title: Adjusting pulse amplitude during transcutaneous electrical nerve stimulation (TENS) application produces greater hypoalgesia.
abstract: Transcutaneous electrical nerve stimulation (TENS) is a noninvasive technique used for pain modulation. During application of TENS there is a fading of current sensation. Textbooks of electrophysical agents recommend that pulse amplitude should be constantly adjusted. This seems to be accepted clinically despite the fact that there is no direct experimental evidence. The aim of the current study was to investigate the hypoalgesic effect of adjusting TENS pulse amplitude on pressure pain thresholds (PPTs) in healthy humans. Fifty-six healthy TENS naïve participants were recruited and randomly assigned to 1 of 4 groups (n = 14 per group): control, placebo TENS, fixed pulse amplitude TENS, and adjusted pulse amplitude TENS. Both active and placebo TENS were applied to the dominant forearm. PPTs were recorded from 2 points on the dominant forearm and hand before, during, and after 40 minutes of TENS. TENS increased the PPTs on the forearm (P = .003) and hand (P = .003) in the group that received the adjusted pulse amplitude when compared to all other groups. The mean final pulse amplitude for the adjusted pulse amplitude TENS group was 35.51 mA when compared to the fixed pulse amplitude TENS group, which averaged 31.37 mA (P = .0318).
  
  
  CONCLUSIONS
  These results suggest that it is important to adjust the pulse amplitude during TENS application to get the maximal analgesic effect. We propose that the fading of current sensation allows the use of higher pulse amplitudes, which would activate a greater number of and deeper tissue afferents to produce greater analgesia.
authors.affiliation: University of the City of Sao Paulo (UNICID), Physical Therapy Department, Sao Paulo, Brazil.
authors.forename: Manuela A
authors.initials: MA
authors.lastname: Pantaleão
authors.forename: Marjorie F
authors.initials: MF
authors.lastname: Laurino
authors.forename: Natalie L G
authors.initials: NL
authors.lastname: Gallego
authors.forename: Cristina M N
authors.initials: CM
authors.lastname: Cabral
authors.forename: Barbara
authors.initials: B
authors.lastname: Rakel
authors.forename: Carol
authors.initials: C
authors.lastname: Vance
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Sluka
authors.forename: Deirdre M
authors.initials: DM
authors.lastname: Walsh
authors.forename: Richard E
authors.initials: RE
authors.lastname: Liebano
mesh_terms: D000293:Adolescent; D000328:Adult; D000698:Analgesia / Q000379:methods*; D000704:Analysis of Variance; D005260:Female; D005542:Forearm; D006801:Humans; D008297:Male; D010146:Pain / Q000503:physiopathology; D059408:Pain Management; D010147:Pain Measurement; D017288:Pain Threshold / Q000502:physiology*; D011312:Pressure; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*