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Transcript – Programme 9: Relieving Pain: TENS and acupuncture

How acupunc­ture and TENS can help relieve pain, plus, a new web ser­vice aim­ing to edu­cate health pro­fes­sion­als about pain

To lis­ten to this pro­gramme, please click here.

We take a look at the role of the pain spe­cial­ist nurse in the com­mu­ni­ty, eaves­drop­ping on two con­sul­ta­tions giv­en by Kathryn Nur at her nurse-led clin­ic at Ten­by Cot­tage Hos­pi­tal, Pem­brokeshire. We hear how Kath helps her patients, learn­ing about what TENS machines are, how to use them and how they can help those in pain, how acupunc­ture can also help, and the impor­tance of lis­ten­ing to what the patient has to say.

On the con­tentious issue of how lit­tle train­ing med­ical stu­dents receive on pain mat­ters – few­er hours than vets – Ann Tay­lor from the fac­ul­ty of pain med­i­cine at Cardiff Uni­ver­si­ty talks about a web ser­vice that may go some way towards redress­ing the imbalance.

Issues cov­ered in this pro­gramme include: TENS, acupunc­ture, elec­tro-acupunc­ture, web ser­vice, edu­cat­ing health pro­fes­sion­als, pain spe­cial­ist nurs­es, back pain, depres­sion, ache, lis­ten­ing to patients, GPs and insomnia.

Paul Evans: Hel­lo and wel­come to Air­ing Pain, a pro­gramme brought to you by Pain Con­cern, a UK char­i­ty that pro­vides infor­ma­tion and sup­port for those of us who live with pain. Pain Con­cern was award­ed first prize in the 2009 NAPP Awards in Chron­ic Pain and, with addi­tion­al fund­ing from The Big Lot­tery Fund’s Awards For All Pro­gram and the Vol­un­tary Action Fund Com­mu­ni­ty Chest, this has enabled us to make these programmes.

I’m Paul Evans and in today’s pro­gramme I’ll be look­ing at an alter­na­tive ther­a­py that’s become more wide­ly avail­able in the health service.

Richard: I’ll be hon­est with you. I don’t know whether there is any sci­en­tif­ic worth in it or whether it’s a place­bo effect, but I don’t care because it works for me. It’s as sim­ple as that.

Evans: And I’ll be look­ing at how a new web­site should help health pro­fes­sion­als become more con­ver­sant with chron­ic pain-relat­ed issues.

Ann Tay­lor: The British Pain Soci­ety has recent­ly done a sur­vey and it shows that, in fact, vets get more edu­ca­tion than health care professionals.

Evans: And I’ll be look­ing at the role of the pain spe­cial­ist nurse in the community.

Kathryn Nur: The treat­ments that I tend to offer in my area of being a nurse spe­cial­ist is that I do acupunc­ture, which involves man­u­al acupunc­ture or elec­tro-acupunc­ture. I also do trig­ger-point injec­tions to mus­cles, such as trapez­ius mus­cles, using steroids and local anaes­thet­ics. I show them how to use things like TENS machines and then oth­er things are relax­ation tech­niques, man­age­ment advice about med­ica­tion, the prob­lems that they might be hav­ing with oth­er sleep issues, things like that.

Evans: Kathryn Nur is a spe­cial­ist nurse in Pem­brokeshire, West Wales. She works with peo­ple in chron­ic pain. I joined her at her nurse-led clin­ic in Ten­by Com­mu­ni­ty Hospital.

Nur: We’re doing some treat­ment with this gen­tle­man called elec­tro-acupunc­ture, where we apply elec­tri­cal cur­rent to pairs of nee­dles. The idea behind that is that with long-term acupunc­ture treat­ment, what you want is to try and extend the ben­e­fit as long as you can, obvi­ous­ly, between each treat­ment. The evi­dence sug­gests that slight­ly more stim­u­la­tion pro­duces a longer ben­e­fit, so we use elec­tri­cal cur­rent to incite a deep­er stim­u­la­tion effect.

So that’s what we’re going to do this morn­ing. We obvi­ous­ly tar­get the area where this gentleman’s got pain. There are some recog­nised acupunc­ture points, which over­lie the area, which we use, but we also use a West­ern approach, which is trig­ger point needling, which is often over the myofas­cial points, so we tend to use a com­bined approach. We use some tra­di­tion­al Chi­nese points and some West­ern points, which are the trig­ger points.

