The TENS machine

Does it work? Yes. My own experience says so, and so do randomised controlled trials, but it has limitations.

What is it? A transcutaneous electrical nerve stimulation (TENS) machine is a small, battery-operated device that passes electrical impulses through your skin via sticky pads (electrodes). You attach the pads directly to your skin over the area of pain. There are a variety of programs you can use. I like the one that alternates through lots of different sensations (because I’ve found it most effective rather than because I like the feeling best). The sensation of having it on varies from the feeling of a mobile phone vibrating against your skin to buzzing to lots or rapid taps. If the sensation you’re feeling is unpleasant or too strong, you’ve probably got it turned up too high for the part of your body it’s on, just turn it down. I generally eventually stop noticing it’s doing anything, especially after the pain’s gone. Its main effect is while you're wearing it, although the pain doesn't necessarily return when you switch it off, especially if it was caused by tense muscles that relaxed due to lack of pain while you were wearing the TENS machine.

When I wear my TENS machine I typically wear it either for at least three hours or until bedtime or until the pads fall off. The battery use is minimal, so I never worry about the cost of that, and being pain-free while wearing it is no guarantee of remaining pain-free when you turn it off, although sometimes the pain does stay away. I find that it generally takes 5-15 minutes to start working fully.

Who does it work for? Researchers still seem to be trying to work out what it does and doesn’t work for. In theory, I think it could work for any sort of pain below the neck (some people also think it works for neck and head pain, but I can’t get the pads to stick to my neck for long and I wouldn’t want to stick them to my face). I find it good for back pain. It may well also work for other musculoskeletal problems, although I found it didn’t work for my hip or thigh.

I’ve heard it’s also good for the pain of giving birth and this paper says there’s evidence that it works for acute, emergent and postoperative pain conditions. 

Who doesn't it work for? 

• Anyone who can’t reach the necessary part of their body to stick the pads over their pain and doesn’t have anyone who can stick them on for them.
• Anyone who needs pain relief while trying to sleep. This is because you can’t wear it while sleeping because you would knock the pads off and probably damage the wires and possibly also harm yourself.
• Anyone who needs pain relief while in water (or anywhere else a battery operated device with electrodes isn’t suitable).
• Anyone embarrassed to wear the machine in public while in public (it’s fairly small and discrete, but mine had a light that showed even through clothes, so people tended to notice even if I wore it under clothes. I never minded my colleagues or friends asking me about it, but if that sort of thing worries you, then it may be a problem for you, as my experience is that people do ask).
• Anyone allergic to the sticky on the pads (I have a lot of allergies and I’m not, but I reckon it’s at least theoretically possible).
• I don’t recommend it for people whose pain is in the neck or head because of difficulty placing the pads.
• Also, if you want to treat an area of pain larger than your back, you may need more than one machine, which would be awkward with all the wires.

Where can I get it?  You can buy them on the Internet. Boots also sells them, although I really can’t recommend the one I got from Boots (pictured) because of its tendency to constantly beep to warn me the pads are not attached to its satisfaction. This was such a problem that I’ve mainly stopped using it, especially now my pain’s timing and location is no longer as suitable for this treatment method.

How much does it cost? The cheapest one I could find on Amazon with 4 pads and a high (4.5 star) rating on the basis of lots of reviews was £16.99. The machines hardly use any battery, to the extent that batteries are barely even a consideration. I think I changed the batteries about once a year when I was in my high usage phase. But you will find yourself getting through a lot of pads. These electrode pads are available for £3.79 for 3 packs of 4 (although some reviews don’t think those ones stick well enough). I'm not sure if they match the TENS machine I just linked to, but at that price it's probably worth trying out. Pads can be a large expense. Pushing my luck, I could make a pack last about a month during my high usage phase, but for optimum performance I should probably have changed them more often than that, say once every 5-10 days of use. Based on all the beeping, my Boots machine clearly takes the view that I should be changing them every time, but that costs too much for my taste. I’ve noticed that conductive TENS gel  is now also available to extend the life of your pads.

Is there a cheap/free version? Nope, the prices above are about as cheap as it gets, but actually, as pain products go it’s none too pricey.

Is there any evidence for it? It depends where you look. The NHS says there’s not enough good quality evidence yet and more research is needed. This article says a meta-analysis showed positive treatment effects of electrical stimulation for relief of chronic musculoskeletal pain, and randomised controlled trials consistently demonstrate the effectiveness of TENS for acute, emergent, and postoperative pain conditions.

Are there any downsides? It’s a hassle trying to put the pads over your pain (particularly positioning them and the wires through winter clothes, and you will need something to attach the unit to, such as a belt). Also it only works while the machine’s on, with a little residual effect afterwards if you’re lucky. You need to keep replacing the pads and it’s hard to hide the unit from the curious gaze, especially as many of them tend to beep (lots if you’re unlucky, occasionally if you’re lucky) and have lights that shine through your clothes.

Are there any other upsides? It’s a non-drug, non-surgical treatment, so it’s about as side-effect-free as you get.

Was it worth the money? Yes, while I had the right sort of pain.

