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Book Review

117ACUPUNCTURE IN MEDICINE 2003;21(3):117-118.www.medical-acupuncture.co.uk/aimintro.htm

TENS: Transkutane elektrische Nerven-

stimulation in der Schmerztherapie (TENS:

Transcutaneous electrical nerve stimulation in

pain therapy)

Raymond Pothmann (editor)

Paperback,Pages: 153,Price:^34.95

Hippokrates Verlag (Thieme Verlagsgruppe),

Stuttgart (2003)

3rd edition,revised and enlarged

www.hippokrates.de

ISBN 3-8304-5228-4

 TENS (transcutaneous electrical nerve

stimulation) is an important tool for any

practitioner who works with pain.

Since Deirdre Walsh’s standard textbook on TENS was published in 1997,1 the only new UK 

books on the subject have been marketed by

distributors of TENS devices, that by Keith Tippey

being the most useful.2

For those who read German, this new edition

of a book which first appeared 12 years ago neatly

complements Walsh’s. Its 21 chapters include

contributions from highly experienced French and

Finnish as well as German authors. Technicalities

are kept to a minimum, and clearly explained.

Chapters are short and pithy, with the personal

expertise of the authors bringing their subject

matter to life.

Pöntinen, for example, broadens his discussion

of the neurophysiology of TENS to include laser

stimulation, and contributes a whole chapter

on the vascular effects of TENS in which the

various treatment options are lucidly outlined

(I particularly like his extension of Kaada’s

protocol, 2-4 Hz non-segmental stimulation

of LI4, to include treatment at ST36). He alsowrites realistically about the limitations and side

effects of TENS, and how to circumvent them.

Suggestions on treatment parameters that will

be unfamiliar to many non-European readers

are made by Hankemeier and Krizanits-Weine

in their brief chapters on back and joint pain.

 There are useful chapters on cancer pain

(Schara), childbirth, gynaecology and paediatrics

(Pothmann). The contribution on pain in dentistry

(Scherman, Goepel), constructed around a small

clinical study, is particularly instructive.

However, other chapters are disappointing.

Pothmann’s introduction to TENS as a form of 

muscle stimulation (TEMS), for example, is

skimpy, lacking in practical data. Gessler’s

contributions on neurogenic, stump and phantom

pain, and headache do not appear to have been

updated for this edition, and lack the evidencebased approach of some of the other authors,

such as Goepel, writing on postoperative pain.

Gessler also contributes a useful if somewhat

stodgy chapter on the practicalities of TENS in

the pain clinic, and Hankemeier and Krizanits-

Weine include a brief summary of the choices

involved in deciding whether or not to employ

 TENS with particular patients.

For the acupuncturist, three chapters are

particularly relevant. The first (Pothmann), on

 TENS and acupuncture, includes some usefulcomparisons between the two methods, suggesting

when manual or electroacupuncture (MA, EA)

or TENS is likely to be most helpful. The second,

by Heydenreich (and Pothmann), is one of the

longest and most informative in the book,

describing the results of the many studies he

carried out on his method of acupoint probe

stimulation (PuTENS) before his death. Even

though this work is old, it is rigorous, and deserves

to be far better known outside Germany than it is.

Hopefully, with the launch of a new, CE-marked

version of the PuTENS device by Schwa Medico,

this will happen. The third chapter, on EA, by

Irnich (and Pothmann) includes some recent

material, so must be one of the ‘revised’ ones

mentioned on the book cover, although it is so

very minimal that it can hardly have been

‘enlarged.’ However, it might be useful as a

reminder of the indications and contraindications

of EA, and includes a list of points useful for

acupuncture analgesia.Illustrations in the book are simple and

uncluttered. One nice touch is that the bodies

shown are not sylph-like and angular, but

comfortably rounded! Given our increasing

corpulence in the west, this does feel rather

appropriate (or maybe I’m getting middle aged).

All in all, I think this is a useful book, but it

will not satisfy those looking for in-depth

discussion of the topics covered. The contributions

by Pöntinen and Heydenreich (and co-author?)

in particular are well worth reading.

