Medical Science
April 3, 2020

Back Pain in General Population and TPNS Application

Rick Rowan
CEO & Founder

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

NuroKor is committed to the development of bioelectronic technologies. We’re evidence-led and research-driven with proven healthcare applications, and our devices are CE-marked and FDA-cleared to deliver personalised treatment for a variety of conditions.


 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.


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