Chronic pain affects one in five people, including one in three Australians over 65[1], according to the advocacy group Pain Australia. It adversely affects the lives of those who experience it, reducing the scope of their daily activities and affecting their ability to work and participate in hobbies and activities. It can also lead to mental health challenges, such as depression, anxiety and substance abuse.
To make the right decision about effective
therapies for reducing chronic pain, it’s important to understand how each
method works, and what results you can expect.
We are here comparing two drug-free therapies
that are available to assist with chronic pain management: TENS
(Trans-cutaneous electrical nerve stimulation) and Red Light Therapy (also
known as Low-Level Laser (Light) Therapy (LLLT) or Photobiomodulation (PBM).
We will compare the following:
1. How is the therapy administered?
TENS
The TENS machine consists of a control unit, an
electrical lead and gel pads which act as electrodes and are applied to the
skin. When turned on, the TENS machine delivers a low voltage current through
the electrode pads placed on the skin. This current activates non-painful
sensory nerve fibers and creates a tingling sensation.
You can use at a doctor or physiotherapist
clinic. You can also hire or purchase a TENS machine to use at home.
Red Light Therapy
Red light therapy is delivered using either cold
lasers or a device with rows of light-emitting diodes (LEDS) that emit light at
specific, therapeutic frequencies. The device, often designed like a belt, is
wrapped around the target area of the body and switched on for a specific
period of time.
A red light therapy device can be used at a
physiotherapist or massage clinic. You can also purchase a red light therapy
belt to use at home.
2. How does the therapy reduce chronic pain?
TENS
The electric current from the TENS machines acts
on both the peripheral nervous system (nerves extending to your limbs and skin)
and the central nervous system (the brain and spinal cord) to reduce pain.
In the peripheral nervous system, TENS reduces pain through a mechanism called ‘gate control’. The TENS current activates fast transmitting, non-painful sensory nerves. This nervous input travels much faster than the slowly transmitted pain signals, reaching the central nervous system first. These signals compete with the painful nerve signals, preventing the pain signals from traveling to the higher pain centers of the brain[2].
In the central nervous system, TENS acts by
releasing pain inhibiting chemicals, including natural endorphins and serotonin,
and reducing chemicals that otherwise elevate painful sensations. There’s also
evidence that pain inhibiting activity occurs in the central cortex of the
brain during TENS therapy.
Red Light Therapy (LLLT, PBM)
Red light therapy consists of two important wavelength distributions of light, red and near infrared. Both penetrates the cells of your body to act on the metabolic system. Targeting the cytochrome c oxidase in the mitochondria (the powerhouse of the cell), near infrared causes nitric oxide to dissociate , and increases the metabolism of the cell. More ATP (the most basic energy molecule in your body) is produced.
Nitric oxide plays an important role in pain management, helping the blood vessels to widen. This lowers blood pressure and increases blood flow to the region. More blood means that there are more nutrients and oxygen available for metabolism. Increasing metabolism increases the rate of healing in the region reduces inflammation faster and provides effective pain relief[3].
3. How long does the therapy take, and how
often should you use it?
TENS
For effective pain relief, a TENS machine needs
to be used for 30-60 minutes and can be used for up to 2 hours. It can be used
several times a day, as needed.
Red Light Therapy (LLLT, PBM)
The optimum dose depends on the strength of the
irradiation produced by the device being used. To treat chronic pain, the light
therapy can be delivered in some cases in as little as 10 minutes to as much as
60 minutes, applied from 2 to 14 times per week depending on the condition you
are treating. Increasing the dose doesn’t generally have an enhanced
therapeutic affect (in other words, more doesn’t mean better).
4. How long does the pain relief last for?
TENS
The pain relief can last for 30 minutes, or up
to 4 hours after the machine is switched off.
Red Light Therapy (LLLT)
Patients have reported declining pain levels within as little as 30 minutes and for some people within a few days. A recent study on chronic back pain showed a 50% reduction in pain after 7 weeks of treatment[4], with pain progressively declining towards the end of the seven-week period. In this study, patients used the red light therapy belt just once a week.
