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PMod > ELECTRICAL STIMULATION FOR PAIN RELIEF > Flashcards

ELECTRICAL STIMULATION FOR PAIN RELIEF Flashcards

1
Q

Electrical stimulators capable of delivering pulsed currents, for __ nerve fibers through the skin using __

A

depolarizing peripheral (sensory), surface electrodes

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2
Q

Application of pulsed electrical current for inducing electroanalgesia

A

TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS)

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3
Q

Primarily used to address pain/relieve pain

A

TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS)

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4
Q

GATE CONTROL THEORY (GCT) by

A

Melzack and Wall

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5
Q

GATE CONTROL THEORY (GCT)

A

Substantia gelatinosa in lamina 2 @ spinal cord (allows the passageway of pain if the gates are open) –> Once the pain reaches the thalamus and the higher centers of the brain, it will be perceived as painful

Pain signals are transmitted by A-delta fibers and C fibers

  • Electrical stimulation will stimulate the heavy
    myelinated and larger A-beta fibers, allowing faster conduction of nerve velocity going to the higher centers and will reach first the SG

o Inhibitory nature of SG is activated thus
closing the gate
o Pain signals cannot pass through the gate
o Majority of the pain sig

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6
Q

DESCENDING PATHWAY INHIBITORY TRACT (DPIT) aka

A

Endogenous Opiate System/Endorphin Release

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7
Q

Opiopeptines; also referred as

A

endorphins
and encephalins

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8
Q

controls the pain by binding to specific
opioid receptors in the nervous system

A

Opiopeptines

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9
Q

will allow the release of these
opiopeptines

A

Electrical simulation

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10
Q

Influences certain areas of the brain
(___ found in
the brain stem)

A

periaqueductal and ruffae nucleus

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11
Q

Strongly inhibits transmission of pain signals
from the spinal cord to the higher centers of
the brain

A

DESCENDING PATHWAY INHIBITORY TRACT (DPIT)

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12
Q

DESCENDING PATHWAY INHIBITORY TRACT (DPIT) leads to

A

Leads to analgesia
Chemical in nature
Stays in the blood system of the body
therefore has a more lasting effect as
compared to GCT

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13
Q

Convential TENS aka

A

high-rate TENS

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14
Q

Most commonly used mode of TENS in the clinics

A

CONVENTIONAL TENS

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15
Q

Uses short-duration high-frequency pulses to
produce comfortable sensation without muscle contractions to modulate acute pain (GCT)

o Can relieve pain d/t gate control theory
o Effect is not that long-lasting

A

CONVENTIONAL TENS

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16
Q

process by which there is
an adaptation that happens

A

Accommodation

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17
Q

Stimulus is modulated to

A

prevent accommodation

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18
Q

Conventional TENS Accomodation

A

Decrease in frequency of action
potentials and decrease in
subjective sensation of the
stimulation when ES is applied
without variation

o Constantly applying a certain parameter
causes the nerve to just adapt
▪ No longer respond effectively to the
application of ES
▪ Gate control principle can no longer
be activated

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19
Q

Convential TENS Parameter

A

Adequate amount of intensity should be
applied for the patient to comfortably feel
the electricity

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20
Q

Conventional TENS Parameters

Waveform, Pulse freq, Pulse Duration, Intensity, Treatment Time

Cameron

A

-
100-150 pps
50-80 usec
comfortable, tingling sensation
20-30 min

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21
Q

Conventional TENS Parameters

Waveform, Pulse freq, Pulse Duration, Intensity, Treatment Time

Michlovitz

A

Mono-/Biphasic PC
High: ~ 100 pps
Short: 50-100 usec
comfortable, tingling sensation
20-30 min

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22
Q

Conventional TENS Parameters

Waveform, Pulse freq, Pulse Duration, Intensity, Treatment Time

Clinical

A

Biphasic PC
High: 80-110 pps
Short: 50-150 usec
comfortable, tingling sensation
20-30 min

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23
Q

Acupuncture-like TENS

A

low-rate TENS

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24
Q

Repetitive stimulation of motor nerves to produce
brief repetitive muscle contractions/twitches;

A

ACUPUNCTURE-LIKE TENS

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25
Q

ACUPUNCTURE-LIKE TENS

Stimulation of __ nerves to produce __
(activation of DPIT)

