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Physical Agents II > Pain Modulation with Electrotherapy > Flashcards

Pain Modulation with Electrotherapy Flashcards

1
Q

Gate Control Theory

A

Uses a-Betas to block C fibers
- C and A-delta inhibit/block inhibitory interneurons
- a-Beta fibers activate inhibitory interneurons
- Theory is that e stim activates inhibitory interneurons to block fibers from going to the brain

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2
Q

What is Stimulation Produced Analgesia

A
  • Stimulation of the Periaqueductal gray region produces profound, selective analgesia
  • Not associated with general inhibition of afferent input
  • Can still respond to touch, pressure and temperature
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3
Q

How does stimulation produced analgesia work?

A
  • Descending projections block the output of neurons from laminae I and V via direct and indirect inhibitory actions.
  • They also interact with endogenous opioid containing circuits in the brain
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4
Q

Endogenous Opioids

A
  • Manufactured by the brain
  • Bind to opioid receptors distributed widely in the CNS, but are particularly concentrated in areas that process nocicepetive information (PAG, raphe nuclei and dorsal horn)
  • we are trying to get opioids to bind to receptor sites to decrease sensation of pain
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5
Q

Which is the better pain control theory for chronic pain?

A

Stimulation Produced Analgesia

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6
Q

What nerve fibers are recruited with high frequency TENS

A

large diameter, superficial cutaneous nerve fibers
(sensory-level TENS)

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7
Q

High frequency TENS parameters

A
  • Frequency: 50-100 + pps
  • Amplitude: Perceptible “tingling”
  • Phase duration: low (<150 microsec)
  • Treatment time: 30 mins
  • Analgesia time:: minimal residual effect
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8
Q

Low Frequency TENS

A
  • Produces a visible muscle contraction
  • A.k.a. low rate TENS and motor TENS
  • Some “acupuncture-like TENS” is based on the same principle
  • Supported by endogenous opiate mode of pain modulation
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9
Q

Low frequency TENS parameters

A
  • Frequency: 2-4 pps
  • Amplitude: Strong visible contraction
  • Phase duration: > 150 microsec (200-300)
  • Treatment time: 30-45 min
  • Analgesia time: hours
  • passive treatment
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10
Q

Noxious level stimulation

A
  • A.k.a. hyperstimulation
  • Can be performed in a remote site
  • Endorphin mediated mechanism
  • May get motor nerve stimulation, but often
    applied to area with minimal motor nerve
    fibers
  • Point stimulation (right over area that hurts)
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11
Q

Noxious level stimulation parameters

A
  • similar to motor level stimulation except:
  • phase duration is long ( up to 1 msec)
  • treatment time is seconds to minutes
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12
Q

Comparison - Conventional

A
  • higher frequency
  • low intensity
  • short phase duration
  • moderate treatment time
  • minimal carry over
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13
Q

Comparison - Motor/Noxious level

A
  • lower frequency
  • High intensity
  • Long phase duration
  • Long/short treatment time
  • long carry over
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14
Q

Frequency

A
  • Abeta few synapses, myelinated –> moves fast –> high frequency
  • SPA or opioid modulation need time to build up chemicals –> no need for high frequency; also, higher frequency –> stronger motor contraction (not desirable)
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15
Q

Phase duration

A

Need longer phase duration to recruit motor nerves and very long PD to stimulate areas related to noxious nociceptors such as C-fibers

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16
Q

Multiple methods of electrode placement

A

– At site of pain
– Follow nerve path
– Dermatonal
– Acupuncture points
– Crossing (ICF)

17
Q

What is Interferential Current

A
  • uses “medium frequency” (>1000 Hz); most often 2500 Hz or 4000 Hz
  • Need two circuits of slightly different frequency
  • Current #1: 4000 Hz
  • Current #2: 4100 Hz
  • Interference Frequency = 100 Hz
18
Q

How is IFC modulating pain?

A
  • Carrier frequency is 4000Hz (4000 cycles
    per second) –> 1/4000 =250sec –> ½ for
    phase (1/2 cycle) duration = 125 microsec
19
Q

What kind of nerve fiber can we recruit at 125 microseconds?

A

A beta sensory fibers

20
Q

What do the crossing circuits of IFC do

A
  • “clover leaf” distribution of stimulation
  • More 3-D effect
  • Theory that higher frequency –> less skin impedance –> more penetration
21
Q

How is IFC different from TENS?

A
  • Scan feature gives even larger coverage area
  • Many modulations
    – Scan for amplitude ?
    – Always use “sweep” which is a frequency modulation
  • Electrodes must be crossed to get all effects
22
Q

What does scan allow?

A
  • allows amplitude to go down then come back up and repeat
  • Dr Conroy is ok with 20% scan
23
Q

What is sweep

A

a frequency modulation that is predetermined
- helps prevent accommodation
- 80-150 is pretty common

24
Q

Comparison - TENS

A
  • relatively low frequency (2-100 pps)
  • uses gate control theory or opiate theory
  • multiple electrode configurations

Physical Agents II (8 decks)

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