While longitudinal studies still need to be
completed, testimonials and current studies indicate that red light therapy can
produce a lasting healing affect, not just temporary pain relief.
5. Can the therapy be applied to any part of
the body where there is chronic pain?
TENS
TENS should not be used on broken or
desensitised skin, over an area of infection or a malignant tumour.
Areas of the body where it is unsafe to use TENS
include the head, the front of the neck, or through the chest. You should avoid
placing the electrode over the carotid artery.
You can use TENS where the electrodes are placed
on either side of the spinal column, but you should not place the TENS
electrodes directly over the spinal column.
Patients who should not use a TENS machine
include women who are less than 36 weeks pregnant, patients with a cardiac
pacemaker, or patients with epilepsy.
Red Light Therapy
Red light therapy can be applied safely to any
part of the body, with some caution for those with photosensitivity or fragile
skin. It has been approved by the FDA (Food and Drug Administration, USA) and
the TGA (Therapeutic Goods Administration, Australia), as a safe therapy.
6. Will the therapy interfere with my medication?
TENS
You can use a TENS machine alongside other pain
relief methods such as prescribed medication.
Red Light Therapy
You can use red light therapy alongside your
current medication without contraindication.
7. Are there any risks or side effects?
TENS
Most people will not experience side effects,
however there is a small risk of allergic reaction to the electrode pads.
Overuse of the machine may lead to muscle soreness, and setting the intensity
too high can produce discomfort and muscle twitching.
Red Light Therapy (LLLT)
There are no reported side effects for Red Light
Therapy when the device is used according to the instructions.
8. What evidence is there for this therapy in reducing chronic pain?
TENS
At this stage, there is no conclusive evidence about the effectiveness for TENS in reducing chronic pain. The studies that are available lack the quality, size and data to draw an evidence-based conclusion[5]. In particular the effect on chronic back pain is uncertain. Despite this, TENS machines are regularly recommended by health professionals.
It is indicated that effective pain relief will be limited once the patient develops tolerance to TENS therapy. There is evidence suggesting that TENS can help patients with fibromyalgia and spinal cord injury[6].
Red Light Therapy (LLLT)
There is evidence building that red light therapy can help with lower back pain[7]. It is also effectively used to treat sciatica, neuropathy, arthritis, bursitis, neck pain[8], tendinopathy[9] and a range of other conditions that lead to chronic pain.
Choosing between TENS and Red Light Therapy
For Chronic Pain
Here’s a summary of this article:
TENS VS Red Light Therapy
TENS
Red Light Therapy
Can it be used at home?
Yes
Yes
What does the therapy consist of?
Electrical current
Red light
Which biological system does it act
on?
Nervous system
Cellular metabolism
How long does a treatment take?
30-60 minutes
10-60 minutes depending on area or
condition being treated.
How long does pain relief last?
up to 4 hours
ongoing reduction of pain with
continued use
Which body parts can be treated?
Any – applied to clean skin.
Who can use the therapy?
This therapy can be used unless you
have a pacemaker, have epilepsy or are in the first 36 weeks of pregnancy.
Anyone
Can I continue my other medications?
Yes
Yes
How convenient is it to use?
TENS units are small, portable and
are relatively discreet.
LED Devices are plugged into
available power supply (home, office or car) and are easy to use.
Are there side effects?
Minimal side effects – skin allergy
to electrodes or setting intensity too high which causes muscle spasm
None reported
Can this therapy provide a lasting
solution for chronic pain?
Relief of pain is short-term. So far
there is no evidence that TENS provides a long-term solution to chronic pain.
Relief of pain is both short-term
and long-term for some people. There is building evidence that red light
therapy can contribute to reduction of chronic pain over time, with further
research required.
The table above summarises the information
currently available about red light therapy and TENS.
TENS offers the reduction of pain without
serious negative side effects, however it does not provide ongoing pain relief once the
treatment is ceased. TENS is also not an option for those suffering chronic
pain who may have a pacemaker, are pregnant or have epilepsy.