How long have you been com­ing in now, Richard? It’s a quite a while, isn’t it? About a few years now.

Richard: A few years with you. I start­ed off with Dr Evans. The first treat­ment I had with my GP and I told her if I thought it would work, I would tell her and if it didn’t, I would also tell her. I’ve lost count of how many pins and nee­dles she’s stuck in me and God knows what else. And I went away from there think­ing, ‘Well, that ain’t much.’ The fol­low­ing morn­ing – I didn’t even con­nect it because it had just gone from my mind because it didn’t do any­thing the day before – the fol­low­ing morn­ing, I woke up, and I can hon­est­ly say it was the first morn­ing for, how­ev­er many years it was, since 1993 that I didn’t wake up in the morn­ing, think­ing, ‘Oh, I’ve got to sit up in bed, and this is going to kill me.’ And it wasn’t until lat­er in the day that I was feel­ing bet­ter and I thought to myself about the day before and it was good. She gave me an inten­sive course for a few weeks and I used to go back to her about once a month. Just for top up.

Evans: And where is your pain?

Richard: It’s sort of a back pain-ish. I’d describe it like a toothache pain: you know where it is, but you actu­al­ly can’t put your fin­ger on it, you know? It’s one of those. And it would move about and it would be here, there and all over the place. Because I had my ster­num removed, prob­lem with that being is, of course, bits and pieces move in entire­ly dif­fer­ent direc­tions than nature intend­ed. And the oth­er thing, of course, is with no ster­num, my clav­i­cles – that’s a good word, isn’t it?

Nur: Yeah.

Richard: Lay­ing on my side some­times they cross over in the night. That’s not too bad, but when you sit up, it’s when they uncross. It’s like some­one just hit you in the chest with a sledge­ham­mer. Literally.

Evans: And for those of us who didn’t know, the ster­num is the breast­bone that joins the ribs and the chest and the clav­i­cles are the collarbones.

Nur: Ready to switch on?

Richard: Yep.

Nur: Also, I’ll need to pre­pare your low­er arm first, Richard, okay. Let me know when we hit the spot.

Richard: Yeah, got one there.

Nur: Hap­py with that? That’s okay?

Richard: Yeah.

Nur: What the elec­tri­cal stim­u­lant is doing its caus­ing sort of a nox­ious stim­u­lant almost. When we do man­u­al acupunc­ture, some acupunc­tur­ists just put the nee­dles in and leave them and some would say, ‘That’s enough stim­u­la­tion [now] that the needle’s in place.’ When I did my train­ing we would sort of man­u­al­ly rotate the nee­dle. We’d give them man­u­al stim­u­la­tion, which is what a lot of acupunc­tur­ists do. But we find in our pain clin­ic, over the years, that by apply­ing elec­tri­cal cur­rent, it seems to last longer between each one rather than with the man­u­al way. You get a few days where it’s bet­ter and, again, there isn’t a lot of sci­en­tif­ic evi­dence to sup­port one way or the oth­er. I think a lot of it is cul­tur­al norms and what cer­tain pain clin­ics have devel­oped, but it seems to work for our client group rea­son­ably well.

Richard: I’ll be hon­est with you. I don’t know whether there is any sci­en­tif­ic worth in it or whether it’s a place­bo effect, but I don’t care because it works for me. It’s as sim­ple as that.

Nur: It’s very small, so the machine’s quite portable, so it can go with me to the var­i­ous out­reach clin­ics, to people’s homes, if nec­es­sary. There isn’t any evi­dence to say it’s got to be a ster­ile pro­ce­dure. In fact, tra­di­tion­al acupunc­tur­ists would shy away from a lot of the over-med­ical­iza­tion of it, real­ly. I mean, cer­tain­ly, we haven’t resort­ed to wear­ing gloves or any­thing like that. We still very much use the tech­niques of almost pass­ing on our ener­gy to patients by actu­al­ly man­u­al­ly, phys­i­cal­ly touch­ing the nee­dle and hope­ful­ly trans­fer­ring our good ener­gy, our good qi, to get rid of your bad qi.