Anything else worth knowing? Ideally you should get one with 4 pads, not just two. It makes it more versatile.

Has anyone found it useful for anything other than back pain? Are there any sorts of back pain it doesn't work for?

The Alexander Technique

Does it work? In my experience, yes (although see also "Is there any evidence for it?" below), but it's not a cure-all. My teacher said right from the start that she only expected to be able to improve my problems, not cure them.

Who does it work for? People with musculoskeletal problems, including everything from a muscle-related bad back, to repetitive strain injury to headaches caused by tense muscles, or even problems with your voice.  If poor posture, bad physical habits or overusing your muscles is contributing to your pain, then the Alexander Technique can help.

Who doesn't it work for? Anyone whose pain isn't caused by muscle tension, poor posture or poor muscle habits, e.g. people with neuropathic pain or tooth pain. I'm not sure how it would interact with arthritis or slipped discs.

What is it? It's one-on-one lessons in how to use your body more efficiently, in both your posture and your movement, for instance how to use your muscles less and bones more to stand or sit or walk more efficiently and how to use as few and relax as many muscles as possible. Your teacher will help you examine how you do things and teach you how to permanently change your habits. Some do this purely through touch, for instance placing their hands on your feet while you are standing so that your feet subtly alter their position for the better, others also include verbal explanations to help you understand how the theory works and apply it.

Where can I get it? If you live in the UK you can find a qualified teacher here: http://www.alexandertechnique.co.uk/searchgeo If you live in Frankfurt, I highly recommend this one (who also speaks fluent English): http://at-ffm.de/index_english.htm.*

How much does it cost? It's not cheap. Expect to pay about £45-£50 per hour depending on things like who the individual teacher is and where they practice, and you'll probably need at least 10 lessons. I ended up going about once a week for 6 months, having initially thought I'd give it a try for 10 sessions, but having found it so helpful I just kept going until I moved away from the area. Because it's lessons not therapy the impact lasts for as long as you remember the lessons. The idea is that it will stay with you forever.

Is there a cheap/free version? You can listen to podcasts about the theory and tips and tricks here: http://bodylearningcast.com. You can also buy books on the topic or read about it on the Internet. My own experience is that going to see a real teacher really helped beyond what I could learn from books or the podcast (although I then found episodes of the podcast a good refresher).

Does the individual practitioner matter? Yes. They all have to go through the same training, but some of them come out of it much better at it than others. If your teacher isn't doing a good job for you you'll probably know within 3 lessons at most, probably even fewer, as you should feel some benefits by then.

Is there any evidence for it? There have been a number of trials. http://www.nhs.uk/Conditions/alexander-technique/Pages/clinical-trial.aspx. I had previously heard that the trials had shown the Alexander Technique to be successful, but I've recently read that there is conflicting evidence, which makes me think that they may have run more trials where that didn't have positive results. http://www.nhs.uk/news/2008/08August/Pages/BackpainandAlexandertechnique.aspx.

Are there any negative side effects? It's not cheap, so your wallet will get lighter. With my first teacher I didn't think any negative consequences were possible, as my body's pretty delicate and I only ever came away feeling better or the same, never worse, but when I tried another teacher in London she suggested I try getting off the table differently in a way that made my back worse for a few days, so if you're delicate enough you can end up putting strain on a part of your body that really doesn't like it. However, I think it's unlikely to be much worse than the things you can accidentally do to yourself in your own home in the first place (sadly for people with HMS that encompasses quite a lot of damage).

Are there any positive side effects? Yes! I used to have poor posture. Now I have lovely posture, which is not only better for my muscles but also looks better. I'm also noticeably less clumsy, especially at eating. We actually spent one of my lessons going through how I use plates and cutlery in realistic situations for me (not because I wanted to be less clumsy, but because it's a regular part of how I move and I wanted to do it more efficiently and make sure I wasn't hurting myself). These impacts have both been permanent. It's now been three years since my last lesson and the improvements have lasted.

Was it worth the money? To me: definitely. If I still lived near my excellent teacher in Frankfurt I think I'd still be popping in for the occasional maintenance lesson.

Anything else worth knowing? It worked faster and better if I put effort in and applied the principles outside the lesson, but even if I had done nothing outside the lesson, I think my posture and pain would still have improved from what we did in the lessons alone. My teacher at no point tried to teach me about anything other than the technique (e.g. diet) or explain how or why it would be my fault if it didn't work (two pet hates of mine) - although I came to it with fairly strong core muscles from Pilates and it's my understanding that if you have very poor muscle tone, they will recommend you do exercises such as Pilates to get your muscles strong enough to do their job. I also found that applying the principles to other things like Pilates was very helpful.

What are your experiences with the Alexander Technique, good or bad? What was it good for? What didn't it work for? Is there anything you'd recommend doing or not doing? Or do you have any questions? Leave a comment below to join the discussion.

* My teacher doesn't even know I'm writing this blog, and I'm not getting anything in return for recommending her or the Alexander Technique.

