ES: TENS - Physiological Effects
- Pain inhibition through gate-control therory:
- Large A-beta fibers activate inhibitory interneurons in dorsal horn, inhibiting smaller A-delta and C fibers.
- Also enkephalin release which combines with opiate receptors to depress release of substance P.
- Pain modulation through descending pathways
- Noxious stim generates endorphin production.
- Efferents from PAG and other areas travel through dorsal SC and synapse with enkephalinergic interneurons in SC to presynaptically inhibit release of substance P from A-delta and C fibers.
ES: TENS - Waveform
Typically assymetrical biphasic Zero net direct current Pulsed monophasic sometimes used
ES: TENS - Modulation
Continuous or Burst
ES: TENS - Conventional High-Rate Indications
Acute or chronic phase of pain Modulation of pain via inhibition of pain fibers by large-diameter A- fiber activation
ES: TENS - Conventional High Rate Parameters
- Onset of p! relief: fast
- Amplitude: comf tingle, parasthesia, no ms response
- Pulse Rate: 50-80 pps (75-120)
- Pulse Duration: 50-100 microseconds
- Mode: continuous
- Duration of Tx: 20-60 minutes
- Duration of p! Relief: short
ES: TENS - Acupuncture Indications
Chronic phase of pain Analagesia produced through stimulation-evoked production of endogenous opiates
ES: TENS - Acupuncture Parameters
- Onset of p! relief: 20-40 min
- Amplitude: strong, comf rhythmic twitches
- Pulse Rate: 1-5 pps
- Pulse Duration: 150-300 microseconds Mode: continuous
- Duration of Tx: 30-40 minutes
- Duration of p! Relief: long-lasting
ES: TENS - Brief Intense Indications
- Rapid onset, short term p! relief during painful procedures (burns)
- Wound-debridement
- Deep friction massage
- Joint mobilization
- Passive stretching
ES: TENS - Brief Intense Parameters
- Onset of p! relief: -
- Amplitude: to patient tolerance
- Pulse Rate: 80-150 pps
- Pulse Duration: 50-250 microseconds
- Mode: continuous
- Duration of Tx: 15 minutes
- Duration of p! Relief: temporary (30-60 minutes)
ES: TENS - Burst Mode Indications
Combines characteristics of high and low rate TENS. Stimulates endogenous opiates (current is more tolerable)
ES: TENS - Burst Mode Parameters
- Onset of p! relief: Similar to low rate
- Amplitude: comf intermittent parasthesia
- Pulse Rate: 50-100 pps,in bursts of 1-4 pps
- Pulse Duration: 50-200 microseconds
- Mode: continuous
- Duration of Tx: 20-30 min
- Duration of p! Relief: long-lasting (hours)
ES: TENS - Hyperstimulation (point) Indications
Uses small probe to locate and noxiously stimulate acupuncture or trigger points. Multiple points per treatment
ES: TENS - Hyperstimulation (point) Parameters
- Onset of p! relief: similar to acupuncture
- Amplitude: strong, to patient tolerance
- Pulse Rate: 1-5 pps
- Pulse Duration: 150-300 microseconds
- Mode: -
- Duration of Tx: 15 to 30 second increments
- Duration of p! Relief: long lasting
ES: TENS - Modulation Mode
Modulate other TENS modes to prevent neural/perceptual adaptation. Can change frequencies, intensities or pulse durations by 10+ % 1-2 times per second
ES: TENS - Electrode Placement
- Acupuncture site,
- dermatome distribution of involved nerve,
- over painful site,
- proximal or distal to pain site,
- segmentally related myotomes,
- trigger points.
ES: TENS - Indications
- Pain modulation through activation of central inhibition of pain transmission (Gate theory)
- Pain modulation through descending pathways generating endogenous opiates
ES: TENS - Contraindications
- Pt w/ demand type pacemaker or over chest w/ cardiac dx
- NOT applied over:
- eyes,
- larygneal/pharyngeal ms,
- head or neck following CVA
- Epilepsy
- mucosal membranes
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Biofeedback8
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Electrical Stimulation26
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Intermittent Mechanical Compression8
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CPM5
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TENS17
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Heat Therapy9
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ES: Medium Frequency6
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Iontophoresis13
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High Voltage5
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Cold Therapy10
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Contrast Baths3
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Massage2
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Aquatic Therapy4
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HydroTherapy4
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Paraffin Bath3
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Tilt Table3
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Ultrasound and Phonophoresis17
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Mechanical Traction6
