ES for pain relief Flashcards
what type of current does TENS deliver
pulsed currents
rationale for TENS
pulsed currents that depolarizes peripheral nerves through the skin = electroanalgesia
what are the 2 mechanisms for pain relief
gate control theory and descending pathway inhibitory tract
GCT and DPIT
exp how ES affects the GCT
vibration from ES is transmitted by A fibers which are faster than C fibers kaya mauuna sha mag activate ng SG which will block transmission of pain in the C fibers
how long does pain relief via GCT last
relief only during the treatment
exp how ES affects the DPIT
ES produces noxious stim that will activate the release of opiopeptins like endorphins and enkephalins via analgesia system
how long does pain relief via DPIT last
longer lasting than GCT since opiopeptins stay in the blood
what are the modes of application for pain relief
conventional
acupunture-like
brief-intense
hyper stimulation
burst mode
IFC
conventional TENS is aka
high-rate TENS
explain what kind of ES conventional TENS uses
short duration high frequency pulses
what is the rationale of conventional TENS
produce comfortable sensations without muscle contractions to modulate acute pain
GCT
why is ES modulated
to prevent accommodation or adaptation of nerves that will lead to dec in AP and sensation
explain what kind of ES acupuncture-like TENS uses
repetitive stim of motor nerves or to stim A delta nerves
what is the rationale of acupuncture-like TENS
stim of motor nerves - repetitive muscle contraction or twitches
stim of A delta - brief sharp pain for DPIT
expected feeling of patient for acupuncture-like TENS
motor: visible muscle twitch
sensory: brief sharp pain
expected feeling of patient for conventional TENS
comfortable tingling sensation
acupuncture-like TENS is aka
low-rate TENS
explain what kind of ES brief-intense stim TENS uses
combines sensory and motor TENS; high freq and short pulse + low freq and long pulse
what is the rationale of brief-intense stim TENS
intensity up to patient’s maximal tolerance for DPIT
expected feeling of patient for brief-intense stim TENS
visible strong muscle twitches
explain what kind of ES hyperstimulation TENS uses
applied using probe electrode over acupuncture points
what is the rationale of hyperstimulation TENS
noxious stim over acupuncture points for relief via DPIT
expected feeling of patient for hyperstimulation TENS
highest tolerated painful stim
hyperstimulation is aka
point stim or electroacupuncture
explain what kind of ES burst mode TENS uses
stim is delivered in bursts
what is the rationale of burst mode TENS
pain relief via DPIT
expected feeling of patient for burst mode TENS
visible muscle contraction
explain what kind of ES IFC uses
alternating MFC that are slightly out of phase
uses of IFC
pain relief
muscle re-education
improving circulation
enhance healing process
compare LFC, MFC and HFC
LFC - has the physio effects but low penetration due to high skin resistance
MFC - low skin resistance; easier to penetrate but no physiologic effects
HFC - thermal effects
relate interference and IFC
since 2 MFC na out of phase mag kaka interference
constructive - waves adds
destructive - cancels each other
explain the concept of beat frequency and AMF
2 MFC - so may 4000 Hz and 4100 Hz
beat freq - is the diff = 100 Hz
apply concept of interference
phase na may constructive is the beat tas may destructive = series of beat and wala = heterodyned = LFC na sila with good penetration and physio effects
what is the carrier or base frequency
the lower frequency betw the 2 MFC
usual base frequency for sensory and motor
sensory - 4 kHz
motor - 2 kHz
what is the usual beat frequency
diff of about 1-200 Hz
usual beat freq for pain relief and motor
pain relief: 80-200 Hz
motor: < 50 Hz
compare constant beat freq and variable beat freq
constant - constant diff betw 2 circuits
variable - freq betw 2 circuits vary within a preselected range to address accomodation; 20 Hz - plus/minus 10 Hz in 100 Hz base
types of IFC
quadripolar static mode
quadripolar scanning mode
premodulated mode
hexipolar mode
exp quadripolar static
2 circuit static IFC field
4 pads in X pattern = 2 circuit = 2 IFC
but effects is one area intersection lang - exactly 45° to perpendicular lines between 2 circuits
exp quadripolar scanning
2 circuit static IFC field
4 pads in X pattern = 2 circuit = 2 IFC
but effect is larger area/scanning - about 45° to perpendicular lines between 2 circuits
use for quadripolar static
localized pain
use for quadripolar scanning
diffused pain
exp premodulated mode
bipolar/exogenous method
MFC is mix in the stim tas appli is via 2 electrodes lang - 1 circuit
exp hexipolar mode
3 circuit IFC c 3 pairs of electrode within in 2 Y-shaped applicators
3 currents intersect within the tissues
sensory effect of IFC
cutaneous stim of sensory nerve fibers
analgesic effect via GCT
wedensky inhib of type C nociceptive fibers - non-acute pain
motor effect of IFC
synch excitation of large diameter and lower threshold or more excitable motor nerves
glidemeister effect
wedensky inhib of motor nerves
exp the glidemeister effect
normal physio contraction - asynch
IFC will start synch then eventually mimic asynch or normal physio contraction
exp the wedensky inhib of motor nerves
d/t prolonged appli = loss of excitation since refractory state na
should be prevented kaya may variable beat
disadvantage of synch muscle excitation
early fatigue of the muscle
indications for both TENS and IFC
pain control
indications for IFC only
relief of muscle spasm
promote tissue healing
edema reduction
muscle re-education
contraindications for both TENS and IFC
over anterior cervical area
demand type cardiac pacemakers or implanted cardioverter-defibrillators
DVT
over pregnant abdomen, pelvic, lumbar in 1st trim
epileptic episodes
over hemorrhagic area
over cancer
w/in 3m from SWD
precautions for both TENS and IFc
over thoracic cage
over cranial are
over metal implants
confused or unreliable patients
over damaged skin
adverse effects of both TENS and IFC
burns - electric or thermal
blisters
