TENS Therapy (Transcutaneous Electro-Neuro Stimulation)

TENS (Transcutaneous Electro-Neuro Stimulation) at Bolest Brno uses precisely calibrated rectangular electrical currents applied through skin electrodes to interrupt pain signalling pathways at the nerve level. The technique is well-established in pain medicine: low-frequency TENS activates endogenous opioid release, while high-frequency TENS works by 'gating' pain signals in the dorsal horn of the spinal cord. One of the distinctive features of Bolest Brno's TENS programme is that patients can borrow portable TENS devices from the clinic's outpatient department for home use between sessions — extending the benefit of clinical treatment into daily life without additional expense. The treatment is covered by Czech general health insurance for insured patients and is offered as part of the clinic's multimodal pain management approach.

TENS (Transcutaneous Electro-Neuro Stimulation) is one of the most studied non-pharmacological analgesic techniques in clinical pain management, with a mechanism grounded in two well-validated models: 1. **Gate control theory** (Melzack & Wall, 1965): High-frequency TENS (80–150 Hz) stimulates large-diameter Aβ sensory fibres, which 'close the gate' to pain signals carried by smaller Aδ and C fibres at the level of the dorsal horn in the spinal cord. The result is a reduction in the central perception of pain without affecting the nociceptive signal at its source. 2. **Endogenous opioid release**: Low-frequency TENS (2–10 Hz) preferentially activates Aδ fibres and stimulates the release of β-endorphins and enkephalins — the body's own pain-relieving neuropeptides. This effect outlasts the treatment session and explains why repeated TENS sessions can produce cumulative benefit. **Clinical application at Bolest Brno:** The clinic uses TENS as part of its broader pain management programme, typically alongside pharmacotherapy, nerve blocks, or acupuncture. The treating algesiologist selects electrode placement, stimulation frequency, pulse width and current intensity based on the patient's pain distribution and underlying diagnosis. Common electrode placements include paravertebral (alongside the spine), dermatomal (over the nerve territory affected), and direct over the painful structure. **Home-use device loan programme:** A key feature of Bolest Brno's TENS offering is the availability of portable TENS devices for patient loan. After an in-clinic session establishes the appropriate settings, a patient can borrow a device to use at home during pain flares or between clinical visits. This extends the treatment window and allows patients to self-manage acute exacerbations without repeated clinic attendance. Devices are loaned free of charge from the outpatient department; the clinic provides instruction on correct pad placement and parameter selection. **Conditions:** TENS is used across a wide range of acute and chronic pain conditions managed at the clinic — including low-back pain, cervical pain, radiculopathy, post-operative pain, fibromyalgia, and joint pain. It is particularly valued for patients in whom pharmacological options are limited (e.g., renal impairment, polypharmacy, drug intolerance). **Session structure:** Electrodes are positioned according to the target anatomy. The device is switched on and current is increased to the patient's comfort threshold. A typical in-clinic session runs 20–40 minutes. After the session, electrode pads are removed and the skin is checked for any reaction. **Contraindications:** Cardiac pacemaker (absolute — never use TENS with an electronic implant). Do not apply electrodes over the carotid sinuses (neck), transcerebrally (across the head), over active malignancy, or over broken or infected skin. Relative contraindications include pregnancy, epilepsy, active thrombosis at the treatment site.