FROM ELECTRIC EELS TO WEARABLE DEVICES: HOW ELECTRICAL STIMULATION CAN HELP TREAT NEUROPATHIC PAIN

How far will people go to stop nerve pain? Well, there’s documented evidence that ancient Romans tried stepping on electric eels for that very purpose. Long before electricity was understood, it was being used as a therapy for treating pain.

The first wearable transcutaneous electrical nerve stimulation (TENS) unit was awarded a patent in 1974, and the devices have come a long way. Today, an array of handheld devices claim to help with a variety of types of pain, ranging from menstrual cramps to diabetic neuropathy.

How does it work?

The principle behind TENS devices is known as neuromodulation, a way of disrupting nerve activity using electricity. “Transcutaneous” indicates that electricity is applied via the surface of the skin. Electrodes send low-voltage electrical signals to painful areas of the body. The electricity is believed to modulate pain signals from peripheral nerves traveling to the brain.

Other techniques include cranial electrotherapy stimulation (CES), which focuses electrical pulses on the head, and repetitive transcranial magnetic stimulation (rTMS), which uses electromagnetic currents.

“While TENS and CES [such as Alpha-Stim devices] have been utilized for chronic pain for quite some time, I wouldn’t say that any are fully recognized or clinically proven as treatments for neuropathic pain,” says Anna Woodbury, MD, MSCR, C.Ac, associate professor of anesthesiology and pain medicine at the Emory University School of Medicine and founding chief for Pain Management at the Veterans Affairs Medical Center in Atlanta, Georgia. However, she adds, “There is promising research regarding these therapies, and more studies are underway.”

Other devices include the Quell system, a wearable sleeve specifically for lower extremity pain that can be operated through an app. The Oska Pulse system uses a pulsing electromagnetic field and is placed wherever pain is felt. Scrambler therapy, which is not wearable or available for home use like other therapies mentioned, sends scrambled electrical signals to the brain to retrain the brain to not recognize pain from that area.

VECTTOR is a therapy created by Donald Rhodes, DPM, a Texas podiatrist who himself has complex regional pain syndrome (CRPS). “I use it every day,” he says. VECTTOR uses acupressure points on the body to stimulate nerves to release neuropeptides that increase circulation. This method helps increase circulation at the cellular level, the lack of which can cause neuropathic pain, Rhodes says. Measuring body temperature is a key way to evaluate success.

To date, Rhodes says, thousands of people have used VECTTOR. He shares stories of patients who come to his clinic in a wheelchair and leave walking unassisted. So far, no clinical research studies have been completed to confirm the therapy’s efficacy, but Rhodes is preparing for VECTTOR’s first clinical trials on diabetic foot ulcerations.

A story of relief

Angela Livingston, a 53-year-old cancer survivor from San Angelo, Texas, uses TENS units to help with the neuropathic pain caused by her 2003 surgery for renal cell carcinoma. She has several other painful conditions, including CRPS and peripheral neuropathy.

“How it feels can vary,” Livingston says. “I have burning pain, pins and needles sensations, numbness and tingling, painful spasms, stabbing pain, and traveling pain that starts in one area and moves to other areas of the body.”

TENS devices, she says, have been helpful in disrupting the pain signals to her brain, stopping painful spasms and acting like a pulsating massage for pain relief. She has used several models, including high-strength units operated by her doctor.

“I use different frequency cycles and intensities,” she says. “These settings change as my pain changes several times per day. If there is no relief in one area, I move it to another.”

She uses the TENS treatments with heating devices and medications, and says the combination lowers her pain levels from a 10 to around a 5 on the pain scale.

Can electrical neuromodulation devices work for me?

The options have come a long way from electric eels. Most neuromodulation devices have been deemed safe enough for FDA clearance for pain treatment.

Many physical therapists, pain practitioners, and primary care physicians will let you try units. Some device manufacturers will offer a free one-month trial period. Others offer device rentals. Many of these patented therapies cost hundreds to thousands of dollars, and while insurance may help cover the cost, not all units are covered by most payors.

However, “TENS units and tDCS [transcranial direct current stimulation devices, which stimulate parts of the brain with electrical currents] are readily available and sold over-the-counter, including on Amazon for as low as $30 for a unit,” says Woodbury.

Woodbury urges people to be cautious of devices that are subscription based, as opposed to a one-time purchase. Discussing the options with your health care provider and trialing various models can help you determine what works best for you.

“It seems like most of the patients I encounter will try a TENS unit and stop there,” says Woodbury. “I would bet that the majority of individuals are not aware of the other non-invasive electrical or brain stimulation devices.”

While most over-the-counter units for neuromodulation tend to be low-risk, it is best to be cautious and consult your health care provider before use if you are pregnant, have a pacemaker or implantable cardioverter-defibrillator (ICD), have epilepsy, or may be sensitive to adhesives (which help the electrodes stick to your skin). The devices also should not be used over broken skin or areas experiencing numbness, as burn injuries may occur if an individual cannot feel the heat produced by some electrical devices.

“Always consult medical professionals and do your research,” says Livingston. “But keep looking for what is best for you and your health, and realize that what works for one person may not work for you. Don’t ever give up.”

“Keep looking for what is best for you and your health, and realize that what works for one person may not work for you. Don’t ever give up.