Fibromyalgia presents a complex challenge, often characterized by widespread pain, fatigue, and sleep dis-
turbances. Diagnosing and managing this condition requires a multifaceted approach, and physiotherapy plays
a crucial role. The prevalence of fibromyalgia is estimated to be around 2-4% of the population, significantly
impacting individuals daily lives and placing a considerable burden on healthcare systems. Within the scope of
physiotherapy practice, Transcutaneous Electrical Nerve Stimulation (TENS) offers a promising avenue for pain
management. This blog post delves into the application of TENS therapy for fibromyalgia, presenting a detailed
case study to illustrate its potential benefits. We aim to provide insights into the practical considerations of using
TENS for fibromyalgia pain management, always within the boundaries of physiotherapy.
Fibromyalgia is more than just muscle pain; it's a complex disorder affecting the way the brain processes pain
signals. This can lead to heightened sensitivity to pain, impacting daily life and overall well-being. Individuals with
fibromyalgia often experience allodynia (pain from stimuli that shouldn't cause pain) and hyperalgesia (increased
response to painful stimuli). While there's no cure for fibromyalgia, various treatments can help manage the
symptoms. These include medications, exercise, and cognitive behavioral therapy. TENS actively provides a
safer pain management intervention with known minimal side effects.
TENS (Transcutaneous Electrical Nerve Stimulation) is a non-invasive pain relief technique used by physiother-
apists. It involves applying low-voltage electrical currents to the skin through electrodes. The goal is to stimulate
nerves, potentially blocking pain signals from reaching the brain and promoting the release of endorphins, the
body's natural painkillers. This hypothesized effect blocks pain signals between painful 1st -order neurons (A-delta
and C-fibers) and 2nd -order neurons (spinothalamic tract). Different types of TENS exist, including conventional,
acupuncture-like, and burst modes, each with potential advantages.
This case study focuses on a 45-year-old female patient, Sarah (name changed for privacy), who had been
diagnosed with fibromyalgia three years prior. Sarah reported experiencing widespread pain, particularly in her
neck, shoulders, and lower back. Her pain levels were consistently rated between 6 and 8 on a 0-10 pain scale,
impacting her sleep, ability to perform daily activities, and overall quality of life. She also reported fatigue and
difficulty concentrating. Sarah's medical history revealed no other significant conditions, and she was not taking
any medications at the time of the assessment.
The initial physiotherapy assessment, conducted by a qualified physiotherapist, involved a thorough evaluation
of Sarah's pain patterns, range of motion, muscle strength, and functional limitations. We assessed her posture,
identified trigger points, and evaluated her ability to perform activities such as walking, lifting, and reaching. The
assessment also utilized questionnaires to actively measure the impact of fibromyalgia on her daily life, including
sleep quality and mood. The Fibromyalgia Impact Questionnaire (FIQ) was used to quantify the impact of her
symptoms. Specific findings included limited range of motion in her neck and shoulders, tenderness in several
trigger points, and reduced strength in her upper back muscles. This comprehensive assessment helped us tailor
a personalized treatment plan that included TENS therapy using the Axonease device. The Axonease device was
chosen for its user-friendly interface and customizable parameters, making it suitable for Sarah's needs.
Based on the assessment, we incorporated TENS therapy into Sarah's treatment plan. The Axonease device,
with its intuitive interface and advanced parameter customization, allows for a highly personalized and effective
TENS therapy experience. As highlighted in research, electrode placement is crucial for effective TENS therapy.
For Sarah, we initially placed the electrodes around the areas of greatest pain intensity in her neck and shoulders.
We considered dermatomal placement, targeting the nerve roots associated with her pain, and trigger point
placement, directly over the most tender areas.
We started with conventional TENS parameters: a frequency of 80 Hz and a pulse width of 50 microseconds.