Richard: It’s like any­thing that’s got some sort of mys­ti­cism about it. There’s a lot of char­la­tans out there which will jump on the band­wag­on, pre­tend all sorts and then they make up more mum­bo jum­bo, so then a cyn­ic like me dis­miss­es the whole lot. It’s a shame, real­ly, because as I say, for me it works. I wish I had tried it years ago, but then, it wasn’t sug­gest­ed to me years ago. It does annoy me that there’s not more open dis­cus­sion about it with­in the Nation­al Health Ser­vice and those peo­ple affect­ed by it, because this lady does a bril­liant ser­vice. It would be nice to think she had a bit more assis­tance, so you could get more times, you know? I can’t praise her enough, because she’s squeezed me in some­times when she’s had a full day. So I’m grateful.

Nur: Oh, you’re going to start me off now.

Richard: It’s alright. She’s a good girl.

Evans: I’m sor­ry to say that Kath’s patient Richard passed away short­ly after we met and I’m very grate­ful to his fam­i­ly for allow­ing us to broad­cast this, par­tic­u­lar­ly in that what he says next should be a real wake up call to some health pro­fes­sion­als. Let us know at Pain Con­cern what you think:

Richard: I got a bit annoyed. I went to a pain clin­ic even­tu­al­ly in Cardiff and she put me onto some­body who was in some sort of pain orga­ni­za­tion. I spoke to this per­son and I was a bit annoyed because she real­ly didn’t have any per­cep­tion of what I was talk­ing about. She wrote me a let­ter – she didn’t actu­al­ly tell me to my face – she wrote me a let­ter which said there was noth­ing else she could do because I had tried some of her options and they were absolute­ly useless.

You see, with one of the things she gave me I was prob­a­bly con­scious for about three hours a day and it was spurts, you know? Which doesn’t work. It doesn’t hurt, but what’s the point of that? I might as well be dead if I’m going to do with some­thing like that [Nur: Nope. No qual­i­ty of life.]. Yeah, nothing.

And then she said I was let­ting the pain run my life. The prob­lem that she didn’t seem to grasp was it’s because I didn’t let it run my life, over­do­ing things made it worse. That was the prob­lem. She could not get that. I’m not knock­ing on the Health Ser­vice com­plete­ly and all the rest, but some doc­tors, they’re sort of in a world of their own. Well, they don’t see peo­ple, they see patients, they see cas­es, num­bers, that’s it, you know.

As far as this bypass busi­ness, I’m a suc­cess, because I’ve sur­vived three years – ‘sur­vived’ being the word. There’s a lot of dif­fer­ence between sur­viv­ing and liv­ing. A lot of peo­ple in the med­ical pro­fes­sion… it’s the old thing isn’t it? Nev­er mind the qual­i­ty, feel the width.

Nur: I think going back to what you were say­ing, we were talk­ing ear­li­er about per­haps peo­ple don’t always lis­ten to what you’re say­ing. They’re mak­ing, sort of, judg­ments about your con­di­tion or your pain descrip­tion rather than actu­al­ly lis­ten­ing to what the pain’s doing to your life. Is that what you were saying?

Richard: That’s it, really.

Ann Tay­lor: The British Pain Soci­ety has recent­ly done a sur­vey and it shows that, in fact, vets get more edu­ca­tion than health care professionals.

Evans: Quite frankly, I find that a shock­ing sta­tis­tic. Ann Tay­lor, of the Welsh Pain Soci­ety and Fac­ul­ty of Pain Med­i­cine at Cardiff University:

Tay­lor: The amount of edu­ca­tion that health care pro­fes­sion­als get is not stan­dard­ised. It’s not oblig­a­tory that they have pain edu­ca­tion with­in their under­grad­u­ate cur­ricu­lum and so the British Pain Society’s now got a work­ing group look­ing at guide­lines for under­grad­u­ate cur­ricu­lum pain activ­i­ty, gener­ic pain train­ing with what should be achieved by the time the per­son qual­i­fies in their pain knowl­edge. It’s ridicu­lous when you think that fifty per cent of peo­ple vis­it their GP because of a pain prob­lem and yet pain is so low in terms of edu­ca­tion­al activ­i­ty that goes on. I mean, obvi­ous­ly, now there’s the Fac­ul­ty of Pain Med­i­cine, which is help­ing to sup­port and edu­cate anaes­thetists to man­age pain appro­pri­ate­ly, but there isn’t that kind of theme inher­ent in the under­grad­u­ate cur­ricu­lum through­out the UK.

