Electroanalgesia in St. Louis

TENS — transcutaneous electrical nerve stimulation. Low-level current delivered through electrodes on the skin. It stimulates peripheral sensory neurons and modulates the pain signal before it reaches conscious perception. Non-invasive, and the method most often continued at home between visits.

PENS — percutaneous electrical nerve stimulation. Current delivered through fine needle electrodes directly into tissue rather than across the skin. Because it bypasses the resistance of the skin, it reaches deeper structures and influences the release of the body’s own opioid peptides. Performed in the office.

Electroacupuncture. Electrical stimulation applied through acupuncture needles, acting on several pain pathways at once.

Implanted neuromodulation. Spinal cord stimulation and peripheral nerve stimulation apply the same underlying principle through an implanted device. These are a different order of intervention, reserved for established neuropathic pain that has not responded to less invasive treatment, and always preceded by a trial.

A 2024 literature review in Cureus screened more than 600 research articles and included 56 clinical studies. It found meaningful benefit for TENS, PENS and electroacupuncture across a range of conditions — chronic low back pain, knee osteoarthritis, fibromyalgia, migraine, and postoperative pain and nausea, where TENS applied at acupoints performed comparably to ondansetron for preventing postoperative nausea and vomiting.

We would rather state the limitation than oversell the result. The studies are heterogeneous and the findings are mixed. Electroanalgesia is a useful adjunct with a reasonable evidence base, not a cure and not a substitute for identifying what is generating the pain. Where it is combined with exercise — in diabetic peripheral neuropathy, for instance — the combination outperforms either alone.

Reddy J, Singhal R, Gaikwad AP, Patel D, Patel P, Gandhi SK. Unraveling the potential of electroanalgesia: a literature review of current therapeutics. Cureus. 2024;16(5):e61122. doi:10.7759/cureus.61122

Neuropathic pain is not one mechanism. It involves peripheral nerve damage, central sensitization, neurotransmitter imbalance, inflammation and maladaptive changes in how synapses behave. Together these raise pain sensitivity and keep pain going after the original injury has resolved.

Electrical stimulation acts at several points in that chain at once. It interferes with transmission in the peripheral nerve, engages the descending pathways that normally dampen pain, and increases endogenous opioid activity. That breadth is the reason it can help where a drug aimed at a single receptor does not.

TENS and PENS are well tolerated. There is no sedation, no incision and no recovery period.

Electrical stimulation is not appropriate if you have a cardiac pacemaker or implanted defibrillator, because of the risk of interference with the device, and it requires caution in epilepsy. Tell us about any implanted device before treatment, not after.

Implanted neuromodulation carries the risks of any implant procedure — infection, lead migration and hardware malfunction — which is why a trial period is required before a permanent device is placed.