Electrical Currents for Pain Control

Question 1

What is pain?

Answer 1

an experience based on a complex interaction of physical and psychological processes. It has been defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage

Question 2

What are the 2 types of pain according to time?

Answer 2

acute and chronic

Question 3

What is acute pain described as?

Answer 3

The response to immediate noxious stimulus

Question 4

Acute pain can last for how long?

Answer 4

up to 6 months

Question 5

When is pain considered chronic?

Answer 5

When it persists past what is considered “normal”

Question 6

Chronic pain results in a decreased production of what?

Answer 6

opiods

Question 7

Nociceptive receptors respond to what?

Answer 7

noxious mechanical, chemical, or thermal stimuli associated with ongoing tissue damage

Question 8

What are some examples of nociceptive pain?

Answer 8

• arthritis
• ischemia
• cancer
• chronic pancreatiti

Question 9

What does neuropathic pain result from?

Answer 9

PNS or CNS dysfunction without ongoing tissue damage

Question 10

What is a common characteristic of chronic pain patients?

Answer 10

they are sleep deprived

Question 11

What is referred pain?

Answer 11

Pain felt at a location distant from its source

Question 12

What are the 3 things in which pain can be referred from?

Answer 12

• A nerve to its area of innervation
• One area to another derived from the same dermatome
• One area to another derived from the same embryonic segment

Question 13

Compare and contrast cutaneous and visceral pain sensations

Answer 13

Cutaneous pain is sharp and well localized, whereas visceral pain is experienced as a deep ache

Question 14

Where do the liver and gallbladder refer pain to?

Answer 14

The right shoulder and neck

Question 15

Where do the lung and diaphragm refer pain to?

Answer 15

The left shoulder and neck

Question 16

Describe the path pain takes to the cerebral cortex

Answer 16

• nociceptive receptors transmits signals to A-delta and unmyelinated C fibers
• these nociceptors (when activated) release neuropeptides which convert the original stimulus into electrical activity in the form of action potentials in a process called transduction
• an action potential propagates along the afferent nerves toward the spinal cord
• this afferent neuron synapses with a second order neuron in the dorsal horn of the spinal cord
• if the painful stimulus is not able to be inhibited, the stimulus travels to the thalamus, then the cortex

Question 17

What can abnormal sympathetic activation result in?

Answer 17

excessive vasomotor or sweating reactions known as Complex Regional Pain Syndrome

Question 18

What are the sensory changes associated with Complex Regional Pain Syndrome?

Answer 18

• allodynia (pain provocation to normally painless stimulus)
• hypo-/hyperalgesia (decrease/increase sensitivity to pain)
• hypo-/hyperesthesia (decrease/increase sensitivity to touch)

Question 19

What are the tropic changes associated with Complex Regional Pain Syndrome?

Answer 19

skin, hair, and nail changes

Question 20

What are the autonomic changes associated with Complex Regional Pain Syndrome?

Answer 20

• • swelling/edema

- sweating

Question 21

What are the motor changes associated with Complex Regional Pain Syndrome?

Answer 21

• weakness
• contractures
• atrophy

Question 22

What are the 2 systems in which pain can be modulated?

Answer 22

• Gate control theory of pain

- Endogenous opioid system

Question 23

What are specifics of pain a PT must assess?

Answer 23

• Location
• Quality
• Severity
• Timing
• Factors that make it better or worse
• The setting in which it occurs
• Associated manifestations
• How it affects a person’s activities, function, and participation

Question 24

How does conventional TENS modulate pain?

Answer 24

It is worn at all times to control pain through sensory modulation

Question 25

Conventional TENS is characterized by ___-duration pulse and ___ frequency

Answer 25

short (50-80 μs)

high (100-150 pps)

Question 26

What should the amplitude be adjusted to for conventional TENS?

Answer 26

Adjusted to produce comfortable sensation without a muscle contraction

Question 27

What nerve fibers does conventional TENS activate?

Answer 27

A-beta sensory nerves

Question 28

How does low-rate TENS modulate pain?

Answer 28

It induces the secretion of endorphines and opiods and it may also elicit a motor response

Question 29

Low-rate TENS is characterized by ___-duration pulse and ___ frequency

Answer 29

long (100-300 μs)

low (2-10 pps)

Question 30

What should the amplitude be adjusted to for low-rate TENS?

Answer 30

Strong enough to elicit a small muscle contraction

Question 31

What nerve fibers does low-rate TENS activate?

Answer 31

motor and A-delta nociceptive nerves

Question 32

How long after treatment is low-rate TENS effective?

Answer 32

4-5 hours

Question 33

Low-rate TENS application should be no longer than 45 minutes, why?

Answer 33

to avoid delayed-onset muscle soreness

Question 34

Why is e-stim used after ACL reconstruction or TKA surgery?

Answer 34

to increase strength

Question 35

Why is e-stim used in osteoarthritis, RA, and patellofemoral syndrome

Answer 35

to reduce pain and swelling

Question 36

Burst Mode TENS utilizes the same mechanism as ___-rate TENS

Answer 36

low

Induces the secretion of endorphines and opiods

Question 37

How does electroacupuncture work?

Answer 37

Electrodes are placed on the skin overlying acupuncture points to promote endorphin release

Question 38

What type of waveform can be used for pain modulation?

Answer 38

Pulse-biphasic or interferential

Question 39

What must the carrier frequency be in order to do IFC?

Answer 39

2500 Hz