About Transcutaneous Spinal
Electroanalgesia
TSE (Transcutaneous Spinal Electroanalgesia)
has been practised as a form of electrical pain
relief since its discovery in 1991. No side
effect or interaction with medication has been
reported. Wherever the pain(s) may be felt, two
surface electrodes are always placed over the
spinal cord. Electrical pulses are delivered at
regular intervals in either the low or medium
frequency range from 100Hz to 50kHz but
typically in the range of 2-20kHz. Typically TSE
pulses are a biphasic square wave of duration
4ms or less; too brief to produce action
potentials in peripheral nerves at voltages
below 150V (peak-to-peak). With shorter pulses,
of the order of 0.5µs, the voltage may be
increased to 500V or more before the threshold
of sensation is reached.
At frequencies employed by interferential
stimulators it has long been known that the
signal penetrates deep tissues more effectively
than longer Transcutaneous Electrical Nerve
Stimulation (TENS) type pulses. TSE is no
exception, with the very short duration pulses
employed tissue impedance is 150 ohm or less,
compared to the 500 ohm seen by typical TENS
machines.
Mechanisms of TSE are theoretical, but are
believe to be a combination of the well known
modes of action of pre-existing forms of
electrically induced pain relief such as
TENS and dorsal column stimulation,
plus additional effects caused by the very high
rates of change of the applied electric field.
These include direct effects on processes that
occur in the central and or peripheral nervous
systems, for example the behavior of
microtubules, the rate of release of certain
ligands and or the responses to them by various
ligand gated receptors. The signal may also have
effects on the mobility of ions associated with
the transmission of action potentials and act
directly on other cell structures such as
voltage gated channels in both the peripheral
and central nervous system.
Direct coupling between applied field and
cell structures have been observed by various
researchers in recent years such as Liu et
al 1990, who observed direct effects of
oscillating electric fields on the activation of
Na+ and K+ pumping modes of (Na,K)-ATPase and
Kotnik et al 2000 explored the degree
of amplification of an external electric within
the cell at various harmonic frequencies and
showed the cell membrane amplifies externally
applied alternating current electric fields.
Studies shown pain relief by TSE for various
conditions is affected by frequency. At first in
1991 a frequency of 100Hz was employed, but
since then, higher frequencies have been
employed in a series of upward steps.
In a pilot study of chronic unilateral
tenderness, TSE at 600Hz produced a significant
reduction in the ratio of thresholds of
mechanical pressure and cutaneous sensitivity of
the affected side as compared with the
thresholds of the control side ( p
<0.001).
A controlled study of TSE (at 625Hz) in man
revealed significant changes in mood in normal
subjects; but only when electrodes were placed
over the spinal cord. The treated group became
significantly less tense ( p
<0.05), at the same time more elated
( p <0.001) and leisurely (
p <0.05) as compared with
control subjects.
A formal, randomised, double blind, crossover
clinical trial n8, comparing TSE (at a frequency
of 10kHz) with a control form of stimulation
(TENS) for the relief of chronic pain, showed
the analgesic effects of TSE to be significantly
superior ( p <0.005).
Treatment time for chronic pain is on average
twenty minutes. The duration of relief of
chronic pain following the first treatment is on
average eight hours. This phenomenon is
particularly useful in the management of
conditions such as migraine, non-specific back
pain, post-trauma or post-operative pains where
no inflammation persists.
A study of 150 patients completed in January 2005 using the new Acticare TSE device - average age 66 years, average duration of pain 9.5 years - showed that 79% of patients enjoy 50% pain relief or better from the use of the therapy.
When the frequency of TSE is increased to
20kHz or more, not only chronic but also acute
and acute-on-chronic pains tend to be reduced
for a few hours. At 20kHz, the author discovered
in an open pilot study that within an average of
15mins, the pain of acute conditions ( e.g.
inflammation and acute arthritis pain) may
be reduced. 186 (89.9%) of patients in this
study n207 had 50% or more relief; controlled
trials are planned to explore this observation
further.
Important note: TSE should only be used to treat acute pain under medical supervision where a diagnosis has been made by a health care professional. For this reason, the standard settings of the Acticare TSE device are arranged so that treatment is limited to chronic and acute-on-chronic pains.
Learn more about TSE and Acticare TSE in the
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