Evans: Address­ing some of those issues, Ann Tay­lor was the main author and facil­i­ta­tor of the chron­ic pain direc­tives in Wales, part of which con­clud­ed that all health care pro­fes­sion­als should have access to e‑learning about pain edu­ca­tion. So she, with the Fac­ul­ty of Pain Med­i­cine at Cardiff Uni­ver­si­ty, has devel­oped, an online learn­ing facil­i­ty for health­care professionals.

Tay­lor: It is a com­mu­ni­ty for peo­ple to share infor­ma­tion, for pain edu­ca­tion and train­ing, to look at where cer­tain events are that are local to them, so they can make a deci­sion about whether they suit their edu­ca­tion­al needs. So it’s a very impor­tant resource for help­ing to sup­port peo­ple who don’t want to do for­mal cours­es and peo­ple who have done for­mal cours­es and would like to update in their areas of inter­est and expertise.

Most of the media has been devel­oped from the MSc in Pain Man­age­ment at Cardiff, so it is at quite an advanced lev­el. There isn’t that much that’s suit­able for patients and car­ers, so now in 2011, we’ll be work­ing with key organ­i­sa­tions, to actu­al­ly get cours­es on the site that are more bespoke to the needs of patients and car­ers. We’re fol­low­ing some­thing along the lines of some Open Uni­ver­si­ty cours­es: that if you’re dia­bet­ic, how do you use your insulin pen? How do you mea­sure your blood glu­cose? Which gives quite per­ti­nent, impor­tant mes­sages and we thought we’d look at maybe that kind of approach: how do you man­age your GP? How do you inter­act with your health­care pro­fes­sion­als? Basic phys­i­ol­o­gy to help you under­stand why your back’s hurt­ing; how to rein­force your goal-set­ting and pac­ing mes­sages. So some of those kind of things we’re hop­ing to host on the web­site even­tu­al­ly. We’re open to ideas because it is a com­mu­ni­ty and we have got email address­es if peo­ple want to sug­gest things that they would like to see on the com­mu­ni­ty site.

Richard: I tend to find that some doc­tors that have prob­lems in their own life, what­ev­er they may be – whether they be men­tal, finan­cial, phys­i­cal, what­ev­er – tend to be bet­ter lis­ten­ers, bet­ter under­standers. They’ve expe­ri­enced life, prob­a­bly, and there’re a lot of doc­tors that real­ly think they’re one above God, you know? Because they’ve had a priv­i­leged start and all the rest of it and they’ve just man­aged to go through life being on that plane up there which is not quite the same as the vast majority.

Evans: So here’s your chance now to talk to an imag­i­nary group of young doc­tors, young med­ical pro­fes­sion­als in train­ing. Here’s your chance to tell them. How should they talk to you? How should they deal with you?

Richard: First of all, don’t talk down to me. That’s the most impor­tant thing. Don’t talk to me as if I’m an imbe­cile, just because I don’t nec­es­sar­i­ly know some of the long words. If I ask a ques­tion, it’s not because I want you to lie to me. It’s not because I want you to tell me I don’t need to know. It’s because I want to know. The more I under­stand about any­thing that I do, whether it’s func­tion in my life or some­thing I want to achieve, the bet­ter I can cope with it if it’s not right. Just talk to us like peo­ple. First of all, find out what the patient wants from you, I sup­pose, real­ly, isn’t it?