Pain relief is more long-term

A

Aδ, brief sharp pain

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26
Q

ACUPUNCTURE-LIKE TENS

Parameter Setting

A

Reaching the brief sharp pain even without
visible muscle twitches is already sufficient
enough to activate the DPIT

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27
Q

Acupuncture TENS Parameters

Waveform, Pulse freq, Pulse Duration, Intensity, Treatment Time

Cameron

A

-
2-10 pps
200-300 usec
Visible muscle twitches (motor); brief sharp pain (sensory)
20-45 min

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28
Q

Acupuncture TENS Parameters

Waveform, Pulse freq, Pulse Duration, Intensity, Treatment Time

Michlovitz

A

mono/biphasic
Low: <10 pps
Long: >150 usec
Visible muscle twitches (motor); brief sharp pain (sensory)
20-45 min

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29
Q

Acupuncture TENS Parameters

Waveform, Pulse freq, Pulse Duration, Intensity, Treatment Time

Clinical

A

Biphasic PC
<10 pps
>150 usec
Visible muscle twitches (motor); brief sharp pain (sensory)
20-45 min

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30
Q

Combining sensory TENS (high frequency, short pulse
duration) and motor TENS (low frequency, long pulse
duration)

Intensity up to patient’s maximal tolerance (DPIT)

A

BRIEF-INTENSE STIMULATION

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31
Q

Brief-Intense Stimulation

Waveform, Pulse freq, Pulse Duration, Intensity, Treatment Time

Michlovitz

A

Mono/Biphasic
~100 pps
>150 usec
Visible strong muscle twitches (motor)
<15 min

32
Q

Brief-Intense Stimulation

Waveform, Pulse freq, Pulse Duration, Intensity, Treatment Time

Clinical

A

Mono/Biphasic
~80-100 pps
>150 usec
Visible strong muscle twitches (motor)
<15 min

33
Q

*Aka point stimulation/electroacupuncture
* Applied using a probe electrode over acupuncture
points
o Results to higher current density on the area
* Pain relief via DPIT

A

HYPERSTIMULATION

34
Q

Hyperstimulation

Waveform, Pulse freq, Pulse Duration, Intensity, Treatment Time

Michlovitz

A

Monophasic
Low: 1-5 pps
High: 100 pps

Long:>250 usec
Highest tolerated painful stimulus (noxious)
30-60 sec to each point

35
Q

Hyperstimulation

Waveform, Pulse freq, Pulse Duration, Intensity, Treatment Time

Clinical

A

Monophasic
80-100 pps
>150 usec
Highest tolerated painful stimulus (noxious)
30-60 sec to each point

36
Q

: pt will not feel anything even
with ES

A

Subsensory

37
Q

: intensity is increased therefore
electricity can be felt in the body

A

Sensory

38
Q

muscle contractions start to
happen

A

Motor level

39
Q

as intensity further increases,
pain can be felt (tolerated painful stimulus)

A

Noxious level

40
Q
  • Burst: defined as series of pulses delivered in groups
    or packets
  • Stimulation is delivered in bursts
  • Pain relief via DPIT
A

BURST MODE TENS

41
Q

Burst Mode Tens

Waveform, Pulse freq, Pulse Duration, Intensity, Treatment Time

Cameron

A

10 bursts
100-300 usec
Visible muscle contraction (motor)
20-30 min

42
Q

Burst Mode Tens

Waveform, Pulse freq, Pulse Duration, Intensity, Treatment Time

Michlovitz

A

<10 pps
>150 usec
Visible muscle contraction (motor)
20-30 min

43
Q

Burst Mode Tens

Waveform, Pulse freq, Pulse Duration, Intensity, Treatment Time

Michlovitz

A

<10 pps
>150 usec
Visible muscle contraction (motor)
20-30 min

44
Q
  • Minimum frequency required for
    evoking tetanic muscle
    contraction
  • Causes high skin resistance
A

Low-Frequency Current
(1-1,000 Hz)

45
Q
  • Causes lower skin resistance
A

Medium-Frequency Current
(1,000-10,000 Hz)

46
Q

Thermal effects

A

High-Frequency Current
(>10,000 Hz)

47
Q

effects ranges between the low-frequency
and medium-frequency currents

A

Electrical

48
Q

High skin resistance = pt has a tendency to feel
discomfort when__-frequency currents are applied

A

low

49
Q

__-frequency current by itself has no effect on
the body

A

Medium

50
Q

is originally used and by
the time it enters the body, it will be combined to
produce a low-frequency current which is responsible
to produce a physiologic effect
o Allows for more comfort