Red light therapy offers both immediate
alleviation of pain, as well as ongoing reduction of pain over time with
continued use, with no side effects. It has the potential to improve the
quality of life of those suffering from chronic pain by reducing their symptoms
and stimulating healing. Red light therapy is FDA and TGA approved, and can be
safely used in conjunction with a physical therapy program and any existing
pain medications.
[2] “TRANSCUTANEOUS
ELECTRICAL NERVE STIMULATION (TENS)” CHAPTER 9 Mark I Johnson, Professor
of Pain and Analgesia at Leeds Metropolitan University, Oxford University
Press, 2014
AND “ELECTROTHERAPY EXPLAINED –
PRINCIPLES AND
PRACTICE”; FOURTH EDITION. Val Robertson, Alex Ward, John Low
and Ann Reed, Butterworth Heinemann, 2006
[3] Healing the
body with Photobiomodulation, Dr Mercola
[4] Infrared therapy for chronic low
back pain: A randomized, controlled trial
George D Gale,
MBBS FRCA FRCPC DAAPM,1 Peter J Rothbart, MD FRCPC,1 and Ye Li2. Pain Res
Manag. 2006 Autumn; 11(3): 193–196
[5] Transcutaneous electrical nerve
stimulation (TENS) for chronic pain – an overview of Cochrane Reviews. Gibson
W, Wand BM, Meads C, Catley MJ, O’Connell NE, 18th February 2019.
[6] Using TENS for pain control: the
state of the evidence
Carol GT
Vance,1,* Dana L Dailey,1 Barbara A Rakel,2 and Kathleen A Sluka1 Pain Manag.
2014 May; 4(3): 197–209.
[7] Infrared therapy for chronic low
back pain: A randomized, controlled trial
George D Gale,
MBBS FRCA FRCPC DAAPM,1 Peter J Rothbart, MD FRCPC,1 and Ye Li2 Pain Res Manag.
2006 Autumn; 11(3): 193–196.
[8] Efficacy of low-level laser
therapy in the management of neck pain: a systematic review and meta-analysis
of randomised placebo or active-treatment controlled trials
Dr Roberta T
Chow, MBBS; Prof Mark I Johnson, PhD; Prof Rodrigo AB Lopes-Martins, PhD; Prof Jan M Bjordal, PT. The Lancet, Vol. 374, Issue
9705, P1897-1908, November
13, 2009.
[9] Effects of Low-Level Laser Therapy
and Eccentric Exercises in the Treatment of Recreational Athletes with Chronic
Achilles Tendinopathy. Stergioulas, PT, PhD, Marianna Stergioula, PT, Reidar
Aarskog, PT, MSc, Rodrigo A. B. Lopes-Martins, MPharm, PhD, Jan M. Bjordal, PT,
PhD First Published February 13, 2008. American Journal of Sports Medicine,
Volume: 36 issue: 5, page(s): 881-887
What Natural Chemical-Free Therapy Is Best For Chronic Pain? We Compare TENS To Red Light Therapy
Chronic pain affects one in five people, including one in three Australians over 65[1], according to the advocacy group Pain Australia. It adversely affects the lives of those who experience it, reducing the scope of their daily activities and affecting their ability to work and participate in hobbies and activities. It can also lead to mental health challenges, such as depression, anxiety and substance abuse.
To make the right decision about effective therapies for reducing chronic pain, it’s important to understand how each method works, and what results you can expect.
We are here comparing two drug-free therapies that are available to assist with chronic pain management: TENS (Trans-cutaneous electrical nerve stimulation) and Red Light Therapy (also known as Low-Level Laser (Light) Therapy (LLLT) or Photobiomodulation (PBM).
We will compare the following:
1. How is the therapy administered?
TENS
The TENS machine consists of a control unit, an electrical lead and gel pads which act as electrodes and are applied to the skin. When turned on, the TENS machine delivers a low voltage current through the electrode pads placed on the skin. This current activates non-painful sensory nerve fibers and creates a tingling sensation.
You can use at a doctor or physiotherapist clinic. You can also hire or purchase a TENS machine to use at home.
