Electrotherapy for chronic pain - a quick guide to choosing the right one

Noah Lee
Freelance Writer

An ever-increasing number of chiropractors are turning to electrotherapy to provide relief to their chronic pain patients, and there are good reasons for it. Traditional methods of dealing with chronic pain – such as physical therapy or the use of medications – tend to be less effective over time and may even cause more harm than good if they’re not administered correctly.

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Chiropractors are now finding that electrotherapy can be used safely alongside other traditional treatment methods and help relieve chronic pain. By stimulating the nervous system, electrotherapy devices provide pain relief and reduce inflammation through the release of endorphins, the improvement of blood circulation, and without any side effects. In some instances, electrotherapy offers long-term treatment of chronic and neuropathic pain – such as PRF electromagnetic therapies.

Is electrotherapy safe?

Electrotherapies are drug-free, have no side effects, and provide a safe option for those in need of acute or long-term treatment options – some exemptions include individuals with cardiac pacemakers and women during pregnancies. For those with neuropathy, it is the best alternative for pain relief and does not interfere with other treatment modalities or medications.

The different Electrotherapy alternatives

The amount of different electrical stimulation alternatives can be overwhelming: the market offers a wide variety of devices which often can be difficult to distinguish. Being able to decide which type of electrical stimulation to use for a certain condition is important: each device uses specific sets of electrical currents (e.g., intensity of stimulation and frequency of stimulation) on different areas of the body. The mode of action on symptoms and pain condition also differs in each electrotherapy device.

Here below, we want to provide you with a short summary of the electrotherapy devices that are most commonly used in chiropractic care. We will focus on the intended use, on the mode of action, the pros and cons for each device:

1. Transcutaneous electrical nerve stimulation (TENS)

  • Intended for symptomatic relief of chronic and neuropathic pain, short-term relief of muscular soreness
  • Mode of action: based on the gate-control theory, TENS impulses override painful stimuli
    (read more about this at: 
    Gate control theory of pain” by Physiopedia – https://www.physio-pedia.com/Gate_Control_Theory_of_Pain)
  • Pros: cheap alternative
  • Cons: you can find several types of TENS machines online which can be confusing.
    The amount of different devices on the market suggests that the technology behind this machine is still unspecific and there is no consent on which stimulation parameters are the most efficient.
    Limited results.

2. Pulsed radiofrequency electromagnetic therapies (PRF)

  • Intended for chronic intractable pain, pain control, post-surgical or post-traumatic acute pain
  • Mode of action: high-frequency (100-300kHz) electromagnetic fields travel at fast speed along nerve axons and target nerve mitochondria. PRF trigger gene expression changes and recovery from chronic or acute pain
    (read more about this at: “PRF research” by Algiamed Technologies https://www.algiamed.com/research/)
  • Pros: the only long-term alternative for chronic and acute pain. Long-term relief is achieved in 3 to 5 sessions.
  • Cons: often confused with TENS, even though its mode of action is completely different.
    New device.

3. Neuromuscular electrical stimulation (NMES)

  • Intended for muscle strengthening, muscle spasms and muscular rehabilitation
  • Mode of action: based on improvement of blood circulation and increased muscle contractions
  • Pros: optimal for muscle recovery after sport injuries and enhance atrophy from disuse
  • Cons: short-term effects, so repeated applications are necessary.
    Enhances but does not directly provide function

4. Functional electrical stimulation (FES)

  • Intended for similar to NMES but with more therapeutical intervention on neurological rehabilitation
  • Mode of action: based on the idea that muscle contractions can be turned into functional movements
  • Pros: daily use of FES can help improve walking and range of motion
  • Cons: usually paired with physical exercises.
    Repeated applications are necessary.

5. Interferential current (IFC) electrical stimulation

  • Intended for relief of pain from muscle spasms
  • Mode of action: similar to TENS but more powerful stimulation leading to strong muscle contractions
  • Pros: Higher frequencies travel to muscles or joints, so to deep tissues
  • Cons: non-specific for chronic or neuropathic pain, but only for acute pain from muscle injuries

6. Electrical muscle stimulation (EMS or Russian stim)

  • Intended for muscle strengthening, muscle endurance and muscle recovery.
    Strong muscle contractions
  • Mode of action: Similar to NMES and FES
  • Pros: Used by professional athletes, also known as Russian stimulation, since it was used by the Russian team to enhance performance of their Olympic athletes
  • Cons: non-specific for pain, used for functional recovery after muscle/sport injuries