David Mayor 

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Equipment Review

118ACUPUNCTURE IN MEDICINE 2003;21(3):118-119.

www.medical-acupuncture.co.uk/aimintro.htm

ITO ES-160 Electroacupuncture Unit

Price: £255 + VAT

Available from:

http://www.itolator.co.jp/english/products/

cat15.html

 The ‘state of the art’ electroacupuncture stimulator

device from the Japanese firm ITO is a six-channel

machine with a stunning appearance. It is powered

by four C-size (LR14) alkaline batteries, which

will give thousands of hours’ use. There are three

LCD display panels showing pulse frequency,pulse width and duration of treatment (timer)

which can each be independently adjusted.

 The first channel allows a search and

stimulation facility using a grounding rod held by

the patient, and a probe controlled by the therapist,

which detects areas of low skin resistance.

Curiously this is a T-shaped device with an 8mm

diameter probe at one end, and a cup to receive a

water-soaked pledglet of cotton wool for Ryodoraku

point measurement. I must confess that I do not

know the first thing about Ryodoraku point

measurement, and although the operation manual

explains briefly how to make measurements, there

is no explanation on how to interpret the values.

 The 8mm search probe is good at finding low

resistance areas by showing increasing numbers in

the middle window and a buzzer that becomes

more excited as the probe gets nearer to the

acupuncture point. Unfortunately, the 8mm probe

is too big and blunt for accurate location of points,

and is of no use for identifying ear points. The electroacupuncture outputs allow

considerable adjustment in terms of pulse

frequency (0.5-500Hz), pulse width (50-400us)

and output (max 16v, 32mA peak). There are

five basic output modes: Constant - symmetric

bi-phasic rectangular pulses; Burst – on/off bursts

of pulses; Surge – crescendo/decrescendo bursts

of pulses; Fast and Slow – alternating frequency

speeds; and Sweep – frequency modulated. The

lower frequency is always a third of the higher

frequency set, and there are visual and audible

representations of the output. Again, the operation

manual offers no suggestion as to which mode touse for specific conditions, but a clinical user

guide – Introduction to Japanese Electric

Acupuncture and Ryodoraku - will be available

shortly, and contains much useful information.

It is disappointing that it is not possible to mix

independently two frequencies such as 4 Hz (to

stimulate beta endorphin production in the brain

stem) with 100 Hz (to release spinal dynorphin,

and serotonin), in dense-disperse fashion.

Instead, there are three preset programs that

give an assorted output of different modes andfrequencies, each lasting 2 to 4 minutes. This uses

the best stimuli from the machine giving the

following sequence for example, program 3:

And that should activate about every opioid

peptide in the body in 15 minutes!

 There are many safety features, which will

prevent you from harming your patient, and the

operation manual has six pages of precautions!

 The unit comes with six electrode cords, 12

miniature alligator clips, a search/stimulation

probe and a 21-page operation manual.

 The unit looks very attractive and has a host of 

features, many of which will not be used by a

Mode Frequency Pulse width Time (mins)

Constant 20 150 2

Fast+Slow 2/6 400 4

Surge 100 100 3

Sweep 3-10 300 3

Constant 70 100 3

Reference list 

1. Walsh DM. TENS: Clinical applications and related

theory. Edinburgh: Churchill Livingstone; 1997.

2.  Tippey KE. TENS: the user's guide to pain relief. A

systematic approach. Nidd Valley Medical, Knaresborough,

UK (revised edition); 2000. www.niddvalley.co.uk

Figure 1 This is an image of the ITO ES-160 

Electroacupuncture Unit .

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Equipment Review

119ACUPUNCTURE IN MEDICINE 2003;21(3):118-119.www.medical-acupuncture.co.uk/aimintro.htm

Western (medical) acupuncturist. This is not a

machine for beginners in electroacupuncture.

Critically, I would say that the search probe needs

a more precise tip, and I would like to see a mixed

frequency stimulation mode of alternating 4 and

100Hz frequencies (Han stimulation).However it is exceedingly good value for

money, and must come high on the list of anyone

looking for an extremely well specified

electroacupuncture unit.

I am grateful to Oxford Medical Supplies Ltd

(tel: 0800 975 8000) for making the unit available

for testing.

Tested:1st July 2003

Declared interests: none. Independent review.

Colin Lewis 

Correction

AIM 2003;21(1-2):47

Practising Acupuncture in the Developing World

Sarah Watki ns 

Sarah Watkins’ correct email address is

[email protected]

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stimulation in pain therapy)(TENS: transcutaneous electrical nerveNervenstimulation in der SchmerztherapieTENS: transkutane elektrische

David Mayor

doi: 10.1136/aim.21.3.117

2003 21: 117-119Acupunct Med

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