Red Light Therapy
Red light therapy is delivered using either cold lasers or a device with rows of light-emitting diodes (LEDS) that emit light at specific, therapeutic frequencies. The device, often designed like a belt, is wrapped around the target area of the body and switched on for a specific period of time.
A red light therapy device can be used at a physiotherapist or massage clinic. You can also purchase a red light therapy belt to use at home.
2. How does the therapy reduce chronic pain?
TENS
The electric current from the TENS machines acts on both the peripheral nervous system (nerves extending to your limbs and skin) and the central nervous system (the brain and spinal cord) to reduce pain.
In the peripheral nervous system, TENS reduces pain through a mechanism called ‘gate control’. The TENS current activates fast transmitting, non-painful sensory nerves. This nervous input travels much faster than the slowly transmitted pain signals, reaching the central nervous system first. These signals compete with the painful nerve signals, preventing the pain signals from traveling to the higher pain centers of the brain[2].
In the central nervous system, TENS acts by releasing pain inhibiting chemicals, including natural endorphins and serotonin, and reducing chemicals that otherwise elevate painful sensations. There’s also evidence that pain inhibiting activity occurs in the central cortex of the brain during TENS therapy.
Red Light Therapy (LLLT, PBM)
Red light therapy consists of two important wavelength distributions of light, red and near infrared. Both penetrates the cells of your body to act on the metabolic system. Targeting the cytochrome c oxidase in the mitochondria (the powerhouse of the cell), near infrared causes nitric oxide to dissociate , and increases the metabolism of the cell. More ATP (the most basic energy molecule in your body) is produced.
Nitric oxide plays an important role in pain management, helping the blood vessels to widen. This lowers blood pressure and increases blood flow to the region. More blood means that there are more nutrients and oxygen available for metabolism. Increasing metabolism increases the rate of healing in the region reduces inflammation faster and provides effective pain relief[3].
3. How long does the therapy take, and how often should you use it?
TENS
For effective pain relief, a TENS machine needs to be used for 30-60 minutes and can be used for up to 2 hours. It can be used several times a day, as needed.
Red Light Therapy (LLLT, PBM)
The optimum dose depends on the strength of the irradiation produced by the device being used. To treat chronic pain, the light therapy can be delivered in some cases in as little as 10 minutes to as much as 60 minutes, applied from 2 to 14 times per week depending on the condition you are treating. Increasing the dose doesn’t generally have an enhanced therapeutic affect (in other words, more doesn’t mean better).
4. How long does the pain relief last for?
TENS
The pain relief can last for 30 minutes, or up to 4 hours after the machine is switched off.
Red Light Therapy (LLLT)
Patients have reported declining pain levels within as little as 30 minutes and for some people within a few days. A recent study on chronic back pain showed a 50% reduction in pain after 7 weeks of treatment[4], with pain progressively declining towards the end of the seven-week period. In this study, patients used the red light therapy belt just once a week.
While longitudinal studies still need to be completed, testimonials and current studies indicate that red light therapy can produce a lasting healing affect, not just temporary pain relief.
5. Can the therapy be applied to any part of the body where there is chronic pain?
TENS
TENS should not be used on broken or desensitised skin, over an area of infection or a malignant tumour.
Areas of the body where it is unsafe to use TENS include the head, the front of the neck, or through the chest. You should avoid placing the electrode over the carotid artery.
You can use TENS where the electrodes are placed on either side of the spinal column, but you should not place the TENS electrodes directly over the spinal column.
Patients who should not use a TENS machine include women who are less than 36 weeks pregnant, patients with a cardiac pacemaker, or patients with epilepsy.
Red Light Therapy
Red light therapy can be applied safely to any part of the body, with some caution for those with photosensitivity or fragile skin. It has been approved by the FDA (Food and Drug Administration, USA) and the TGA (Therapeutic Goods Administration, Australia), as a safe therapy.
6. Will the therapy interfere with my medication?
TENS
You can use a TENS machine alongside other pain relief methods such as prescribed medication.
Red Light Therapy
You can use red light therapy alongside your current medication without contraindication.
