Electroanalgesia Health Article

KEY TERMS

Dysmenorrhea—Painful menstruation.

EDA—Electrical dental analgesia.

Endorphins—Natural, morphine-like substances in the brain.

Enkaphalins—Natural, morphine-like substances in the brain.

PENS—Percutaneous electrical nerve stimulation.

TENS—Transcutaneous electrical nerve stimulation.

EDA is administered through small pads placed inside the mouth or on the outside of the cheeks. The patient controls the amount of electroanalgesic administered and feels only a pins-and-needles sensation rather than pain. Once the dental procedure is over and the EDA pads are removed, the patient has no residual numbing as often occurs with the use of local anesthetics.

Neither PENS nor electroacupuncture were approved by the FDA by 2001, and often are not covered by standard medical insurance. TENS and EDA have been approved. However, all of these electroanalgesic therapies should be used as a supplement to conventional treatment and should not be the primary or alternate course of treatment. Since pain is an indication of many serious conditions, pain should not be ignored or eliminated until the source of the disorder is found. Then, any number of pain management therapies including electroanalgesia may be used.

Preparation

There is no preparation for this procedure, except to identify the location of the pain. For TENS treatment, the patient should be given three separate treatments in the practitioner's office. An assessment of the patient's pain level after treatment, measured against a standard scale, must be discussed and recorded. The patient can then be instructed in the use of the apparatus for self-treatment at home. Once several treatments are completed, the patient should be evaluated. If the pain has stopped or reached a plateau, treatment should cease. If the pain is gone, even after only one minute of treatment during the first treatment, treatment should cease for that day. Often the patient feels immediate relief; sometimes, it is delayed over a day or two. It is important to remember that with progressive pathologies such as cancer and degenerative diseases like arthritis, pain most likely will return. The patient will need repeated treatments which are often taken at home under the patient's control.

For PENS therapy, the patient receives treatment in the practitioner's office. The practitioner must locate the areas of pain and place the steel probes into the soft tissue at specific points near the pain.

Aftercare

With proper use, there is no need for aftercare from these procedures.

Complications

The only complications with electroanalgesic therapies are the risk of infection in invasive techniques (probes) and continuation of therapy after pain is eliminated or has reached it's lowest threshold. In these instances, continuing treatment may cause the pain to return.

Results

Before treatments begin, the physician and patient must come to an agreement on the goals of therapy. Normal expected results are to diminish or eliminate pain; however, goals must be reasonable and workable according to the patient's condition. Often, patients report more freedom of movement, better sleep patterns, and considerable reduction in the need to use oral analgesics following electroanalgesic therapies.

Health care team roles

PENS therapists require special training in the use of the equipment and insertion of probes. There is an art to the therapy, much like the art associated with acupuncture.

TENS training is less delicate but still necessary. Since this therapy is relatively new, many physicians have written a prescription for a TENS unit, or given a unit to a patient without proper patient education about the use of the unit and the necessity for determining the appropriate frequency to obtain the necessary results. By administering the first three treatments in the office, the practitioner can determine the appropriate settings for the patient and his or her particular type of pain before sending the unit home with the patient.

Because dental patients control the amount of electronic anesthesia they receive, dentists and dental assistants must be trained in the use of the EDA units so they can instruct the patient how to dispense their individual level of pain suppression.

PERIODICALS

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Hamilton, Kendall, and Joan Raymond. "More Lasers, Less Lidocaine: Meet Dr. Friendly, D.D.S." Newsweek 131, no. 15 (April 13, 1998): 14.

Hamza, Mohamed A., Paul F. White, William F. Graig, El-Sayed A. Ghoname, Hesham E. Ahmed, Timothy J. Proctor, Carl E. Noe, Akshay S. Vakharia, and Noor Gajraj. "Percutaneous Electrical Nerve Stimulation." Diabetes Care 23, no. 13 (March 2000): 365.

Somers, David L, and Martha F. Somers. "Treatment of Neuropathic Pain in a Patient with Diabetic Neuropathy Using Transcutaneous Electrical Nerve Stimulation Applied to the Skin of the Lumbar Region." Physical Therapy 79, no. 18 (August 1999): 767.

Janie F. Franz