TENS

Question 1

6 Characteristic of TENS

Answer 1

1) It is an application of low voltage electrical stimulation for pain control.
2) Stimulates sensory receptors
3) Does not generally “cure the pain” it manages it
4) Alternative therapy to medication
5) Allows the client to perform ADL’s & Home exercise
6) Increases the quality of life for those who have chronic pain.

Question 2

3 Pieces of TENS equipment

Answer 2

1) Device: portable and clinical
2) Lead wires: polarity of wire (red or black) does not matter with TENS
3) Electrodes: adhesive v. carbon. Uses 2 or 4 electrodes.

Question 3

Concept of Amplification

Answer 3

Pain is influenced by physiological, psychological, behavioral, cognitive, affective, and environmental factors.

Question 4

3 Types of pain

Answer 4

1) Acute: rapid/sudden onset. Sympathetic response- fight or flight.
2) Chronic: More diffuse, all consuming, affects function; greater than 30 days.
3) Referred: in an area other than original injury sit. Hypersensitive areas; pain generally in the fascia.

Question 5

3 Characteristics of Melzack & Wall’s Gate Theory 1965: Sensory Theory of TENS

Answer 5

1) Nocioceptive (pain) nerve fibers are C fibers which are poorly mylenatied and therefore travel slowly.
2) Sensory nerve fibers are A-beta fibers of Alpha A fibers which are highly myelinatied fibers and travel faster to the hypothalamus.
3) Competition of the two fibers result in sensory stimulation blocking the lesser myelinated pain fibers.

Question 6

4 Characteristics of the Endorphin Theory: Motor level theory of TENS

Answer 6

(must create a twitch)

1) Electrical stimulation increases levels of endorphins in central and peripheral nervous system.
2) TENS stimulates motor nerve which facilitates release of endorphins.
3) Believers of this theory feel the analgesic effect is systemic and long lasting.
4) Requires a minimum of 20-30 min of TENS to get the endorphin release.

Question 7

Acupuncture Theory

Answer 7

TENS alters flow of energy

Question 8

Myofascial Theory

Answer 8

TENS stimulated local vasodilation which alters trigger point to decrease pain.

Question 9

A TENS sensory technique

Answer 9

Conventional TENS

good for pts. w/ sharp well defined pain

Question 10

Conventional TENS Pulse Frequency

Answer 10

50-100pps

Question 11

Conventional TENS Pulse Duration

Answer 11

50-100 micro-seconds

Question 12

Conventional TENS Tx. Time

Answer 12

15-30 min, all day, or when having pain (prn)

Question 13

Conventional TENS pulse amplitude

Answer 13

(Dial) Turn up until pt. feels a tingling, tapping, or pins & needles, without a muscle twitch.

Question 14

A TENS motor or acupuncture technique

Answer 14

Low Frequency TENS

Good for more diffuse, throbbing, burning pain

Question 15

Low Frequency TENS pulse frequency

Answer 15

1-4pps

Question 16

Low Frequency TENS pulse duration

Answer 16

150-200 micro-seconds

Question 17

Low Frequency TENS tx. time

Answer 17

30-45 minutes

Question 18

Low Frequency TENS pulse amplitude

Answer 18

Place electrode over motor point: turn up until a muscle gets a twitch

Question 19

A TENS that applies brief intense stimulation.

Answer 19

Noxious TENS
Rarely used because it is very uncomfortable
Very low pulse frequency and duration.
Hold on usually w/ a probe stimulator 20 seconds over point- very aggressive, high skill level.

Question 20

Modulation Concept

Answer 20

Pts. will accommodate over time if left on continuous setting. Once TENS set up need to choose an alternate setting (i.e. modulation, burst) which will deliver the stimulation in a random fashion to reduce accommodation.

Question 21

Electrodes

Answer 21

Looking to chose the correct size to achieve specificity of muscle and enough penetration.

Question 22

Carbon Electrodes

Answer 22

Need gel or wet sponge as transmission medium

Question 23

Polymer Self Adhesive Electrodes

Answer 23

Can re-use; watch for loss of stickiness. Rehydrate and reapply to plastic between use, store in ziploc pouch. Too old: creates skin problems due to uneven current density.

Question 24

Disposable Electrodes

Answer 24

Like a band-aide, readhesive is not great, one time use.

Question 25

Electrode sizes

Answer 25

1”, 2”, 3”

Can cut down to 2” - most common w/ UE

Question 26

Electrical current per unit area

Answer 26

Current Density

The smaller the electrode the higher the current density (delivering same amount of current but to a smaller area)

Question 27

3 Characteristics of Small Electrodes

Answer 27

1) greater current density so may not need to turn amplitude up as far to get a response.
2) Targets the stimulation and therefore cuts down on overflow to adjacent tissue.
3) Increase chance of burning or galvanic response if less than 1”

Question 28

3 Characteristics to Electrode Placement Choices

Answer 28

1) Identify the area of worst pain and place one electrode there and one proximal.
2) Determine the sensory dermatone pathway and place electrodes within the dermatone, at least one proximal.
3) Over a motor point of acupuncture paint (use a chart)

Question 29

5 Patterns of Electrode Placement

Answer 29

1) Proximal: Between brain and pain
2) Parallel: On either side of an incision site or scar
3) Crossed Method: use of 4 electrodes on 4 corners w/ the worst pain in the center
4) Unilateral, linear, and overlapping with distal point.
5) Contra-laterally: trait opposite side: used to treat phantom pain or RSD pt.s who can’t tolerate.

Question 30

What occurs when electrodes are placed to close

Answer 30

They get a higher current density at surface and therefore create a skin reaction.
Penetration depth is directly related to the distance of the electrodes (if you spread them apart you get a deeper penetration)

Question 31

What creates a resistance to current

Answer 31

Dirt, sweat, lotion.
Get in the habit of cleaning the skin.
Hair (shave)
Dry skin, poor contact/old electrode.

Question 32

6 Common uses for TENS

Answer 32

1) Acute Chronic Pain
2) Phantom limb pain
3) Post operative pain
4) Obstertic Pain
5) Neurological pain: Shingles
6) Potential Painful Tx’s. (?)

Question 33

Contraindication and Precautions

Answer 33

Follow general electro-modality

Question 34

TENS Application

Answer 34

Position in a place of relaxation, ask questions, inspect skin, remove lotions that limit penetration. Assess pain level before tx.
Explain procedure, describe the sensation, & potential benefits.
Place elecdtrodes, set to continuous, select parameters (pulse frequency and pulse duration)
Turn machine on slowly increasing the amplitude until pt. reports a sensory response.
Adjust to one of the other settings (burst, modulate, etc.) to prevent accommodation.
Evaluate effectiveness with a pain scale and or ability to complete a fx. task.