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First Steps

Head and neck pains.

Use as in the instructions for use leaflet, but perhaps place the pads further round the neck than shown in the picture so that they are more directly over the transverse processes. In practice this means almost directly under the ears.

Pains below head and neck.

Initially place pads over T1 and somewhere in the region of T10 to T12. It is most important that the lower pad is not lower than T12. In the majority of cases this is all that is required ? most patients will report early and significant pain relief. However, after talking to many hundreds of patients on the help line, it appears that the following refinements are of great benefit to those who do not respond well initially.

Head pains.

Either use the “migraine collar” or try placing the pads on the hairless area just behind the ears.

Neck and upper limb pains.

The nerve supply to these areas can be mixed between cervical and thoracic – it is therefore reasonable to expect that mixing the electrode placements might help. In practice, placing the pads in the T1, T10 position for 20 to 30 minutes followed immediately by 20 minutes in the “head and neck” position can be very effective. If this gives only modest improvement, it is worth raising the lower pad to about T5.

Pains elsewhere in the body.

A similar mix of pad positions seems to be helpful in many cases though trial and error suggests that for optimum effect the time in each position should be adapted slightly. The standard helpline advice is now to suggest 30 to 40 minutes in the “up and down” (that is T1 to T10) position followed by just 15 minutes in the neck position.

Headache after treating low back pain.

This problem seems to be associated with those who have degenerative low back problems. The suspicion is that as we relieve the low back pain they become aware of a headache associated with a cervical problem. This problem is almost always overcome by using the device in the usual head and neck pain positions for just 10 minutes at the end of a normal treatment.

In all cases the patient should be encouraged to be flexible with treatment times. There have been some patients who become a little light headed after a normal treatment. They require much shorter treatment times. On the other hand, some patients seem to require longer treatment times of several hours to get an initial benefit. Experience suggests that these patients can subsequently reduce their treatment times back to the normal lengths.

Last resort electrode placement.

Perhaps this placement should not be labelled “last resort”, but it seems so odd to most people that it has been reserved for those patients who do not respond to other electrode placements. The patient should place one pad in the midline on the back of the neck as high as convenient below the hairline and the other pad under the chin – not on the throat.

We have been advising this electrode placement for those patients who have failed to respond to ENM at all and are about to return their device. Just under 15% of these patients respond positively to this placement and find it worth retaining the device.

In summary, the ENM device is very simple for most patients to use. The vast majority follow the instructions for use booklet and need no further advice. For the rest, the advice detailed above can be very helpful.

The above advice has been developed from direct patient contact after the patients have acquired their own devices directly. Those patients attending a Pain Management Clinic will often be more difficult to treat and may need to use the alternative electrode placements more often than the general population of patients in pain.