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TENS and Metastases

I have a client with severe shoulder secondary to a fall several months ago who was interested in trying TENS. He has a history of bowel cancer and there are some concerns about the possibility of metastases to the right shoulder contributing to the right shoulder pain. Diagnostic imaging to rule this out may be impractical. What is the consensus of using TENS over area that may be a site of metastases? In reviewing some of the literature I discovered several articles examining the use of TENS to manage cancer related pain. Is it a contraindication to use? Thanks, Ron

Ronald Miles

5 days ago

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Niki Giada
Niki Giada

luisef258 said:

Niki. Devices and their manuals are dated, and science is always in progress. What is an indication today may be a contraindication tomorrow. Can't a judge be sensible to this? I'm form Portugal, and never had any similar problem, but I'm sure that this argument, suported by good articles, may win the cause.

Maybe in Porugal :°D In Italy? ....mhhh... I dunnow :°D Even with the prescription of the specialist (like Oncologist) , if something strange hapennes after, and the pt thinks is your bad and discovery that you did something frobidden in the manual, believe me, the specialist stay safe (maybe some fee) but the therapist goes to Jail and an extra refund for the Pt...

Niki Giada
Niki Giada

luisef258 said:

Niki. Devices and their manuals are dated, and science is always in progress. What is an indication today may be a contraindication tomorrow. Can't a judge be sensible to this? I'm form Portugal, and never had any similar problem, but I'm sure that this argument, suported by good articles, may win the cause.

Maybe in Porugal :°D In Italy? ....mhhh... I dunnow :°D Even with the prescription of the specialist (like Oncologist) , if something strange hapennes after, and the pt thinks is your bad and discovery that you did something frobidden in the manual, believe me, the specialist stay safe (maybe some fee) but the therapist goes to Jail and an extra refund for the Pt...

luisef258
luisef258

Niki. Devices and their manuals are dated, and science is always in progress. What is an indication today may be a contraindication tomorrow. Can't a judge be sensible to this? I'm form Portugal, and never had any similar problem, but I'm sure that this argument, suported by good articles, may win the cause.

luisef258
luisef258

Ronald. Like Tim and Cliff I do have the opinion to use TENS on cancer pain, and I've used it. The local of application may present some doubts. Sure we must avoid it directly over the affected area, but metastases, are often silent, sudden and spreaded enlarging the crital area of aplication. Anyway it seems, form literatura, to be a realtively safe technique for improving cancer pain. Take a look to this papers: "Effectiveness of Neurostimulation Technologies for the Management of Chronic Pain: A Systematic Review." http://bit.ly/2mdA3BZ "Transcutaneous electrical nerve stimulation for treatment of sarcoma cancer pain" http://bit.ly/2kgXE46. Regards

Cliff Eaton
Cliff Eaton

Dear Ronald TENS/NMES manufacturers generally contraindication neoplasms based on the fact that they cannot demonstrate that their machines will not cause harm I agree with Prof Watson, if not used directly over the affected area then it should be fine. TENS could placed on or above associated nerve root (Pain Gate theory) Best wishes Cliff

Niki Giada
Niki Giada

Prof Tim Watson said:

Ron. This is a 'popular' topic in my e mail inbox! Yes, we use TENS in cancer pain - in palliative care and at other stages - with good evidence of benefit. There is actually noting out there in the evidence that says TENS increases the rate of development of tumour, masses or mets. Most therapists steer clear on the basis that they would rather not take the risk of making things worse. In the Contraindications chapter for the new textbook, we have TENS listed as a local contraindication - i.e. advised not to employ in the immediate area except when the patient is receiving palliative care. It does not sound, from your message, that the patient is in that stage as yet (though I can't be sure). Personally, I would consider it to be a valid treatment option so long as the patient is aware that there is the POSSIBILITY (nothing stronger than that) that the TENS COULD change the rate of development of any metastases if they are present, even though there is no direct evidence that this is the case. Sorry if that is not the definitive answer that you were hoping for. Maybe others will come up with a more definite response? Tim

Anyway, Professor, the problem is that we must follow the indications written in the manual of usage of the device: specially in Italy, if something is written to be not done, and something happen to the Pt after we dit the forbidden thing (despite literature, evidence...), front of a Judge, it could be our guilty. How is in the UK? USA?

Prof Tim Watson
Prof Tim Watson

Ron. This is a 'popular' topic in my e mail inbox! Yes, we use TENS in cancer pain - in palliative care and at other stages - with good evidence of benefit. There is actually noting out there in the evidence that says TENS increases the rate of development of tumour, masses or mets. Most therapists steer clear on the basis that they would rather not take the risk of making things worse. In the Contraindications chapter for the new textbook, we have TENS listed as a local contraindication - i.e. advised not to employ in the immediate area except when the patient is receiving palliative care. It does not sound, from your message, that the patient is in that stage as yet (though I can't be sure). Personally, I would consider it to be a valid treatment option so long as the patient is aware that there is the POSSIBILITY (nothing stronger than that) that the TENS COULD change the rate of development of any metastases if they are present, even though there is no direct evidence that this is the case. Sorry if that is not the definitive answer that you were hoping for. Maybe others will come up with a more definite response? Tim

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