Does all chronic pain respond to the same treatment? Two competing theories

Theory 1: chronic pain all responds to the same one-size-fits-all treatment
Theory 2: it doesn't

I'm with theory two. I'm with this theory on the basis of my body, which doesn't act like they said it should at the Centre of Pain Education and also failed to respond to the one-size-fits-all treatment that at least one member of staff there tried to explain to me was best for everybody.

Don't get me wrong, I'm not against centres of pain education. I think the information and treatment they provide can be very useful if you have the right sort of chronic pain or if you didn't know the information they provide before. I've heard people repeat back to me the sorts of things they told us there as information that genuinely has a useful impact on their lives and improved both how they feel about their pain and their quality of life. But I'm not one of them and part of the reason for that is the source of my pain.

My pain comes from having hypermobility syndrome (HMS)* and it turns out that the NHS specialist centre for hypermobility syndrome in London runs its own centre of pain education because the other centres of pain education don't provide the best advice for us, because our bodies don't work like everyone else's and nor does our pain.

This leads me to two possible conclusions:
1. not all chronic pain is the same and not all of it responds to the same treatment, and/or
2. not all pain suffered for longer than 6 months should be classified as chronic pain (hence it not responding well to treatments for chronic pain).

Now, I'm quite happy for them to redefine chronic pain to exclude me and other HMS sufferers (we could call my pain "persistent pain" or "enduring pain" instead if it helped). But for now, I have to conclude that not everything that currently gets called "chronic pain" is that same thing and not all of it responds to the same treatments. And while what I've said so far doesn't entirely rule out the possibility that there are in fact only two types of chronic pain: HMS chronic pain and non-HMS chronic pain, I have my doubts about that too, as I don't see why musculoskeletal chronic pain and neuropathic (nervous-system-based) chronic pain would be the same or respond to precisely the same treatments either. At the very least, I'd say more evidence is required here. Luckily for this blog and unluckily for me, I have quite a broad range of chronic pain, so I can test out solutions for a wide range of chronic pain problems. My types of chronic pain include:

• muscle pain from almost constantly very tight muscles (a side-effect of  my ligaments not doing their job properly and the muscles taking the strain);
• frequent joint pain from my joints hyperextending (= extending too far; hypermobility = double-jointedness) and just generally being prone to injury and healing slowly;
• widespread chronic pain (similar to fibromyalgia), which in my case seems to be related to my central nervous system, as it responds to gabapentin, which is a med used to treat neuropathic (nervous system) pain;
• postural pain problems (i.e. pain that comes from my body not being able to cope with most postures for any length of time) – there's a lot of crossover with my muscle pain here, but I thought I'd mention it separately;
• pain from repetitive movements, such as using a mouse.

Compiling that list, I can't help thinking I'm probably forgetting something. Certainly it's not an exhaustive list of the problems that HMS causes for my body. But it's the ones I can think of that definitely fall into the "chronic pain" category, so for now it will have to do. The key point is, I get lots of sorts of pain, so when I review treatments I'll try and say which types of pain I think they were helpful for for me and if there are other types of pain I think it would work for.

Well, that's my blog's mission set out. In the next post I'll be getting down to business with my first review: the Alexander Technique.

* Just to confuse you, hypermobility syndrome is also known as joint hypermobility syndrome (JHS) and benign joint hypermobility syndrome (BJHS), and some people say it's the same thing as Ehlers Danlos Syndrome - Hypermobility Type (also know as EDS hypermobility type, or sometimes just referred to as EDS), but others don't. Either way, the treatment's the same.

What is this blog about?

I have chronic pain. I've been to lots of doctors, I'm on a lot of meds, I've attended a centre of pain education ("COPE") and I've tried a lot of things, but my pain is still very bad (although it would be a lot worse if left completely untreated, as I've discovered from trying to drop some of the things I've tried). I've started this blog as a place to record what works for me and what doesn't. My hope for this blog is that other people will also contribute their experiences and the blog will become a resource for people everywhere with chronic pain.

Declaration of interests: as at the time of writing no one is paying me any money at all to write about or promote anything or giving me free trials of any kind of treatment method. If that changes, I'll let you know in the blog post about the treatment in question.

Two things I learnt about chronic pain from the centre of pain education are that:

• chronic pain is still very badly understood,
• scientists have not gathered very much in the way of evidence for what works (other than for meds).

This annoys me no end, as I'm a great believer in evidence-based medicine (I like things to be tested to see how well they work rather than just relying on theories and not bothering to test them. The history of medicine is littered with theories that were later proved completely incorrect and sometimes even harmful). Unfortunately I'm in no position to gather good scientific evidence about what works and what doesn't, as that would involve doctors, researchers, double blind trials and millions of pounds, and I don't have any of those. The best I can do is try things out and see what works for me and what doesn't and put them in this blog and hope that other people will contribute their own experiences. Technically this is only anecdotal evidence, and even if I gather lots of anecdotal evidence from lots of different people, it's still not as good as proper scientific evidence. As the saying goes: the plural of anecdote is not data. What it is though, is a start. A start that people can use to inform their decisions about what to try next and a start that might help scientists work out what they should be researching next to see if it really does work. My biggest hope for this blog is that it will prove useful: to me, to the pursuit of knowledge and to other sufferers of chronic pain.