Nur: Peo­ple do find it very dif­fi­cult. Even our­selves, if we go and see our GP, we’re not quite sure how to find the words to explain. I think it’s some­times – it’s not maybe the words, the descrip­tors – I think it’s more impor­tant to know how that pain’s actu­al­ly affect­ing you, what it’s actu­al­ly doing to you as a per­son. I think that gives you a bet­ter insight. As health pro­fes­sion­als, we appre­ci­ate that pain is mis­er­able and although we under­stand that, we’re not feel­ing that pain for that patient, so it’s impor­tant more to explain to the health pro­fes­sion­al the impact that that pain’s hav­ing. That prob­a­bly is more impor­tant in terms of your man­age­ment of it than actu­al the sever­i­ty of the pain, because sever­i­ty of the pain is… it’s very dif­fi­cult to put a num­ber on it some­times. Peo­ple do find that quite dif­fi­cult because we’re are very focused on assess­ing peo­ple by num­bers and per­cent­ages; peo­ple do find that quite hard, because that doesn’t always reflect on the amount of dis­tress or dif­fi­cul­ties they’re hav­ing in deal­ing with every­day things, so I think just try and encour­age peo­ple to talk about how it’s affect­ing them.

Tay­lor: You need to under­stand why peo­ple have got pain, even if it’s a very basic under­stand­ing. You need to know that very few peo­ple who suf­fer pain fit into a stan­dard­ised patient group, that chron­ic pain is a mul­ti-faceted phe­nom­e­na that needs to be man­aged appro­pri­ate­ly using a whole range of dif­fer­ent approaches.

I’ve done some focus group work with GPs, with peo­ple work­ing in the health­care are­na who are not pain spe­cial­ists and they want short, time-delin­eat­ed, clear edu­ca­tion­al activ­i­ties that meet their needs. What we’ve done in Pain Com­mu­ni­ty Cen­tre is we’ve tried to keep all edu­ca­tion­al activ­i­ties very short. You can actu­al­ly go on the site and say, ‘I’ve only got five min­utes. Show me all the activ­i­ties that only take five min­utes.’ And you get a list of edu­ca­tion­al activ­i­ties for five min­utes. We’ve actu­al­ly geared them so they have got very per­ti­nent take-home mes­sages by key peo­ple who are prac­ti­tion­ers through­out the UK in the hope that because it’s short, because it’s very per­ti­nent, because they’re key indi­vid­u­als that are pro­vid­ing the learn­ing, the uptake will be good. So, we’re hop­ing that it will have a big impact into the improve­ment in edu­ca­tion, which will only ben­e­fit, hope­ful­ly, patients’ lives.

Evans: Ann Tay­lor, of the Fac­ul­ty of Pain Med­i­cine at Cardiff Uni­ver­si­ty. That web­site, once again, is There’s no gaps in that:

You’re lis­ten­ing to Air­ing Pain. And one of our aims is to get answers to ques­tions you’ve raised with us. Here’s one: ‘I find TENS machines mod­er­ate­ly effec­tive, but have major prob­lems get­ting the elec­trodes to stick all day, par­tic­u­lar­ly if I’m also using heat. Does any­one have any ideas?’ Well, keep lis­ten­ing – our next con­sul­ta­tion at Ten­by Com­mu­ni­ty Hos­pi­tal answers many ques­tions about TENS machines.

Nur: I’m Kath, and obvi­ous­ly we’ve got you here this morn­ing to show you how to use our TENS machine. Do you feel com­fort­able just sort of telling me about how your pain start­ed? I know, obvi­ous­ly, you’ve already gone over this with the doc­tors, but if you don’t mind just going over…

Patient 2: How it started?

Nur: I’m sure it’ll be help­ful to oth­er peo­ple, if you feel con­fi­dent speak­ing now.

Patient 2: I don’t know what caused it. Prob­a­bly just life, isn’t it? It just went like that, and that’s it.

Nur: Hmm. How long ago was this?

Patient 2: Oh, I was, must have been… well, I’m 50 now, must have been about 21 when it start­ed. And I’ve always been on pills for it, but it just got worse and worse as I was get­ting old­er. Just get­ting more intense, sort of thing. And then I had the oper­a­tion then.

Nur: You’ve had surgery on your back?

Patient 2: Yeah, I did a spinal fusion.

Nur: How long ago was that?

Patient 2: That was four years ago.

Nur: Right.

Patient 2: And it just didn’t make a difference.

Nur: No. You still had back pain.

Patient 2: Yeah.

Nur: So what else have you tried? Have you had injections?

Patient 2: I’ve had, yeah, injections.

Nur: Acupuncture?

Patient 2: Acupunc­ture, yeah.

Nur: That didn’t help either?

Patient 2: Noth­ing.

Nur: Nothing’s done.

Patient 2: Noth­ing at all.

