TENS Flashcards
6 Characteristic of TENS
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.
3 Pieces of TENS equipment
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.
Concept of Amplification
Pain is influenced by physiological, psychological, behavioral, cognitive, affective, and environmental factors.
3 Types of pain
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.
3 Characteristics of Melzack & Wall’s Gate Theory 1965: Sensory Theory of TENS
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.
4 Characteristics of the Endorphin Theory: Motor level theory of TENS
(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.
Acupuncture Theory
TENS alters flow of energy
Myofascial Theory
TENS stimulated local vasodilation which alters trigger point to decrease pain.
A TENS sensory technique
Conventional TENS
good for pts. w/ sharp well defined pain
Conventional TENS Pulse Frequency
50-100pps
Conventional TENS Pulse Duration
50-100 micro-seconds
Conventional TENS Tx. Time
15-30 min, all day, or when having pain (prn)
Conventional TENS pulse amplitude
(Dial) Turn up until pt. feels a tingling, tapping, or pins & needles, without a muscle twitch.
A TENS motor or acupuncture technique
Low Frequency TENS
Good for more diffuse, throbbing, burning pain
Low Frequency TENS pulse frequency
1-4pps
Low Frequency TENS pulse duration
150-200 micro-seconds
Low Frequency TENS tx. time
30-45 minutes
Low Frequency TENS pulse amplitude
Place electrode over motor point: turn up until a muscle gets a twitch
A TENS that applies brief intense stimulation.
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.
Modulation Concept
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.
Electrodes
Looking to chose the correct size to achieve specificity of muscle and enough penetration.
Carbon Electrodes
Need gel or wet sponge as transmission medium
Polymer Self Adhesive Electrodes
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.
Disposable Electrodes
Like a band-aide, readhesive is not great, one time use.
