With an unprecedented number of workers becoming temporarily home-based, it is important that health and well being is kept top of mind whilst adjusting to this new work routine. Both patients and clinicians need to be exploring ways to adjust to this remote living. A 2019 seminar by law firm, Clyde & Co, suggests that employers must provide extra care for employees that work from home, or there will be an increase in the number of Musculoskeletal Disorders(MSDs) Furthermore, the closure of physiotherapists and shift to remote client - physio relationships, is changing the landscape of how clinicians and patients alike are dealing  with back pain management. 

This article provides you with important information about back pain, the treatments, the possible complications and side effects. Within the treatments, it is included in a more natural, yet underutilised approach, called Transcutaneous Peripheral Nerve Stimulation (TPNS) also often referred to by its delivery method (TENS).

It is important to note here, whilst TPNS is an important treatment approach, results and applications are frequency and protocol specific.

For this reason, TPNS is one of three NuroKor Technology’s neuromodulation therapeutic techniques. In a number of patients, this approach alone can treat back pain effectively and safely. In other patients, depending on their conditions, TPNS is administered in combination with other treatments. In these cases, the combination of TPNS with other treatments can significantly increase the pain relief effectiveness.    

Back Pain

Back pain is one of the most prevalent musculoskeletal disorders in modern society, especially lower back pain. In addition to the physical health consequences, chronic musculoskeletal pain can have a profound negative impact on an individual's emotional and social well-being. This impact is only heightened by current lock down restrictions. Back pain can be caused by a variety of factors including degenerative diseases of the spine, back strain, infections, cancer, overweight, occupation and sedentary lifestyle. It is estimated that about 60% to 80% of adults experience at least one episode of back pain in their lifetime. Acute or chronic back pain can be very severe and debilitating, often causing disability by reducing the range of motion. 

In the United States, acute back pain is the fifth most common reason for all physician visits, and about 90% of the working population have back pain every year.

In the UK, back pain is the second largest single cause of disability after cardiovascular diseases, with lower back pain alone accounting for 11% of the total disability.

Longer waiting lists for acute back pain treatment increase the likelihood of becoming chronic, resulting in major cost implications in terms of human suffering, social and NHS resources. Furthermore, COVID-19 has resulted in the closure of physiotherapist practices, shifting client to physio relationships to an online modality, and impacting the scope of physical treatment that can be applied. 

Back Pain Treatments 

In the UK, referrals for spinal surgery are constantly increasing, and a growing number of patients are waiting longer than 18 weeks from referral to treatment. Spinal surgery is very traumatic and invasive, with risk of complications. A recent study carried out in Brazil, reported that over 25% of spinal surgery patients in the sample developed complications, of which 11% were major complications that caused prolonged hospital stay and increased suffering. While the sample-wide risk of death was 3%. According to a review carried out by Dr Greenough for NHS England, the volume of spinal surgery is increasing dramatically, with a yearly cost for the NHS of £200m, and about 10,000 adult patients each year that have elective spinal surgery. 

Opioids and non-steroidal anti-inflammatory drugs (NSAIDs) are medicines very frequently prescribed for back pain relief, but they have numerous extremely common and devastating side effects, with limited efficacy. Between 50% and 80% of patients in clinical trials experience at least one side effect from opioid therapy, however in everyday use the incidence may be even higher. The longer opioids are used and the higher is the dose required, as their effectiveness decreases progressively over time, often leading to overdose and death. In North America, individuals, families, communities, and health care providers are struggling to cope with the impacts of opioid use disorder, which has reached epidemic levels. In the United States, opioids overdose has risen steadily over the past two decades, becoming one of the leading causes of death. 

Given that acute or chronic lower back pain is very common, and can be excruciating and debilitating, and considering the numerous complications and adverse effects resulting from these treatments, therefore identifying and implementing alternative approaches is paramount. 

An Effective and Safe Back Pain Relief Treatment

An effective and safe approach to treat pain is transcutaneous peripheral nerve stimulation TPNS. Indeed, TPNS has been applied in a variety of contexts, and numerous studies have shown both in clinical and laboratory settings that it represents an efficacious and safe method to treat pain. Furthermore, unlike other treatments, TPNS is non-invasive, non-addictive, does not cause complications, and is almost side effects free.

NuroKor’s own research and developments have found that results and applications are frequency and protocol specific and a variation of TPNS and Neuromuscular Electrical Stimulation (NMES) is most effective.