Nur: And med­ica­tion? Are you hav­ing to take that reg­u­lar­ly, your medication?

Patient 2: Every day. I’m con­stant­ly on tablets every day. Some­times I think to myself, ‘Should I try just one day with­out tak­ing them?’ And I just can’t. It’s impossible.

Nur: No, no. So what do you say is the biggest part of being in con­stant pain, in terms of your… how has it affect­ed you as a per­son and your fam­i­ly life?

Patient 2: Oh, it’s affect­ed my whole life! I don’t do a lot any­more. My hus­band does every­thing. He does the cook­ing, the clean­ing. He does every­thing, you know? He helps me when I want to get dressed and if I’m hav­ing a real­ly bad day. You think you’ll get used to it, but you just don’t. You don’t get used to it. You think one day pos­si­bly this is going to stop. This is going to end. But you’ve got to get used to it. That’s it.

Nur: I think prob­a­bly there’s more, I sup­pose, mak­ing adap­ta­tions, isn’t it? Try­ing to find oth­er ways of cop­ing with it.

Patient 2: Cop­ing with it, yeah. That’s why you have got to try things like this sort of thing, because like I’m say­ing, if you’re out of pain – cause I don’t know what it’s like to be out of pain now – if you’re just out of pain that lit­tle bit, oh, it would be a big thing.

Nur: If you could have a goal or an aim, is there any­thing that you’d wish you could do bet­ter or more of?

Patient 2: I wish I could just clean up. That would be some­thing! Just to go around with the hoover and things, you know? Like, I do try. Some­times I try and then I’ve got to give it to him and he fin­ish­es it. You’re just liv­ing on pain. That’s it. That’s the only way I can describe it.

Nur: So when you met the doc­tor, did you dis­cuss any oth­er things, apart from – obvi­ous­ly the TENS machine was some­thing you haven’t tried and you thought it was worth a try – but did he talk about longer-term strate­gies or man­age­ment or anything?

Patient 2: I think I’ve tried every­thing. I don’t think there’s much else I can try.

Nur: He didn’t men­tion to you about a pain man­age­ment pro­gram or any­thing like that? No? Okay. I think in the longer term, from what you’re telling me about the impact it’s hav­ing on your life, there might be ways of try­ing to help you man­age the pain bet­ter by look­ing at how it’s affect­ing you and some of the things that we can try and get you to work with. There’s a whole pro­gram called a pain man­age­ment pro­gram, where you would come along and be in a group set­ting and again, not every­one feels com­fort­able with that.

Patient 2: Oh, no, I’m not that type of per­son, to tell you the truth.

Nur: Yeah, but usu­al­ly peo­ple have sim­i­lar prob­lems. Any­way, I’m not going to go on, but I just want to put that seed in your mind to start think­ing about. You say­ing you’ve tried every­thing, but that might be a point at which you think, ‘Well, I have to look maybe beyond get­ting com­plete­ly rid of my pain, but actu­al­ly accept­ing that I have got pain.’ I know it’s hard for any­one to say that. But there comes a point at which we have to think, ‘Well, we can just give in and say that’s it.’ But I’m sure you don’t want to do that because you’ve said you want to be able to do things. You have got goals that you want to try and achieve and it may be only that small goal that helps you then move on and feel a bit bet­ter about things.

Patient 2: Yeah. Because I was always active all the time, like after six chil­dren, you’re on the go all the time. When I was in my late 20s and 30s, I used to go to aer­o­bics and things like that, and I used to – because of my back – do it as a just walk­ing sort of thing, not jump­ing sort of thing, but just walk­ing it. It would just be love­ly, but now I feel like I can’t do any­thing. It’s just tak­en over my life, I can hon­est­ly say.

Evans: My thanks to Kath Nur’s patient for being so open about her pain con­di­tion. Sit­ting in on the con­sul­ta­tions and hear­ing how rela­tion­ships are being built between her and the patients rein­forces the words of cau­tion we give in every edi­tion of Air­ing Pain. And that is that whilst we believe the infor­ma­tion and opin­ions are accu­rate and sound and based on the best judg­ments avail­able, you should always con­sult your health pro­fes­sion­al on any mat­ter relat­ing to your health and well­be­ing. He or she is the only per­son who knows you and your cir­cum­stances and, there­fore, the appro­pri­ate action to take on your behalf.