7. Are there any risks or side effects?
TENS
Most people will not experience side effects, however there is a small risk of allergic reaction to the electrode pads. Overuse of the machine may lead to muscle soreness, and setting the intensity too high can produce discomfort and muscle twitching.
Red Light Therapy (LLLT)
There are no reported side effects for Red Light Therapy when the device is used according to the instructions.
8. What evidence is there for this therapy in reducing chronic pain?
TENS
At this stage, there is no conclusive evidence about the effectiveness for TENS in reducing chronic pain. The studies that are available lack the quality, size and data to draw an evidence-based conclusion[5]. In particular the effect on chronic back pain is uncertain. Despite this, TENS machines are regularly recommended by health professionals.
It is indicated that effective pain relief will be limited once the patient develops tolerance to TENS therapy. There is evidence suggesting that TENS can help patients with fibromyalgia and spinal cord injury[6].
Red Light Therapy (LLLT)
There is evidence building that red light therapy can help with lower back pain[7]. It is also effectively used to treat sciatica, neuropathy, arthritis, bursitis, neck pain[8], tendinopathy[9] and a range of other conditions that lead to chronic pain.
Choosing between TENS and Red Light Therapy For Chronic Pain
Here’s a summary of this article:
The table above summarises the information currently available about red light therapy and TENS.
TENS offers the reduction of pain without serious negative side effects, however it does not provide ongoing pain relief once the treatment is ceased. TENS is also not an option for those suffering chronic pain who may have a pacemaker, are pregnant or have epilepsy.
Red light therapy offers both immediate alleviation of pain, as well as ongoing reduction of pain over time with continued use, with no side effects. It has the potential to improve the quality of life of those suffering from chronic pain by reducing their symptoms and stimulating healing. Red light therapy is FDA and TGA approved, and can be safely used in conjunction with a physical therapy program and any existing pain medications.
[1] https://www.painaustralia.org.au
[2] “TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS)” CHAPTER 9 Mark I Johnson, Professor of Pain and Analgesia at Leeds Metropolitan University, Oxford University Press, 2014
AND “ELECTROTHERAPY EXPLAINED – PRINCIPLES AND PRACTICE”; FOURTH EDITION. Val Robertson, Alex Ward, John Low and Ann Reed, Butterworth Heinemann, 2006
[3] Healing the body with Photobiomodulation, Dr Mercola
[4] Infrared therapy for chronic low back pain: A randomized, controlled trial
George D Gale, MBBS FRCA FRCPC DAAPM,1 Peter J Rothbart, MD FRCPC,1 and Ye Li2. Pain Res Manag. 2006 Autumn; 11(3): 193–196
[5] Transcutaneous electrical nerve stimulation (TENS) for chronic pain – an overview of Cochrane Reviews. Gibson W, Wand BM, Meads C, Catley MJ, O’Connell NE, 18th February 2019.
[6] Using TENS for pain control: the state of the evidence
Carol GT Vance,1,* Dana L Dailey,1 Barbara A Rakel,2 and Kathleen A Sluka1 Pain Manag. 2014 May; 4(3): 197–209.
[7] Infrared therapy for chronic low back pain: A randomized, controlled trial
George D Gale, MBBS FRCA FRCPC DAAPM,1 Peter J Rothbart, MD FRCPC,1 and Ye Li2 Pain Res Manag. 2006 Autumn; 11(3): 193–196.
[8] Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials
Dr Roberta T Chow, MBBS; Prof Mark I Johnson, PhD; Prof Rodrigo AB Lopes-Martins, PhD; Prof Jan M Bjordal, PT. The Lancet, Vol. 374, Issue 9705, P1897-1908, November 13, 2009.
[9] Effects of Low-Level Laser Therapy and Eccentric Exercises in the Treatment of Recreational Athletes with Chronic Achilles Tendinopathy. Stergioulas, PT, PhD, Marianna Stergioula, PT, Reidar Aarskog, PT, MSc, Rodrigo A. B. Lopes-Martins, MPharm, PhD, Jan M. Bjordal, PT, PhD First Published February 13, 2008. American Journal of Sports Medicine, Volume: 36 issue: 5, page(s): 881-887