For this reason, NuroKor utilises TPNS with a combination of other electrotherapy modalities, TPNS, NMES and microcurrent stimulation (MCS).  TPNS is important to NuroKor’s technology as it utilises pure energy in the form of electrical current impulses, generated by specific devices, and delivered through electrodes placed on the skin. Such electrical impulses stimulate specific sensory nerves, and thereby activate two natural pain relief mechanisms, which prevent the pain signals from reaching the brain, and also stimulate the production of the body’s natural pain killers. In essence, pain relief is not achieved by introducing foreign substances into the body, but through a controlled flow of pure energy. Electrical impulses occur constantly within the body, as they are an integrating part of many physiological functions, such as the heart contraction, muscular contraction and neuronal activity.

‍

Montreal General Hospital, Canada TPNS Application in Back Pain

A study conducted in the Montreal General Hospital, Canada, evaluated the effectiveness of a TPNS protocol to treat lower back pain and reduced mobility. Patients were divided into two groups, one group received TPNS application and the other group received a specific and light massage. The results showed that after the treatments lower back pain decreased and mobility (straight leg rise) increased, however,  these improvements were significantly greater in the TPNS group compared with the massage group.

In the light of these facts, it is highly desirable that hospitals, medical centres, physicians and health care providers worldwide, utilise applicable TPNS protocols to treat back pain and improve physical function.

Furthermore, since TPNS devices have been proven  easy to use, as demonstrated by the study conducted in the emergency department at a community hospital, in the United States*. Therefore, people personally affected by back pain or physicians who have patients impacted by back pain can utilise bioelectronic technology for themselves/ a patient for treatment as required, from the comfort of their home.

As we have seen, TPNS application represents a viable and efficacious intervention to treat pain, including lower back pain. TPNS has many advantages, as it is non-pharmacological, non-invasive, non-toxic, non-addictive, easy to use and almost side effects free.  With this in mind,

NuroKor is creating ultra-wearable personal electrotherapy devices based on medical evidence, combined with cutting-edge technology. In addition to TPNS, our devices combine other electrotherapy modalities.

It is not only a system of healing, but also a method that harnesses the power of the vital bioelectrical phenomena occurring constantly within the human body, which are crucial for achieving and maintaining health, fitness and wellbeing. 

About NuroKor:

Founded in 2018, NuroKor is a company committed to the development of bioelectronic technologies. NuroKor develops and formulates programmable bioelectronic software for clinical and therapeutic applications, in a range of easy to use, wearable devices. It provides the highest-quality products, delivering personalised pain relief and recovery support and rehabilitation to patients.

‍

‍ Footnote: ‍

*Casey AG, McKernan MP and Reb J.H. Transcutaneous Electrical Nerve Stimulation (TENS) in the Emergency Department for Pain Relief: A Preliminary Study of Feasibility and Efficacy. Western Journal of Emergency Medicine. 2018. Volume 19, No. 5.

References

Andersen LL, Clausen T, Carneiro IG, Holterman A. Spreading of chronic pain between body regions: prospective cohort study among health care workers. Eur J Pain. 2012. 16:1437–1443.

Andersson, G.B., 1999. Epidemiological features of 14. Van Tulder, M.W., R. Ostelo, J.W. Vlaeyen, chronic low-back pain. Lancet, 354(9178): 581-585.

Baker DW. History of the Joint Commission’s Pain Standards: lessons for today’s prescription opioid epidemic. JAMA. 2017; 317(11):1117-1118.

Casey AG, McKernan MP and Reb J.H. Transcutaneous Electrical Nerve Stimulation (TENS) in the Emergency Department for Pain Relief: A Preliminary Study of Feasibility and Efficacy. Western Journal of Emergency Medicine. 2018. Volume 19, No. 5.

Escortell-Mayor E, Riesgo-Fuerte R, Gurrido- Elustondo, et al.  Primary care randomized clinical trial: manual therapy effectiveness in comparison with TENS in patients with neck pain. Man Ther. 2001. 16 (1): 66-73. doi: 10.1016/j.math.2010.07.003. Epub 2010 Aug 5.

Fenelon A, Chen LH, Baker SP. Major causes of injury, death and life expectancy gap between US and other high income countries. JAMA. 2016;315(6):609-611.

Florence CS, Zhou C, Luo F, Xu L. The economic burden of prescription opioid overdose, abuse, and dependence in the United States. Med Care. 2016;54(10):901-906.

Fosbol EL, Gislason GH, Jacobsen S, et al. Risk of myocardial infarction and death associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) among healthy individuals: a nationwide cohort study.

Hart LG, Deyo RA, Cherkin DC. Physician office visits for low back pain. Frequency, clinical evaluation, and treatment patterns from a US National Survey. Spine 1995;20:11-9.

Hartvigsen J, Davidsen M, Hestbaek L, Roos EM. Patterns of musculoskeletal pain in the population: a latent class analysis using a nationally representative interviewer-based survey of 4817 Danes. Eur J Pain. 2013.17:452–460.

