?TENS causing Cervicogenic Symptoms

Hi All,

Had this occur with a patient recently and was wondering if anyone had any thoughts...

Was demonstrating a TENS unit for pain in cervical and lumbar regions (mod - severe osteopenia + DDD throughout spine with pronounced thoracic kyphosis) - demonstration was at the lower cervical spine, single channel only. Ran through the usual with the client, had them adjust the intensity to their preference (which ended up being relatively low - about 2 on the dial) and kept it going for about 5 minutes before the client reported feeling "heavy headed". Turned the TENS off, removed electrodes, "heavy-headnesses" persisted along with "increased clicking in the Csp on Rotn R)", nausea, and legs felt "wobbly" when attempting to stand (no LOB). Started to resolve after about 10-15 minutes.

Client is convinced it was the TENS unit but I've never come across symptoms like it before when using TENS. Just wondering if anyone has come across something similar or if can suggest why TENS might produce these symptoms?

Cheers,
Ray

I have certainly never come across this nor head of it before. It would get me thinking to an underlying cause though. Does he have any other central or peripheral symptoms suggestive of anything else? e.g. neuropathy, paresthesia etc.

A heavy head could be the result of muscles relaxing that were once "holding". Dizziness could also result from an increased blood-flow as a result. Did you notice any cardiac changes during his symptoms such as an elevated or depressed pulse?

All things being equal and if there are no other signs or symptoms (and patient is willing) you might be able to repeat the treatment and see if it happens again. It may not happen the second time around. Give them a nice chair to relax in for 30 mins though. :smokin

Thanks for the response - no obvious underlying neural pathology, no obviously noticable change in cardiac condition during or post-Rx. I considered an underlying VBI but patient claims to have not had these symptoms prior to using the TENS and tests negative for VBI. Patient has refused to try TENS again so don't think I'll be getting a comparison anytime soon.

Cheers,
Ray

Hi,

Some TENS units may provide such feelings. It is a result of pressure “sensors” that are activated by current. Amplitude needs to be lowered. Patient may experience light touch but not “weight”.

Hi Bernard,

Thanks for the info... I thought that was interesting about the amplitude affecting pressure receptors - unfortunately with this patient the amplitude was relatively minimal (2 on a dial from 1 - 9) so I'd anticipate a lower amplitude probably wouldn't be therapeutically viable. But I will keep it in mind for next time.

Cheers,
Ray

Ray,

It is possible to lower the amplitude because it is actually known that subtreshold currents works and the other possibility is to change the impulse duration.

Please make sure that you are well aware of the precautions and contraindications while doing any form of electrical stimulation. These are as under:

1- TENS or NMES (Neuromuscular electrical stimulation) over the thoracic region because current may interfere with the function of vital organs including heart.

2- TENS or NMES in the thoracic region of the patients with demand type of cardiac pace makers because the current may interfere with pace maker activity and may lead to asystole or ventricular fibrillation.

3- TENS or NMES in the region of phrenic nerve or urinary bladder stimulator because current may interfere with the normal operation of these devices.

4- TENS or NMES over the carotid sinus because current may interfere with the normal regulation of the blood pressure and cardiac contractility and may produce cardiac arrhythmia or bradycardia.

5- TENS or NMES in hypertensive or hypotensive patients because autonomic responses may adversely affect control of blood pressure.

6- TENS or NMES in the area of peripheral vascular disorders such as venous thrombosis or thrombophilibitis because of the risk of releasing emboli.

7- TENS or NMES in the region of neoplasm or infections because muscular and circulatory effects may aggravates these conditions.

8- TENS or NMES on the trunk of pregnant females because of the risk of inducing uterine contractions which may influence the developing fetus.

9- TENS or NMES in close proximity to diathermy devices because of the potential for loss of control of stimulation parameters.

10- TENS or NMES in areas of excessive adipose tissue as in obese patients because level of stimulation required activating muscle in such patients may produce adverse autonomic reactions.

11- TENS or NMES in patients who are unable to provide clear feedback regarding the level of stimulation such as infants, senile subjects, or individuals with mental disorders.

Please also have a look over this article

Transcutaneous electrical nerve stimulation (TENS)

If any body has any idea or more suggestions, please, feel free to discuss that.

Hi.

I don't know about the purported effects of TENS on different nerve types... but the symptoms sound like a vasovagal reaction.

Maybe you got "lucky" on an electrode placement!