A

Medium-frequency current

51
Q

2 waveforms both fall on the positive side
and will add-up
o If both fall below the isoelectric line, adding
them up will produce a much lower peak

A

Constructive interference

52
Q

If the two waveforms that are applied
simultaneously and the first one produces a
lower effect and the other one has a positive
effect, it will only negate each other

A

Destructive interference

53
Q

wavelengths are slightly
different from each other
▪ There is a point where they will add
up and there is a point where they
can cancel out

A

Out-of-phase

54
Q

If the waves are ___, both interferences will
occur

A

out-of-phase

55
Q

process where we produce a lower
frequency from the 2 medium frequency currents
o Series of constructive and destructive
interferences

A
  • Heterodyne
56
Q

Amplitude modulated frequencies that are
summated is now called the

A

beat
▪ Responsible for producing the
physiologic effects

57
Q

Sensory application

A

: 4 kHz

58
Q

Motor application:

A

2 kHz

59
Q

difference between the 2 original
AC’s; typically between 1-200 Hz

A

Beat frequency

60
Q

constant differences between
the 2 circuits

A

Constant beat frequency/selective beat
frequency

61
Q

frequency between the 2
circuits varies within preselected ranges
(modulated type to address
accommodation)

A

Variable beat frequency/automatic or sweep
beat frequency

62
Q

Pain relief =

A

80-200 Hz

63
Q

Motor application =

A

50 Hz or lower

64
Q

Scanning of amplitudemodulated beats at an arc of
~45deg
that allows current to
conduct through a greater
volume of tissue
* Diffused pain

A

Quadripolar scanning

65
Q

Maximum amplitude modulation
effect occurs at 45deg
to
perpendicular lines extending
between the 2 circuits
* Localized pain

A

Quadripolar static

66
Q

o Application of two-medium frequency
currents via four electrodes so that they
intersect in the tissues (quadripolar)

A

Quadripolar scanning mode/two-circuit scanning
interference field

67
Q

Modulation already happened in the
machine before it is brought to the pt
▪ Beat frequency is delivered by 2
electrodes
o Application of two-medium frequency
currents by mixing the two currents in the
stimulator prior to application via two
electrodes (one-circuit); (bipolar)

A

Premodulated mode/Exogenous/Bipolar method

68
Q

Created when three-circuit IFC is applied
with three pairs of electrodes contained
within two Y-shaped applicators that allows
the three currents to intersect within the
tissues
o Depicts the 3D nature of our tissues

A

Hexapolar mode/Three-circuit IFC

69
Q

Sensory effect

A

Cutaneous stimulation of sensory nerve
fibers
o Analgesic effect via GCT
▪ Wedensky Inhibition of type C
nociceptive fibers: makes the
stimulation more comfortable
and addresses non-acute type of
pains

70
Q

Motor Effect

A

Synchronous excitation of the large diamater, lower-threshold and more
excitable motor nerve fibers
▪ Versus physiologic muscle
contraction → asynchronous
excitation of motor nerve fibers
▪ Disadvantage: results to early
fatigue

o Gildemeister effect: IFC may also mimic
pattern of normal physiologic muscle
contraction (asynch)

o Wedensky inhibition of motor nerve fibers
▪ If applied for prolonged period of
time, IFC can inhibit muscle
response d/t adaptation or loss of
excitation of the nerves
(refractory state)
▪ Variable beat frequency is
important to prevent this
phenomenon

71
Q

Tens & IFC indication

A

Pain control

72
Q

IFC Indication

A
  • Relief of muscle spasm
  • Promote tissue healing
  • Edema reduction
  • Muscle re-education
73
Q

Contraindications

A
  • Over anterior cervical area
    *may activate the carotid
    nerves/vagus nerve = effect on heart
    and lung function
  • Rate-responsive or demand-type
    cardiac pacemakers or implanted
    cardioverter-defibrillators (ICD)
  • Deep venous thrombosis
  • Over abdominal, pelvic or
    lumbar areas of pregnant
    women in 1st trimester
  • Epileptic episodes
  • Over hemorrhagic area
  • Over cancerous area
  • Within 3m from SWD device
74
Q

Precautions

A
  • Over thoracic cage area
  • Over cranial area
  • Over metal implants
  • Confused or unreliable patients
  • Over damaged skin
75
Q
A

PMod (10 decks)

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