripheral Nerve Stimulation and TENS. Since the extent of the lesions in the nerve is clearly known, the nerve in peripheral nerve stimulation is stimulated proximal to lesion to provide relief from the pain. Recent research also indicates that transcutaneous electrical nerve stimulation is also effective in painful diabetic neuropathy and is being increasingly used because it is a noninvasive procedure that uses conducting gel pads placed directly over the skin.

Another subtype of electrotherapy, called electrical muscle stimulation is widely used for various indications. In neuropathy, it is used in rehabilitation if the peripheral neuropathy has caused loss of motor function, for e.g. as in Guillain-Barre Syndrome. The paralyzed muscles are stimulated electrically at regular intervals to prevent muscle atrophy while the nerve slowly heals. Electrical muscle stimulation during recovery of nerve function helps in faster improvement of strength and muscle control.

Patients with autonomic neuropathy may have urinary and fecal incontinence. Electrotherapy can be tried as a therapeutic option in such patients. Often the treatment provides at least some beneficial effect and may even cause complete continence. Electrotherapy can also speed up the wound healing. This is especially important in diabetic patients, where poor wound healing is a troublesome complication of the long-standing diabetes mellitus. Although more research is still needed, the current research data supports the efficacy of the electrotherapy in wound healing. It is postulated that electrotherapy exerts its beneficial effects on wound healing mainly by enhancing the microcirculation and protein synthesis in the area to which it is applied.

Procedures in Pain Management

Pain management is a field that has some great new technology to it, and from it patients are enjoying better results than ever. Some of the new procedures allow patients to decrease the amount of narcotics necessary for pain relief, and also allow more functional patients.

What exactly are the best pain management procedures in existence right now? What you can see is that newer is not always better, and this top 5 list includes some procedures that have been around for decades along with the new ones.

1. Epidural injections – These injections have been around since the 1960’s and remain the gold standard for nonoperative treatment of sciatica symptoms due to a herniated disc. A JAMA study showed that patients who opt for nonoperative treatment for a herniated disc achieve the same outcomes as surgery at the one year point, yet do not have the risks of surgery. So many patients opt for epidural steroid injections, and with good reason. They work really well, the risks are small, and patients can receive a few in a series to receive better pain relief.
2. Facet Blocks – Facet injections are a great nonoperative treatment for facet arthritis (facet syndrome). The reason is that surgery into facet joints is not a good idea, since arthritis is usually present in multiple joints at one time. So the injection can provide excellent relief and serve both a diagnostic and therapeutic purpose. Months of relief can be obtained, and if the pain returns the injection can be repeated or the patient can opt for a radiofrequency ablation.
3. Radiofrequency ablation – This procedure just keeps getting better and better as technology improves. The procedure involves the pain doctor heating up the tiny little nerve endings which provide sensation (and hence pain) to facet joints of either the neck or low back. The heat kills the nerve endings, and the procedure may reduce pain for up to 2 years!
4. Spinal Cord Stimulation – electrical stimulation involves providing a “paddle” into the spinal canal permanently. The paddle is able to transmit electrical impulses with optional programming to relieve patient back pain, leg pain, or it can also be put into numerous other areas such as the neck. It is a great option for people who are not surgical candidates and need a last resort for pain relief. These stimulators can achieve 60-90% pain relief which is amazing for patients who have no surgical option and are stuck with narcotics.
5. MILD – Minimally Invasive Lumbar Discectomy – this is a fairly new procedure that is fluoroscopy guided and percutaneous. It permits the doctor to decompress the spinal canal in the face of spinal stenosis. The jury is still out on it because of its “newness” but it’s showing promise.

What Is Purpose of Physical Therapy Clinics?

Physical therapy clinics bridge the gap between post-hospitalization and the patient’s primary care practitioner. In essence, physical therapy is mainstream medicines answer to chiropractic care. Their techniques are similar, but not precisely the same. Chiropractic care revolves around an adjustment or spinal manipulation to keep all vertebrae in the spine in correct alignment. The contention is a correctly aligned spine will encourage the body’s self-healing mechanism to kick-in and provide natural pain relief.

When the physical therapist (PT) performs a manipulative thrust or spinal manipulation, it is basically to generate mobility in a taunt joint. To clarify only licensed chiropractors perform “adjustments”; whereas, a licensed PT may provide “spinal manipulation”. Most physical therapy schools in the US have now added manipulation techniques as part of their standard curriculum. In contrast, other countries have taught spinal manipulation in for decades.

After graduating, spinal manipulation is used according to the individual therapist’s discretion. Otherwise, they employ mobilization techniques or passive movement to joints. Among general procedures performed by PT’s include:

range-of-motion exercises, ambulation exercises, coordination exercises and muscle strengthening. One area in particular, where the therapist is a shining star is post-hospitalization care for stroke victims. People who have suffered strokes must face a long rehabilitative road in order to reach their potential quality of life. Goals are to maintain/improve current physical condition, regain their normal function to the extent possible, relearn previous skills and learn new skills, as needed.

Rehab begins while the patient is still hospitalized and afterward, the PT strives to enhance their activities of daily living. They will also suggest ways to make the person’s home environment safer. Coordination exercises are taught to the stroke patient who is re-learning to perform simple tasks that restore balance and coordination. Simple tasks, that incorporate a group of muscles, such as picking up a pen, are done repetitively.

Osteoarthritis is a medical condition that can be helped by the physical therapist. Heat therapy may be employed to reduce stiffness and treat muscle spasms. Cold therapy helps relieve pain. To protect the joints, aids such as walkers, canes, crutches and/or splints are commonly used. Licensed therapists may also perform massage therapy with or without additional deep heat and ultrasound.

They will also assist the person with learning stretching and strengthening exercises. Correct exercises strengthen the muscles around compromised joints for shock absorption. Healthy cartilage can be better maintained through exercise. Sports injuries benefit from therapy, such as traction, water therapy, hot and cold packs, when incorporated with therapeutic exercises.

Clinics that have trained physical therapists on staff play a valuable role in rehabilitation and maintenance of activities of daily living. Now that you know their purpose, it should remove any fear or reluctance about taking advantage of their services.

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