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Book Review
TENS: Transkutane elektrische Nervenstimulation in der Schmerztherapie (TENS:
Transcutaneous electrical nerve stimulation in
pain therapy)
Raymond Pothmann (editor)
Paperback, Pages: 153, Price: ^34.95
Hippokrates Verlag (Thieme Verlagsgruppe),
Stuttgart (2003)
3rd edition, revised and enlarged
www.hippokrates.de
ISBN 3-8304-5228-4
TENS
(transcutaneous
electrical
nerve
stimulation) is an important tool for any
practitioner who works with pain.
Since Deirdre Walshs standard textbook on
TENS was published in 1997,1 the only new UK
books on the subject have been marketed by
distributors of TENS devices, that by Keith Tippey
being the most useful.2
For those who read German, this new edition
of a book which first appeared 12 years ago neatly
complements Walshs. Its 21 chapters include
contributions from highly experienced French and
Finnish as well as German authors. Technicalities
are kept to a minimum, and clearly explained.
Chapters are short and pithy, with the personal
expertise of the authors bringing their subject
matter to life.
Pntinen, for example, broadens his discussion
of the neurophysiology of TENS to include laser
stimulation, and contributes a whole chapter
on the vascular effects of TENS in which the
various treatment options are lucidly outlined
(I particularly like his extension of Kaadas
protocol, 2-4 Hz non-segmental stimulation
of LI4, to include treatment at ST36). He also
writes realistically about the limitations and side
effects of TENS, and how to circumvent them.
Suggestions on treatment parameters that will
be unfamiliar to many non-European readers
are made by Hankemeier and Krizanits-Weine
in their brief chapters on back and joint pain.
There are useful chapters on cancer pain
(Schara), childbirth, gynaecology and paediatrics
(Pothmann). The contribution on pain in dentistry
(Scherman, Goepel), constructed around a small
clinical study, is particularly instructive.
However, other chapters are disappointing.

Pothmanns introduction to TENS as a form of


muscle stimulation (TEMS), for example, is
skimpy, lacking in practical data. Gesslers
contributions on neurogenic, stump and phantom
pain, and headache do not appear to have been
updated for this edition, and lack the evidence
based approach of some of the other authors,
such as Goepel, writing on postoperative pain.
Gessler also contributes a useful if somewhat
stodgy chapter on the practicalities of TENS in
the pain clinic, and Hankemeier and KrizanitsWeine include a brief summary of the choices
involved in deciding whether or not to employ
TENS with particular patients.
For the acupuncturist, three chapters are
particularly relevant. The first (Pothmann), on
TENS and acupuncture, includes some useful
comparisons between the two methods, suggesting
when manual or electroacupuncture (MA, EA)
or TENS is likely to be most helpful. The second,
by Heydenreich (and Pothmann), is one of the
longest and most informative in the book,
describing the results of the many studies he
carried out on his method of acupoint probe
stimulation (PuTENS) before his death. Even
though this work is old, it is rigorous, and deserves
to be far better known outside Germany than it is.
Hopefully, with the launch of a new, CE-marked
version of the PuTENS device by Schwa Medico,
this will happen. The third chapter, on EA, by
Irnich (and Pothmann) includes some recent
material, so must be one of the revised ones
mentioned on the book cover, although it is so
very minimal that it can hardly have been
enlarged. However, it might be useful as a
reminder of the indications and contraindications
of EA, and includes a list of points useful for
acupuncture analgesia.
Illustrations in the book are simple and
uncluttered. One nice touch is that the bodies
shown are not sylph-like and angular, but
comfortably rounded! Given our increasing
corpulence in the west, this does feel rather
appropriate (or maybe Im getting middle aged).
All in all, I think this is a useful book, but it
will not satisfy those looking for in-depth
discussion of the topics covered. The contributions
by Pntinen and Heydenreich (and co-author?)
in particular are well worth reading.
David Mayor

ACUPUNCTURE IN MEDICINE 2003;21(3):117-118.


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Equipment Review
Reference list
1. Walsh DM. TENS: Clinical applications and related
theory. Edinburgh: Churchill Livingstone; 1997.

2.

