What is TSE?

Acticare Transcutaneous Spinal Electroanalgesia (TSE) is a clinically proven form of electrical stimulation for treating chronic pain through eliciting analgesia. TSE is a relatively new electrical pain relief modality which uses a very brief pulse duration, usually four microseconds or less using electrodes placed over the skin underlying the spinal cord ¹. The brief pulse duration permits high voltages to be reached before any sensation is felt, allowing penetration of deeper tissues and influence the central nervous system ¹.

Figure 1: TSE pulse width and pulse voltage compared to TENS.

Figure 2: Acticare TSE Device

TSE was first discovered in 1991 by Drs Alex Macdonald and Tim Coates as an alternative to Spinal Cord Stimulation (SCS) which is an invasive neurosurgical implementation of electrodes ². SCS was effective for chronic pain however had drawbacks due to its invasiveness, costs and risk of infection. In 1995 Dr Macdonald and Coates published their research report on TSE and found that it significantly reduced tenderness in patients with chronic unilateral tenderness compared to the contralateral side (p < 0.001) ². They also established that TSE is significantly better at producing an analgesic effect when compared to TENS. The exact mechanism of TSE is not known yet but is theortisized that it effects the rate of release of certain central ligands and their effect on ligand gated receptors, as well as causing changes in voltage gated ion channels ¹. Macdonald and Coates concluded the following pros of TSE:

• Non-invasive
• High Compliance
• Standardised electrode location
• Minimum onset time of analgesic effect is 8 minutes
• Minimum 8 hours of pain relief after first treatment
• Increasing Cumulative pain relief effect after successive treatments

Figures 3 and 4 show the two primary electrode placements used with TSE for most effective outcomes to occur. These placements are optimal as Macdonald and Coates state the closer the electrodes are placed together then the lower voltage needed to produce tingling sensations which inturn prevents electrical current reaching the spinal cord ². TSE allows electrode location to be standardised to the spinal cord regardless of the location of pain due to the fact that TSE provides stimulation to the CNS. Therefore the electrodes will always be placed over the spinal cord regardless of whether pain is occurring at the spine, hip, knee or shoulder ².

Figure 3: Electrodes placed on skin underlying transverse processes of C3/C4.

Figure 4: Electrodes placed on skin underlying spinous processes of T1 and T12.

References:


1) Acticare: TSE notes for practitioners (2006). Retrieved from http://www.acticare.com/docs/SM-00040_TSE_Notes_Practitioner.pdf


2) Macdonald, A.J. Coates, T.W. (1995). The discovery of TSE and its relief of chronic pain. Journal of Physiotherapy 81(11).

• All images sourced were sourced from: http://www.acticare.com/docs/SM-00040_TSE_Notes_Practitioner.pdf 

* note: none of the authors of this blog have any commercial interests in Acticare TSE.