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Utility of transcutaneous electrical nerve stimulation in neurologic pain disorders

Transcutaneous electrical nerve stimulation (TENS) has now been used over 40 years in the treatment of pain. In 1967, Wall and Sweet successfully treated patients with “chronic cutaneous pain”; this proved to be the beginning for the increasing and widespread use of TENS in different nociceptive and neuropathic pain syndromes. The scientific basis for this treatment was presumed to be Wall and Melzack's gate control theory,1 which stated that large nerve fiber activation, as applied by TENS, could modulate pain sensations conducted in small fiber nerves, by gating or blocking the transmission within central nociceptive pain pathways. Recent research and clinical observations in some patients, such as those with delayed analgesia or persisting anesthesia after stimulation, has made it clear that the gate control theory cannot explain all effects of TENS; nevertheless, the lack of a solid scientific rationale has not hindered the implementation of TENS in pain therapy.

In this issue of Neurology ®, Dubinsky and Miyasaki,2 representatives of the …