The intensity was gradually increased until Sarah reported a comfortable tingling sensation without muscle
contraction. Each TENS session lasted for 30 minutes, and she was instructed to use the device twice daily.
We also educated Sarah on how to adjust the parameters based on her pain levels and response to treatment,
emphasizing the importance of staying within comfortable stimulation levels. It's also important to prioritize
patient comfort and safety during TENS application, adhering to established guidelines and best practices. We
ensured Sarah understood the importance of skin preparation and electrode maintenance to prevent irritation.
Safety precautions and contraindications specific to the Axonease device were also reviewed.
After four weeks of consistent TENS therapy using the Axonease device, Sarah reported a significant reduction in
her pain levels. Her average pain rating decreased from 6-8 to 3-5 on the pain scale. She also noted improvements
in her sleep quality and ability to perform daily activities such as cooking and light housework. Sarah expressed
feeling more energetic and less fatigued throughout the day. She was now able to walk for longer periods and
participate in light social activities. Moderate and substantial pain intensity reduction predicts improvement in
other outcomes and substantial quality of life gain.
Importantly, Sarah experienced no adverse side effects from the TENS therapy. She found the Axonease device
easy to use and appreciated the ability to control the intensity and frequency of the stimulation. Sarah's treatment
plan was continuously refined based on her feedback and progress, ensuring a truly personalized approach to pain
management. Sarah stated, "I finally feel like I have some control over my pain. The Axonease device has made a
real difference." The long-term follow-up plan included regular check-ins to monitor her progress and prevent relapse.
While TENS therapy proved beneficial for Sarah, it's important to acknowledge that its effectiveness can vary
from person to person. Some individuals may experience greater pain relief than others, and some may not
respond to TENS at all. It's also crucial to address potential challenges and plan for long-term pain management.
One challenge is the potential for habituation, where the body becomes less responsive to the stimulation
over time. To mitigate this, we advised Sarah to periodically adjust the TENS parameters (frequency, intensity,
electrode placement) to prevent her body from adapting to the stimulation. We also emphasized the importance
of combining TENS therapy with other physiotherapy interventions, such as exercise, stretching, and manual
therapy, for a more comprehensive approach to pain management. Other physiotherapy interventions that can
be combined with TENS therapy include hydrotherapy. Furthermore, we discussed lifestyle modifications, such as
stress management techniques and sleep hygiene strategies, to support her overall well-being. These included
meditation and yoga. Regular follow-up appointments with the physiotherapist are also essential to monitor
progress and adjust the treatment plan as needed. It's also important to be aware of contraindications for TENS
therapy, such as pregnancy or the presence of a pacemaker. Consider the electrical stimulation treatment for pain
and muscle rehabilitation.
This case study illustrates the potential benefits of TENS therapy, specifically using the Axonease device, as part
of a physiotherapy treatment plan for fibromyalgia treatment, always within the scope of physiotherapy practice.
Sarah's experience highlights how TENS can contribute to pain reduction, improved sleep, and enhanced function
in individuals living with fibromyalgia. However, it's crucial to remember that TENS is just one component
of a comprehensive pain management strategy. TENS is not a standalone treatment and should be used in
conjunction with other physiotherapy interventions. The key findings of the case study and their implications for
the use of TENS therapy in fibromyalgia management are significant.
If you're living with fibromyalgia and seeking effective pain management options, consult with a qualified
physiotherapist to determine if TENS therapy is right for you. A thorough assessment and personalized treatment
plan are essential for maximizing the potential benefits of TENS and achieving long-term pain relief. Remember,
physiotherapy for fibromyalgia is about empowering you to take control of your pain and improve your quality of
life, under the guidance of a qualified physiotherapist. By offering a non-invasive and potentially cost-effective pain
management option, TENS therapy can contribute to more accessible and affordable healthcare for individuals
with fibromyalgia. Sarah's journey exemplifies our commitment to transforming physiotherapy, one patient at a
time, by providing personalized care powered by innovation.