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Pain Control - TENS Flashcards

1
Q

what does TENS stand for

A

transcutaneous electrical nerve stimulation

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2
Q

what type of stimulus is TENS considered? what could change this?

A

external

TENS with dry needle

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3
Q

what is electroanalgesia

A

electrical stimulation for pain modulation

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4
Q

how do analgesic effects occur

A

electrical stimulation to peripheral/central NS

– more so focused on peripheral

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5
Q

what can be manipulated in TENS units

A

intensity
pulse rate
pulse width

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6
Q

what are dorsal column stimulators

A

electrodes inserted in dorsal column that are used to modulate pain

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7
Q

what is typically manipulated to avoid accommodation

A

frequency or pulse width

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8
Q

what type of device is a TENS unit? why does this matter?

A

its a class 2 medical device
– patient must be issued and instructed by medical professional on how to use for reimbursement to occur

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9
Q

explain education in relation to TENS administration

A

obviously how to use it, but also how to control intensity to achieve desired analgesic pain effects

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10
Q

modes of TENS application

A

conventional
burst mode
acupuncture like
brief intense

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11
Q

what is the differentiator between conventional vs acupuncture or burst mode TENS

A

conventional = sensory response
ac/burst = sensory and motor response

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12
Q

explain the practicality of conventional TENS

A

very much so, most common type used

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13
Q

what does conventional TENS stimulate

A

sensory level via large sensory fibers

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14
Q

how is accomodation possible with conventional TENS

A

modulation of intensity or decreased rate

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15
Q

explain the effectiveness of conventional TENS

A

effective as long as the stimulus is applied

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16
Q

what is the rate of conventional TENS

A

high = 60-150 pps

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17
Q

explain the width of conventional TENS

A

narrow = 50-100 microseconds

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18
Q

describe intensity related to conventional TENS

A

comfortable tingling sensation without muscle contraction

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19
Q

explain duration of conventional TENS treatment

A

until pain relief is achieved, should be within 15-20 min and less than 30

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20
Q

where to place electrodes when doing conventional TENS

A

on painful area

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21
Q

indications of conventional TENS

A

acute/chronic pain

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22
Q

when applying conventional TENS and you notice a motor response, what can be done?

A

increase pps

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23
Q

explain why intensity may change during conventional TENS treatment

A

as patient gets more comfortable with stimulus, intensity can be increased

if too intense, can move electrode away from area to decrease the subjective feeling of “intensity” (not the actual value)

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24
Q

remind me about the gate control theory… what cells are involved

A

a beta fibers are activated
blocking a delta and c fiber

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25
explain rate related to burst mode TENS
high rate stimulating current administered in bursts at a low rate current = 100pps bursts = 1-4pps
26
explain pulse duration of burst mode TENS
0.1-0.3 msec
27
explain treatment time related to burst mode TENS
20-45 minutes
28
what should be visually observed during burst mode TENS treatment
muscle contractions
29
explain effects of burst mode TENS and why?
effects can last several hours due to release of systemic endorphins
30
where to place electrodes in burst mode TENS
acupuncture points motor points trigger points
31
indications of burst mode TENS
sharp chronic severe pathologic pain
32
explain what acupuncture like TENS stimulates
small diameter nerve fibers C-fibers primarily
33
explain the effects of acupuncture like TENS application and why?
relatively longer period of relief due to endorphin release / liberation of endogenous opiates
34
indication of acupuncture like TENS
chronic pain syndromes
35
explain rate and width of acupuncture like TENS
low rate = 2-4 pps wide = 200 microseconds
36
explain intensity related to acupuncture like TENS
as high as patient can tolerate - looking for visible contraction
37
electrode placement in acupuncture like TENS
"acupuncture points" "well damn, you must be in a doctorate program or something"
38
explain rate and width of brief-intense TENS
high rate = >100-150 pps wide = >150-200 microseconds
39
explain intensity related to brief-intense TENS
noxious -- as high as the patient can tolerate looking for muscle contraction
40
explain electrode placement in brief-intense TENS
acupuncture points motor points trigger points
41
what type of muscle contraction is looked for during brief-intense TENS
tetanic muscle contraction
42
explain on and offtime related to brief-intense TENS
on = 5 sec to 1 min per pt tolerance off = 1-5x on time
43
explain treatment duration of brief intense TENS
as tolerated, max of 15 min
44
explain what brief-intense TENS can also be used for
will produce a brief surface analgesia --- can be used in more painful procedures to accommodate pain signal
45
explain tetanic muscle contraction and its purpose
muscle will maintain a contraction without fatiguing - causes endoprhin/enkephalin release that will modulate pain response via descending pathways
46
explain CNS stimulation related to brief-intense TENS
will stimulate periaqueductal gray region of midbrain via a-delta and C fiber afferents "Bypasses gate control theory"
47
explain the difference in stimulation necessary when comparing wide dynamic range vs nociceptive specific neurons
wide range = a beta fiber stimulation nociceptive = a-delta / c-fiber stimulation
48
in general, where do electrodes need to be placed
in place where patient can access them and reapply if necessary
49
explain skin resistance to flow in relation to distance between electrodes
direct relationship - want to have at least the size of another electrode between
50
explain why bracketed electrode placement would be indicated
larger treatment area
51
clinical use of TENS
orthopedic pain MSK pain decreased pain associated with inflammation acute post-op pain neurological pain OB/GYN associated pain
52
precautions of TENS
do not submerge in water (no shit) change in pressure against pads will change intensity of current educate patient that TENS should be used as much and as little as needed do not use while sleeping
53
explain supra-sensory TENS
application of tens that is slightly above sensory level -- aim to release endorphins and enkephalins in conjunction with gate control theory
54
explain supra-sensory dosage
dose dependent higher amplitude/intensity = higher analgesic response
55
types of opioid receptors
delta kappa mu
56
explain frequency associated with mu-opioid receptor stimulation
low frequency = 1-10 Hz
57
explain frequency associated with delta-opioid receptor stimulation
high = 50-150 Hz
58
explain how prescription opioids affect TENS application
will bind with Mu receptors -- making TENS ineffective at lower frequencies, will need high frequency
59
what opioid receptors does TENS stimulate
MU / Delta
60
explain what amplitude-dependent dosage is? why is it clinically important?
higher amplitude tolerated by patient = greater analgesic effect apply amplitude to "noxious level" then decrease back to "strong but tolerable" -- will naturally increase threshold of initial "noxious" intensity for treatment
61
what does intensity depend upon
pulse rate pulse width area of application
62
noxious TENS rate and width paramenters
high rate = 150 pps high width = 400 microseconds
63
on/off time of noxious TENS
10 sec on & 10 sec off with a 2 second ramp
64
treatment time of noxious TENS
15-20 min total
65
explain VAS scores related to noxious TENS
hit a 9/10 level initially, then reduce to a 5-7/10 for the actual treatment
66
electrode placement related to noxious TENS
surrounding painful area
67
considerations of noxious TENS
educate on anticipated risks/benefits --- typically for patients with central/peripheral sensitization of chronic pain syndromes
68
explain outcome pain measures associated with TENS interventions
should be collected during standardized activity that causes/onsets pain
69
how to objectively assess pain measures
pressure algometer
70
when should TENS be included
during functional activities and components of exercise

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