estim and pain Flashcards
Whats TENS voltage, carrying frequency and intensity
all low
Whats IFC voltage, carrying frequency and intensity
low
medium
medium
Whats HVPC voltage, carrying frequency and intensity
high
low
high peak but low average
is HVPC biphasic
no, monophasic
Physiological rationale for EPA’s
segmental mechanisms
extrasegmental mechanisms
Placebo
segmental mechanisms
ascending
GATING
gating
the gate control theory
inhibition of T cells by activating AB, Adelta or c fibres
hows gating best achieved
high frequency, low intensity
TENS
weaknesses of segmental mechanisms
doesn’t account for pain in small diameter nerve fibres being destroyed
doesn’t consider role of higher centres in pain perception
extrasegmental mechanisms
descending
Stim of A-delta may provoke impulses at midbrain down SC to inhibit nociceptors
A delta sim releases ____ to inhibit _____ activity similar to _____
enkephalins
C fibers
morphine like
motor level of stem releases ____
dynorphins
extra segmental effects best evoked by
low frequency
high intensity
(AL TENS)
over motor points with intensity /pulse duration enough for mm twitch
TENS activates __ and ___ receptors
opioid
serotonin
does high or low frequency TENS impact serotonin
no , low is just as good as high
how to treat persistent pain
exercise manual Rx education self management EPA
why can EPA help with pain
pt gets positive experience with movement in less pain to normalize it
5 reasons estim/TENS is used clinically
relatively safe
evidence support physiological benefits
easy
PART of a treatment plan
4 contraindications for TENS
impaired cog/comm
recent fracture/osteop
seizure/epilepsy
electronic implant
HVPC TENS shared contraindications
recent fract / osteoporosis
impaired cog//comm
should you use ice and stim
NEVVER
adverse effects of stim
skin irrational (red) skin burns
reasons to change TENS settings
some work better in better areas of body
sensation can change
if two different size electrodes where the greater current intensity
under the smaller one
why is gel good
electrode specific and has higher salt
CONVENTIONAL TENS settings
80-150 HZ
60 micro
comfortable tingle, modulated
AL TENS settings
10Hz
200 microsexs
intensity to mm twitch at motor points
modulated
should you apply TENS daily
no, theres an opiod tolerance
outcome tests of TENS
VAS
NPRS
pain thermometer
disease specific scales
other outcome measures for TENS
pain relief
distraction from pain
dec feeling mm tension/spasm
indirect benefits of TENS
med reduced
enhanced function
psych benefits
ability to rest
5 things to chart with stim
that you covered contraindications/prec sensation test parameters response changes of treatment
t/f TENS inhibits cortical actives of various pain related areas
t
is setting intensity to patients by saying let it be strong but comfortable reliable
no
what mode of tens helps immediate pain
conventional
which TENS reduces pain more than ice
AL Tens
which TENS helps reduce long term pain
burst
