TENS: Clinical Applications and Related Theory.

TENS: Clinical Applications and Related Theory

Walsh DM. New York, NY 10011, Churchill Livingstone Inc, 1997, hardcover, 167 pp, illus, $38.95.

Written for 3 different groups--students, practicing clinicians, and researchers--this text includes 10 chapters, an appendix, an index, and a bibliography. Chapter 1 provides the introduction and a historical perspective that reviews electrotherapy from about 2000 BC to the present day. This chapter describes advantages and disadvantages of transcutaneous electrical nerve stimulation (TENS) units and electrodes and finishes with a discussion of electrodes and acupuncture. Chapter 2 covers pain and pain modulation. It describes neurophysiology, neuromodulation, and psychology of pain well. Chapter 3 deals with the physiological principles and stimulation parameters of TENS. It very clearly describes the waveforms, stimulation parameters, frequencies, positive ratios, intensity and amplitude, and conventional modes available in TENS therapy. Chapter 4 deals with the principles of electrodes and electronic equipment. This chapter is essential to clinicians because it describes proper patient care and the electrode-skin interface. Chapter 5 describes the experimental studies on TENS, including neurophysiological studies, animal studies, human studies, and pain studies. Again, this chapter is ideal for researchers who can quickly review it for research purposes.

Chapter 6 examines clinical studies of TENS, broken down into low back pain, labor pain, arthritis, and dysmenorrhea. This chapter, like previous chapters, is a quick reference that allows clinicians and researchers to review recent clinical studies on TENS. Chapter 7 deals with the clinical application of TENS, providing coverage of indications and precautions, patient preparation, selection of TENS parameters, treatment time, electrode placement and arrangement, polarity, application of gel hydropads, and the attachment of the electrode. This material is well presented and well written. Chapter 8 is an interesting chapter because it discusses the nonanalgesic effects of TENS. It also summarizes the effects of TENS on wound healing and the autonomic system and some interesting studies on all these aspects. Chapter 9 discusses the future of TENS and some possible developments. The author believes that evidence-based practice should be fundamental for all health care professions, and she discusses evidence, studies, and data for the use of TENS in the future. Chapter 10 describes TENS units, electrodes, and accessories, including some of the units available in Europe that are not available in the United States. Finally, the book includes an appendix and an index.

This book is well illustrated and has a good bibliography. This is an ideal book for students, clinicians, researchers, and teachers. It should be in every library. In the foreword, Dr Norman Shealy said that this is the most comprehensive and detailed book on the subject to date. I agree with his assessment.

CK Fernando, PT

Island Rehabilitation and Fitness Center

Naples, Fla

Mr Fernando is President of Island Rehabilitation and Fitness Center and Forest Hills Back Pain Inc. He specializes in back pain, pain management, and electromyographic biofeedback.