The Pulse

Electrical Stimulation in Pain Management

Posted by ACP - Accelerated Care Plus on Jan 24, 2023 8:00:00 AM

Pain is common in the geriatric population leading to a rapid decline in cognition and function with the eventual need for assistance and potential institutionalization. While opioids are often used to treat pain, their side effects are now well established. In therapy, multimodal non-pharmacologic pain management interventions are effective at improving clinical outcomes.

• In 5,589 patients over age 65, 1 in 3 had persistent pain. Those individuals had lower levels of physical function and well-being at baseline and higher rates of decline over 7 yrs. (Ritchie et al., 2022)
• APTA CPGs recommend using biophysical agents (e.g., electrical stimulation) for a variety of musculoskeletal conditions with intended uses that include modulating pain, decreasing edema, and improving circulation. (Page, 2021)
• Individuals receiving TENS following unilateral total knee arthroplasty showed significantly reduced pain levels and opioid consumption with fewer adverse effects. (Li & Song, 2017)

Electrical Stimulation Using OmniVersa® and ACP Approved Electrodes

Proper skin inspection and preparation, electrode size, protocol selection, and intensity have a direct impact on the outcomes achieved with electrical stimulation.


Nociceptive, neuropathic, nociplastic, and/or mixed pain treatment approaches include TENS-LVPC, PREMOD, IFC, HVPC, and PENS at sensory, motor, or mixed (e.g., motor-sensory) frequencies.

• Nociceptive pain is caused by tissue damage and inflammation.
• Neuropathic pain is caused by nerve damage.
• Nociplastic pain is caused by changes in CNS processing with widespread, disproportionate pain.

Procedural pain and/or muscle relaxation treatment approaches include sensory and motor Nerve Block.

The quality of the electrodes (large, low resistance, uniform conducting) is the single most important contributor to safe, comfortable, and effective neuromuscular activation during electrical stimulation.



Li, J., & Song, Y. (2017). Transcutaneous electrical nerve stimulation for postoperative pain control after total knee arthroplasty: A meta-analysis of randomized controlled trials. Medicine, 96(37), e8036. 
Page P. (2021). Making the Case for Modalities: The Need for Critical Thinking in Practice. International journal of sports physical therapy, 16(5), 28326. 
Ritchie, C. S., Patel, K., Boscardin, J., Miaskowski, C., Vranceanu, A. M., Whitlock, E., & Smith, A. (2022). Impact of persistent pain on function, cognition, and well-being of older adults. Journal of the American Geriatrics Society, 10.1111/jgs.18125. Advance online publication. 

Topics: Pain Management, Clinical Tip