Nur: So what we’re going to do today is… the machine I’m going to show you how to use is called a ‘TENS machine’. It’s an abbre­vi­a­tion for tran­scu­ta­neous elec­tri­cal nerve stim­u­la­tion. Long word, so it’s abbre­vi­at­ed down to TENS. And basi­cal­ly what it is, is a lit­tle machine that runs from bat­ter­ies that emits an elec­tri­cal sig­nal along wires, which are then attached to lit­tle sticky pads called ‘elec­trodes’ that stick to you. The idea is that by apply­ing these pads on or around the area where you’ve got pain, you cre­ate a sort of stim­u­la­tion that your brain, if you will, inter­prets as an irri­ta­tion. It’s very much linked to the the­o­ry of… this gate con­trol the­o­ry, which is the way that we think pain is trans­mit­ted through the body along the ner­vous mech­a­nisms. It was sort of dis­cov­ered back in the 60s. Some sci­en­tists did some work, and they came up with the idea that apply­ing elec­tri­cal cur­rent might cre­ate almost an arti­fi­cial stim­u­la­tion, [so] that the brain thinks there’s some­thing going on and responds to it by releas­ing pain-reliev­ing sub­stances and also clos­ing off this ‘gat­ing’ mechanism.

So for some peo­ple it seems to work. Oth­er peo­ple it doesn’t. Everyone’s quite dif­fer­ent how they use TENS. Some peo­ple would say that they prob­a­bly use it most days, that it’s become part of their every­day pain man­age­ment strat­e­gy. Oth­er peo­ple found that they tend to use it for those real­ly bad episodes, which prob­a­bly you have these flare up days when the pain goes up a notch. Some peo­ple will say ‘Well, actu­al­ly, that’s when I tend to use it.’

Patient 2: My pain’s all the time. It doesn’t go up or down, it’s just constant.

Nur: Right. Okay, so it might be some­thing that you want to use more or less every day. And is there a par­tic­u­lar time of day that you feel is worse?

Patient 2: Morn­ings, most­ly. When the tablet have worn off overnight and then when I try to get up in the morn­ing. It’s pret­ty bad then.

Nur: So you’re find­ing that it’s get­ting going in the morn­ing and that’s when…

Patient 2: Yeah, and all through the night. I’m twist­ing and turn­ing and pain all night.

Nur: Okay, so morn­ings are the worst for you. But you don’t sleep very well at night.

Patient 2: No.

Nur: Unfor­tu­nate­ly, we tend to not rec­om­mend that you use the TENS machine through the night. The rea­son being is that because of the way it works, that you’re not real­ly in con­trol of the mech­a­nisms on the con­trols. What also hap­pens is the elec­trode, the lit­tle sticky pad that you put on your skin, seems to peel off more in the night. They stick to bed cov­ers. They start curl­ing up, so it makes it a lit­tle bit more messy. It’s prob­a­bly safer to not use it in the night time. Also we do sug­gest that if you’re going to have a break from using it, you need to have 8 hours with­in a 24 hour peri­od, so night time’s a good time not to have it con­nect­ed on, really.

We have to be real­is­tic. You know that it’s not going to com­plete­ly erad­i­cate your pain. I think it’s use­ful as an addi­tion­al treat­ment maybe – you know, you men­tioned ear­ly that you take painkillers. It’s quite use­ful as an addi­tion­al add on we call an ‘adjunct treat­ment’, as opposed to being a total – that’s all you have and there’s noth­ing else. And oth­er ways of help, you know, oth­er ways in cop­ing – it might be that it enables you to do things a lit­tle bit more that you’ve not been able to do as com­fort­ably – you feel bet­ter in your­self, you being a bit more active, you’re feel­ing a bit more on top of things… So it’s this sort of twofold buy-off from it, real­ly. You can con­trol the set­tings on it, so it’s giv­ing you back some of the con­trol over your pain that per­haps you feel you haven’t real­ly got at the moment.

Patient 2: None at all.

Nur: None at all. Right, so we’re going to get start­ed now. To start with, we would sug­gest you use what we call using a direct approach, where you actu­al­ly apply the pads on the area where you’re actu­al­ly feel­ing the sen­sa­tion of pain. It’s all across your back I’m assuming.