Hedegaard H, Warner M, Miniño A. Drug overdose deaths in the United States, 1999-2016. https://www.cdc.gov/nchs/products/databriefs/db294.htm. 

https://www.england.nhs.uk Blog, The national back pain pathway pages, a review by Dr Charles Greenough

https://www.nhs.uk (NSAIDs pages)  

Johnson, M. I. The clinical effectiveness of TENS in pain management. Critical Reviews in Physical and Rehabilitation Medicine. (2000). 12(2): 131-49

Kalso E, Edwards J, Moore R, McQuay H: Opioids in chronic non-cancer pain: Systematic review of efficacy and safety. Pain 2004; 112:372-380

Koes, B.W., R.J. Scholten, J.M. Mens andL.M. Bouter, 1997. Efficacy of non-steroidal anti inflammatory drugs for low back pain: a systematic stimulation for chronic low back pain. Ann. Rheumatic Dis., 56(4): 214-223.

Macfarlane, G.J., Thomas, E., Croft, P.R., Papageorgiou, A. et al. Predictors of early improvement in low back pain amongst consulters to general practice: the influence of pre-morbid and episode-related factors. Pain. 1999, 80, 113-9.

Madras BK. The surge of opioid use, addiction, and overdoses: responsibility and response of the US health care system. JAMA Psychiatry. 2017; 74(5):441–442.

Mendell LM. Constructing and Deconstructing the Gate Theory of Pain. Pain. 2014. 155(2): 210–216. doi:10.1016/j.pain.2013.12.010

Melzack R, Vetere P, and Finch L. Transcutaneous Electrical Nerve Stimulation for Low Back Pain. A Comparison of TENS and Massage for Pain and Range of Motion. Physical Therapy. 1983 Volume 63 / Number 4. 

Miao Q, Qiang JH, and Jin JL. Effectiveness of neuromuscular electrical stimulation for neck pain relief in patients with cervical spondylosis. Medicine (Baltimore). 2018 Jun;97(26):e11080. doi: 10.1097/MD.0000000000011080.

Ministry of Health. Pharmaceutical Collection. 2013.

Moore RA, McQuay HJ: Prevalence of opioid adverse events in chronic non-malignant pain: Systematic review of randomised trials of oral opioids. Arthritis Research &Theory. 2005; 7: R1046–R1051.

Murthy VH. Surgeon General’s report on alcohol, drugs and health. https://addiction.surgeongeneral.gov/surgeon-generalsreport.

Palmer, S. T., et al. Effects of electric stimulation on C and A delta fiber-mediated thermal perception thresholds. Arch Phys Med Rehabil. 2004. 85(1): 119-28

Parot-Schinkel E, Descatha A, Ha C, Petit A, Leclerc A, Rocquelaure Y. Prevalence of multi-site musculoskeletal symptoms: a French cross-sectional working population-based study. BMC Musculoskeletal Disorders. 2012. 13:122

Patel T, Abna A. Diagnosis and Management of acute low back pain. American Academy 2000;39:2-13.

Ramdas J, and Jella V. Prevalence and risk factors of low back pain. Int J Adv Med. 2018;5(5):1120-1123

Reis RS, Fernandes de Oliveira M, José Marcus Rotta JM et al. Risk of Complications in Spine Surgery: A Prospective Study. The Open Orthopaedics Journal, 2015, 9, 20-25

Rudd RA, Seth P, David F, Scholl L. Increases in drug and opioid-involved overdose deaths d United States, 2010e2015. MMWR Morb Mortal Wkly Rep. 2016;65:1445-1452.

Rudd RA, Aleshire N, Zibbell JE, Gladden RM. Increases in Drug and Opioid Overdose Deaths — United States, 2000–2014. Atlanta, GA: Centers for Disease Control and Prevention; 2016.

Searle RD, Bennet Mi, Johnson MI, et al. Transcutaneous Electrical Nerve Stimulation (TENS) for Cancer Bone Pain. J Pain Symptom Manage. 2009. 37(3):424-8. doi: 10.1016/j.jpainsymman 

Sharma N, Rekha K, and Snirivasan J. Efficacy of transcutaneous electrical nerve stimulation in the treatment of chronic pelvic pain. J Midlife Health. 2017. 8(1): 36–39 

Simmonds M, Harding V, Watson P, Claveau Y. Physical therapy assessment: expending the model. Pain Res Manage 2000; 16:1013-28.

Topol, E.J., 2004. Failing the public health-rofecoxib, Merck and the FDA. New England J. Med., 351(17): 1707-1709.

Tuzun, E.H. Quality of life in chronic musculoskeletal pain. Best Pract Res Clin Rheumatol. 2007. 21, 567-79.