ITO ES-160 Electroacupuncture Unit

representations of the output. Again, the operation


manual offers no suggestion as to which mode to
use for specific conditions, but a clinical user
guide Introduction to Japanese Electric
Acupuncture and Ryodoraku - will be available
shortly, and contains much useful information.
It is disappointing that it is not possible to mix
independently two frequencies such as 4 Hz (to
stimulate beta endorphin production in the brain
stem) with 100 Hz (to release spinal dynorphin,
and serotonin), in dense-disperse fashion.
Instead, there are three preset programs that
give an assorted output of different modes and
frequencies, each lasting 2 to 4 minutes. This uses
the best stimuli from the machine giving the
following sequence for example, program 3:

Price: 255 + VAT


Available from:
http://www.itolator.co.jp/english/products/
cat15.html
The state of the art electroacupuncture stimulator
device from the Japanese firm ITO is a six-channel
machine with a stunning appearance. It is powered
by four C-size (LR14) alkaline batteries, which
will give thousands of hours use. There are three
LCD display panels showing pulse frequency,
pulse width and duration of treatment (timer)
which can each be independently adjusted.
The first channel allows a search and
stimulation facility using a grounding rod held by
the patient, and a probe controlled by the therapist,
which detects areas of low skin resistance.
Curiously this is a T-shaped device with an 8mm
diameter probe at one end, and a cup to receive a
water-soaked pledglet of cotton wool for Ryodoraku
point measurement. I must confess that I do not
know the first thing about Ryodoraku point
measurement, and although the operation manual
explains briefly how to make measurements, there
is no explanation on how to interpret the values.
The 8mm search probe is good at finding low
resistance areas by showing increasing numbers in
the middle window and a buzzer that becomes
more excited as the probe gets nearer to the
acupuncture point. Unfortunately, the 8mm probe
is too big and blunt for accurate location of points,
and is of no use for identifying ear points.
The electroacupuncture outputs allow
considerable adjustment in terms of pulse
frequency (0.5-500Hz), pulse width (50-400us)
and output (max 16v, 32mA peak). There are
five basic output modes: Constant - symmetric
bi-phasic rectangular pulses; Burst on/off bursts
of pulses; Surge crescendo/decrescendo bursts
of pulses; Fast and Slow alternating frequency
speeds; and Sweep frequency modulated. The
lower frequency is always a third of the higher
frequency set, and there are visual and audible

118

Tippey KE. TENS: the user's guide to pain relief. A


systematic approach. Nidd Valley Medical, Knaresborough,
UK (revised edition); 2000. www.niddvalley.co.uk

Mode
Constant
Fast+Slow
Surge
Sweep
Constant

Frequency
20
2/6
100
3-10
70

Pulse width
150
400
100
300
100

Time (mins)
2
4
3
3
3

And that should activate about every opioid


peptide in the body in 15 minutes!
There are many safety features, which will
prevent you from harming your patient, and the
operation manual has six pages of precautions!
The unit comes with six electrode cords, 12
miniature alligator clips, a search/stimulation
probe and a 21-page operation manual.
The unit looks very attractive and has a host of
features, many of which will not be used by a

Figure 1 This is an image of the ITO ES-160


Electroacupuncture Unit.

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Equipment Review
Western (medical) acupuncturist. This is not a
machine for beginners in electroacupuncture.
Critically, I would say that the search probe needs
a more precise tip, and I would like to see a mixed
frequency stimulation mode of alternating 4 and
100Hz frequencies (Han stimulation).
However it is exceedingly good value for
money, and must come high on the list of anyone
looking for an extremely well specified

electroacupuncture unit.
I am grateful to Oxford Medical Supplies Ltd
(tel: 0800 975 8000) for making the unit available
for testing.
Tested:
1st July 2003
Declared interests: none. Independent review.
Colin Lewis

Correction
AIM 2003;21(1-2):47
Practising Acupuncture in the Developing World
Sarah Watkins
Sarah Watkins correct email address is
sallywatkins50@hotmail.com

ACUPUNCTURE IN MEDICINE 2003;21(3):118-119.


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119

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TENS: transkutane elektrische


Nervenstimulation in der Schmerztherapie
(TENS: transcutaneous electrical nerve
stimulation in pain therapy)
David Mayor
Acupunct Med 2003 21: 117-119

doi: 10.1136/aim.21.3.117
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