E-Stim for Pain

Question 1

Iontophoresis

Answer 1

Use of mild direct current (DC - monophasic) to drive negatively or positively charged ions of drug solution into the patient’s skin and underlying tissues

Question 2

Iontophoresis - electrodes

Answer 2

2 electrodes - one delivers the drug and one is the dispersive electrode

Question 3

Current for Iontophoresis

Answer 3

monopolar direct current

Question 4

Benefits of Iontophoresis

Answer 4

delivers medication with the need for a needle stick, risk of infection, or systemic effects

Question 5

Evidence that DC current can move ions _______ below the skin

Answer 5

6 to 20mm

Question 6

Iontophoresis Set Up

Answer 6

Uses a monopolar electrode arrangement
Active electrode has the medication
There is increased blood flow under the active electrode, so you may see hyperemia (increase blood flow)
Feels pins and needles on a more noxious level
If the patient complains of increased skin irritation during treatment, turn off the unit and inspect the skin under the active electrode
Dispersive electrode completes the circuit
Away from the active electrode
Warn patient of sensation of warmth and see some redness
If it is uncomfortable for the patient, stop and readjust

Question 7

Iontophoresis Dosage

Answer 7

amount of charge that is delievered; typical treatments consist of 40 to 80 mA*min

Question 8

Dose

Answer 8

Dose = Current (mA) * Time (min)

Question 9

Standard dosage for Iontophoresis

Answer 9

40 to 41 mA*min

Question 10

Dexamethasone

Answer 10

Negative ion, reduces acute inflammation by inhibiting the response of inflammatory cells

Question 11

Half life of Dexamethasone

Answer 11

36 to 48 hours, can’t give someone this more than once per day

Question 12

3 Types of TENS

Answer 12

Sensory, Motor and Breif-intense

Question 13

Sensory (high) TENS

Answer 13

Primarily used for pain control but can elicit muscle contraction

Question 14

Sensory TENS decreases the perception of pain by decreasing signals from the ____ and ____ fibers to the thalamus and cortex

Answer 14

A delta; C

Question 15

Sensory TENS works by…

Answer 15

the gate control theory

Question 16

Sensory (high) TENS parameters

Answer 16

Asymmetrical balanced biphasic current (the amount of energy is equal on both sides of the line)

Question 17

Sensory - Amps

Answer 17

maximum tolerable sensation; no contraction and no pain

Question 18

Sensory - Frequency

Answer 18

60 to 100 pps

Question 19

Sensory - Pulse width

Answer 19

60 to 100 μsec

Question 20

Sensory - Duration

Answer 20

as needed; anywhere between 5-30 minutes

Question 21

Sensory - Onset of relief

Answer 21

< 10 minutes

Question 22

Sensory - Lasting relief

Answer 22

minutes to hours

Question 23

Sensory - Goal

Answer 23

relieve pain

Question 24

Motor (Low) TENS parameters

Answer 24

Asymmetrical balanced biphasic current

Question 25

Motor - Amps

Answer 25

to muscle twitch

Question 26

Motor - Frequency

Answer 26

2 to 4 pps

Question 27

Motor - pulse width

Answer 27

150 to 250 μsec

Question 28

Motor - duration

Answer 28

30 minutes (at minimum)

Question 29

Motor - onset of relief

Answer 29

20 to 40 minutes

Question 30

Motor - lasting relief

Answer 30

hours

Question 31

Motor TENS works by...

Answer 31

gate control theory and descending pathways

Question 32

Brief-Intense (Noxious) TENS parameters

Answer 32

Asymmetrical balanced biphasic current

Question 33

Brief-Intense - Amps

Answer 33

painful and muscle contraciton

Question 34

Brief-Intense - Frequency

Answer 34

> 100 pps

Question 35

Brief-Intense - Pulse width

Answer 35

300 - 1000 μsec

Question 36

Brief-Intense - Duration

Answer 36

15 to 30 minutes

Question 37

Brief-Intense - Onset of relief

Answer 37

< 15 minutes

Question 38

Brief-Intense - Lasting relief

Answer 38

< 30 minutes

Question 39

Brief-Intense (Noxious) TENS works by...

Answer 39

Endogenous opiate mechanism (descending pain mechanism)

Question 40

Interferential Current

Answer 40

by crossing two slightly different medium frequency alternating currents within a tissue, a third frequency current of greater intensity is created in deeper tissues

Question 41

IFC Example

Answer 41

Channel 1 is set to 4000 Hz interfering with Channel 2 which is set at 4080 Hz then creates a 3rd frequency of 80 Hz

Question 42

IFC

Answer 42

alternating currents

Question 43

IFC Channel 1

Answer 43

high frequency sine wave (4000 Hz - 5000 Hz)

Question 44

IFC Channel 2

Answer 44

variable frequency sine wave

Question 45

IFC - Duration

Answer 45

15 to 30 minutes

Question 46

IFC - Intensity

Answer 46

tolerable sensory or muscle twitch

Question 47

Why IFC?

Answer 47

The high carrier frequency passes through skin and other tissues with ease; more comfortable for your patient

Question 48

Electrodes are set up in a _______ arrangement when using IFC

Answer 48

quadripolar

Question 49

Premodulated Current

Answer 49

A single AC current that is mixed within the generator to provide a sine wave of varying amplitude

Question 50

Premodulated feels similar to IFC, but you use _____ independent channels for stimulation

Answer 50

2; 2 electrodes (bipolar)

Question 51

Premod. base frequency

Answer 51

4 to 5000 Hz

Question 52

Motor (low) TENS

Answer 52

Chronic pain

Question 53

Sensory (high) TENS

Answer 53

acute injuries

Question 54

TENS vs. IFC

Answer 54

TENS - accessibility, take home, easier to control; IFC - creates beat frequency making it more comfortable for the patient

Question 55

Microcurrent Electrical Stimulation

Answer 55

Patient should not feel anything; works at cellular level to assist healing and pain; uses micro-amperage current (1/1000th of a milli-amp)

Question 56

MENS Paraments

Answer 56

monophasic, biphasic, direct, or alternating current

Question 57

MENS - Current

Answer 57

1-999 μamps

Question 58

MENS - frequency

Answer 58

0.1-1000 Hz

Question 59

MENS - pulse duration

Answer 59

0.5-5000 μsec

Question 60

MENS - intensity

Answer 60

subsensory

Question 61

MENS - duration

Answer 61

30 minutes to 2 hours

Question 62

MENS is used for......

Answer 62

acute & chronic pain, wound healing, scar tissue break up