TENS

Question 1

Define TENS

Answer 1

TENS is a type of electrotherapy where electrodes apply an electrical current to the skin which stimulates sensory nerves relieving pain through pain gate mechanism and endogenous opioid mechanism.

Question 2

What are the key tips when using TENS?

Answer 2

1. Make sure the patient is in a comfortable position.
2. Clean the skin before applying the electrodes.
3. Advice the patient to never use TENS whilst driving or when operating machinery.
4. If 2 electrodes aren’t very effective you can change it to 4 as these will have a greater surface area so stimulate more sensory nerves.
5. High TENS = 80-130 Hz and short pulse width = pain gate theory. For more acute pain.
6. Low TENS = 2-5Hz and large pulse width = endogenous opioid system. For more chronic pain.
7. If low TENS or high TENS isn’t effective at reducing pain you could try change the settings to burst mode as this is 2-3 bursts of around 100Hz a second. This will be more effective as it will stimulate both A beta fibres and A delta fibres. Thus meaning that both the pain gate mechanism and endogenous opioid mechanism will be stimulated.
8. If patient is using a TENS machine for long periods make sure they change the pulse width and frequency over this time to prevent patterned stimulation.

Question 3

List all the contraindications of using TENS as an intervention.

Answer 3

1. If a patient cannot understand a physios instructions or is unable to co operate with them.
2. If a patient is pregnant.
3. Implanted electronic devices such as pacemakers.
4. Allergic response to the electrode or gel.
5. Skin conditions such as eczema.

Question 4

Identify 3 precautions that you should take when using TENS on a patient.

Answer 4

1. Abnormal skin sensation
2. Epilepsy
3. Use of abdominal TENS during labour may interfere with foetal monitoring equipment.

Question 5

Can you explain how you would use TENS on a patient?

Answer 5

1. Ask the patient for consent.
2. Remove any clothing or anything else which may be a barrier to treatment.
3. Get the patient in a comfortable position.
4. Carry out skin sensation test via blunt and sharp test.
5. Apply gel to the electrodes if they do not already have it on.
6. Then apply the electrodes to the injury but make sure they are as far apart as possible so they can be as effective as possible.
7. Explain to the patient the TENS should make them feel a comfortable pins an needles sensation
8. Then change the settings so they are at a high TENS or low TENS and gradually increase or decrease so that you find the settings the patient is most comfortable in. If high or low TENS isn’t being effective change to burst mode.
9. Turn off electrodes before removing