by Neil Bauman, Ph.D.
October 24, 2016
A lady asked,
I have lower back pain from degenerative disk disease. I’m wondering if I can use a TENS unit on my back now that I have a cochlear implant?
If you are not familiar with TENS, TENS is not what comes after NINES and before ELEVENS! Rather it is an acronym that stands for “Transcutaneous Electrical Nerve Stimulation”.
Typically, TENS is used to help treat chronic pain. TENS units pass an electrical current through your skin (that’s what transcutaneous means) via two (or more) electrode pads taped to your skin near where the pain signals originate in order to stimulate the underlying nerves using electrical impulses.
The idea is that:
The body is capable of producing natural painkillers called endorphins and encephalins. It is thought that the impulses produced by the TENS machine help your body to produce these painkillers and so reduce pain.
The electrical impulses that are produced by the machine travel along the same nerve pathway as your pain. These impulses interfere with the pain message getting to the brain and override the pain sensation. (1)
Now, what does this have to do with cochlear implants (CIs)? Good question.
If you use a TENS unit too close to your cochlear implant, the current from the TENS unit can alter “the frequency of cochlear implants requiring them to be re-tuned”. (1) In other words, it can wipe out your cochlear implant’s maps. When this happens, you will need to have your cochlear implant reprogrammed. Until you do that, your cochlear implant won’t work and you’ll be left deaf.
Thus, when it comes to electrical equipment, it’s always better to be safe than sorry. So let’s look more deeply into this issue.
The cochlear implant manufacturers are well aware of TENS units and determine how close a TENS unit can be and yet not cause problems with the cochlear implant. Then they add additional distance for an extra margin of safety.
For example, the card that comes with CIs from Cochlear Ltd says not to use a TENS unit on the head or neck.
More specifically, according to otologist Dr. Thomas Haberkamp of the Cleveland Clinic Foundation, “TENS can be used but needs to be 20 cm from the implant: basically any treatment like that needs to be below the shoulder with any grounding below the shoulder.”
If you don’t know your metric conversions, 20 cm is 7.8 inches. Thus, just be sure that you keep any TENS electrodes at least 8” from your implant, and you will be ok. Note: both (all) electrodes need to be more than 8 inches from your implant, not just the “hot” one.
Since the 8” distance figure is already allowing for plenty of extra distance for safety, basically you can use TENS on your back below your neck and upper shoulders with safety.
In your case, since you are going to use it on the lumbar vertebrae in your lower back, you can use TENS without worrying that it may interfere with your cochlear implant in any way.
Does TENS work? Some swear it does and other say it doesn’t. Whether it works or not can also depend on the type of pain you have and where it is located.
However, if you have chronic pain, you can try it for yourself to see whether it works for you or not. It is non-invasive and does not have all the ototoxic and other negative side effects that painkiller drugs have so it can be a good initial treatment for pain management.
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(1) Transcutaneous Electrical Nerve Stimulation (TENS). 2011. Nottingham University Hospitals. https://www.nuh.nhs.uk/.
Thank you for the information. I just purchased one and have a cochlear implant.
I wonder if you an advise
Re use of eye MicroStim 100 i LE
I have been using this little machine for dry Macular degeneration. Recently had Cochlear Implant for R/ear.
I have been advised continued use not recommended as not tested. I am told that this micro electro -stimulation is 100 – 600 times weaker that a TENs unite.
I was hoping at the very least to use for L/eye only
Hi Wendy:
You say you contacted Cochlear Corp and they said “continued use not recommended as not tested”. In plain English, they say they don’t know because they didn’t test this unit to see whether it is safe for a CI or not. So you are in unknown territory–it may be perfectly safe or it may damage your CI map or whatever.
However, as you point out, it is between 100 and 600 times less powerful than a TENS unit, and therefore it seems reasonable/logical to conclude you could use it a lot closer to your CI than you could a TENS unit. Since you need to keep a TENS unit 8″ away (and that’s allowing for a margin of safety), and assuming there is a linear relationship between power and distance–but we don’t know that–this means you could theoretically go up to 2 mm (2 mm is 1/100 of 8″) from your implant and not cause damage. You would never be that close, nor would I recommend it, but using it on your eye, you’d be at least 1″ or more away, so it appears that theoretically it could be safe.
If you quoted Cochlear correctly, they said “continued use not recommended”. Note, they didn’t say “keep it away or you’ll wreck your CI!” I think this is their way of saying you can try it and it probably won’t hurt, but we can’t say that with any authority, therefore we don’t recommend it so you can’t sue us as we are not responsible if something goes wrong.
Basically, it means you assume all the risk.