Patient 2: Yeah, it is.

Nur: So we put one pad there, and then the next one we can put either hor­i­zon­tal­ly or ver­ti­cal­ly con­nect­ed to it or even diag­o­nal­ly, it doesn’t mat­ter, because what hap­pens is the area between the pads and under­neath is the area that we’re going to target.

Patient 2: Do they have to be so much apart or anything?

Nur: No, they can be slight­ly near­er. You can have them with­in, I’d say, half an inch. If they touch each oth­er, they do tend to pick up the neg­a­tive and the pos­i­tive sig­nals and it gets a bit con­fused. So at least half an inch, max­i­mum sort of six inch­es. What we’re going to do now is we’re going to switch the actu­al machine on for you. You won’t feel any sharp thing. Don’t worry.

Patient 2: That’s just what I was just wait­ing for.

Nur: It’s just to reas­sure you. I know, everyone’s wait­ing, tens­ing up there. And we’ll do it very slow­ly, so that the puls­ing sen­sa­tion will come in quite slow­ly and grad­u­al­ly. What I want you to do is to let me know, as soon as you feel some­thing that’s not nor­mal­ly there, some kind of impuls­ing, heart­beat, puls­ing sen­sa­tion, what­ev­er you want to describe it, let me know.

Patient 2: Yes, there.

Nur: Is it irri­tat­ing, do you think?

Patient 2: No, not really.

Nur: Okay. The main thing is, for peo­ple, some­times they have this pre­con­cep­tion that if they turn it on real­ly high and there’s real­ly strong puls­ing com­ing out, that it’s actu­al­ly going to make a dif­fer­ence, that they’re actu­al­ly going to con­trol the pain bet­ter. There isn’t real­ly any evi­dence to sup­port that. There are some sort of what we call ‘pre­scrip­tions’, that cer­tain types of pain seem to respond slight­ly bet­ter to dif­fer­ent lev­els of the fre­quen­cy set­tings, but because often pain is very, very… there’s often some neu­ro­path­ic ele­ment to it, some noci­cep­tive ele­ment, most peo­ple who’ve got chron­ic pain tend to pre­fer to find their own lev­el, if you will. The good thing with TENS, as I said, is that you’re in con­trol of it. You can use it when­ev­er you want. There doesn’t seem to be any evi­dence of over­dos­ing, of hav­ing a bit too much of it. It’s not going to do you any harm. Is that all right?

Patient 2: Yeah, that’s fine. Thank you.

Evans: Now, TENS machines vary from mod­el to mod­el so we won’t con­fuse you by going into all the var­i­ous set­tings. But do make sure that your health pro­fes­sion­al explains the mod­el he or she rec­om­mends thor­ough­ly. My thanks to Kath Nur, Spe­cial­ist Pain Nurse in Pem­brokeshire and her patients for let­ting me sit in on their consultations.

And that’s the end of today’s edi­tion of Air­ing Pain. If you or some­one you know has ben­e­fit­ted from these pro­grams and would like them to con­tin­ue, then please con­sid­er mak­ing a dona­tion to secure Air­ing Pain’s future. Just go to the web­site at where you’ll find a Make Dona­tion but­ton at the bot­tom of the page. You can also down­load all the past edi­tions from there, and if you’d like to put a ques­tion to our pan­el of experts or just make a com­ment about the pro­gram, then please do via our blog, mes­sage board, email, Face­book, Twit­ter, or pen and paper.

I’ll leave you with Richard, whose con­tri­bu­tion to this pro­gram has been invalu­able. Thank you.

Richard: I’ve still got my sense of humour. I’ve always had a sense of humour. Very warped sense of humour some­times, but I’ve always had a sense of humour. There’s no point in being mis­er­able about what you’ve got. You can be mis­er­able inside, but you don’t nec­es­sar­i­ly have to pass it on to every­body else, if you can pos­si­bly help it.


  • Kathryn Nur, Spe­cial­ist Pain Nurse, Hywel Dda Health Board, West Wales
  • Richard, Kathryn Nur’s patient
  • Ann Tay­lor, Fac­ul­ty of Pain Med­i­cine, Cardiff University.