If you decide to risk it and want to use your MicroStim, my take on it is that probably it won’t hurt your CI if you use it on your left ear which is well away from your CI. I’d use it cautiously on your left eye and see whether there are any problems with your CI. I’m betting there won’t be.
Once you tried it for a couple of weeks and know it doesn’t interfere with your CI on the opposite side, then you might–and I emphasize MIGHT–want to very cautiously try it on your right eye and see whether you have an problems with your CI. I don’t know anything about the MicroStim system so don’t know how long you leave it on. You might want to just try it for a few seconds (5 seconds or less) and see what happens. If nothing, then try it for a bit longer until you know it is safe to use (or not).
As I see it, the worst you will do is mess up your map so you’ll have to have your CI reprogrammed again. So if anything sounds different while you are using the MicroStim, take that as a warning that you are too close at that point.
That’s my take on it. I’m not recommending anything either way–that is entirely up to you what you choose to do. I’m just telling you my thoughts on how safe I think it probably is and how I’d probably go about trying it if I was in your situation.
If you do choose to try it, I’d love to know the outcome.
Cordially,
Neil
Hi Neil,
Many thanks for your extremely helpful advice!
Since stopping use of MicroStim have noticed changes in eyes. I think therefore will restart use as you suggest. Kind regards Wendy
Hi Neil,
Correction to power of MicroStim i Le – apparently 600-1000 weaker than a TENs unit
i am to scarred to use on R/eye but will start very cautiously to the left
Thanks
Wendy
Hi Wendy:
That’s even better–much lower power, so you can get closer without problems hepefully.
Try it on your left eye (cautiously) and I’ll bet you’ll have no problems. Then when you are confident there are no problems using it on your left eye, you might want to try it cautiously on your right eye. If you do, using it on the inside (nose side) of your eye would be the farthest from your ear so I’d try it there first and see how it goes.
Cordially,
Neil
Thank you Neil for help
Best wishes
Wendy
Dear Neil,
It is my mother that has dry Macular degen
Re MicroStim
After last contact realised had not achieved circuit contact -attached eye pad to left eye & l held right eye pad.
Am now a bit scarred to use since spotting on back of unit: ‘ Indica Tens 5XS. Patent #4,989,605
On front labled
MicroStim
Model 100i LE.
My question: is :Is it just a relabeled Tens unit?
I had been advised it was alot weaker than a Tens
Pity can’t send a pic of it.
Really appreciate your help
Wendy
Hi Wendy:
I think the MicroStim is really a very low powered TENS unit. If its power output is very small, it may not affect a CI at all. The key is the power it puts out and the distance you keep it from the CI.
Cordially,
Neil
Hi Neil,
I decided to restart use of MicroStim.
Some deterioration in eyesight since stopped use. Used for 5mins Left eye maintaining circuit with other pad.
Usual little transient light flickering noted ( like field vision test. No apparent adverse affects on cochlear Implant ( removed processor during treatment.
Will continue with 5 mins a day for a week & then twice daily.
Thanks Neil-.will keep you
posted
Wendy
My wife had an implant that was mostly removed (just the wire into the cochlea remains). Any time she’s tried a tens unit she feels shock in her ear and gets dizzy.
Hi Rob:
You have left out two critical pieces of information. First, how close was the TENs unit placed in relation to her ear? And second, how powerful was the TENs unit?
Cordially,
Neil
So a tens unit may be used on the lower back and hip area without damaging the cochelar implant inmplanted in the head?
Hi Markie:
That’s how I understand it.
Cordially,
Neil
If I don’t wear the processor of my cochlea implantat it should be okay to use TENS, am I right with that! Cordially, Sabrina
Hi Sabrina:
It depends on how much power your TENS unit puts out and how far away you are from your implant. Taking the processor off is certainly a good idea. But I’d also keep it away from the implant–just as a precaution–even though your maps are in your processor, not in the implant itself.
Read this article again and the information I explained to Wendy in the comments underneath–then make up your own mind.
Cordially,
Neil
Hi Neil,
I have an external hearing aid. Is it safe to use a TENS unit on the side of my neck area when I have my hearing aid in? Does the 8-inch recommendation still apply?
Thank you for all the helpful information you’ve provided already!
Sincerely,
John
Hi John:
Personally, I wouldn’t hesitate to use a TENS unit while I was wearing my hearing aids as they are much different from a cochlear implant. I’ve never heard of any problems with hearing aids being affected by a TENS unit.
If you want to be extra cautious and “safe”, just temporarily take out the hearing aid on the side on which you are using the TENS unit. Do the same for the other side. That way, you’ll always be able to hear from one ear or the other while using the TENS unit.
Cordially,
Neil