TENS Flashcards

1
Q

ES: TENS - Physiological Effects

A
  • Pain inhibition through gate-control therory:
    • Large A-beta fibers activate inhibitory interneurons in dorsal horn, inhibiting smaller A-delta and C fibers.
    • Also enkephalin release which combines with opiate receptors to depress release of substance P.
  • Pain modulation through descending pathways
    • Noxious stim generates endorphin production.
    • Efferents from PAG and other areas travel through dorsal SC and synapse with enkephalinergic interneurons in SC to presynaptically inhibit release of substance P from A-delta and C fibers.
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2
Q

ES: TENS - Waveform

A

Typically assymetrical biphasic Zero net direct current Pulsed monophasic sometimes used

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3
Q

ES: TENS - Modulation

A

Continuous or Burst

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4
Q

ES: TENS - Conventional High-Rate Indications

A

Acute or chronic phase of pain Modulation of pain via inhibition of pain fibers by large-diameter A- fiber activation

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5
Q

ES: TENS - Conventional High Rate Parameters

A
  • Onset of p! relief: fast
  • Amplitude: comf tingle, parasthesia, no ms response
  • Pulse Rate: 50-80 pps (75-120)
  • Pulse Duration: 50-100 microseconds
  • Mode: continuous
  • Duration of Tx: 20-60 minutes
  • Duration of p! Relief: short
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6
Q

ES: TENS - Acupuncture Indications

A

Chronic phase of pain Analagesia produced through stimulation-evoked production of endogenous opiates

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7
Q

ES: TENS - Acupuncture Parameters

A
  • Onset of p! relief: 20-40 min
  • Amplitude: strong, comf rhythmic twitches
  • Pulse Rate: 1-5 pps
  • Pulse Duration: 150-300 microseconds Mode: continuous
  • Duration of Tx: 30-40 minutes
  • Duration of p! Relief: long-lasting
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8
Q

ES: TENS - Brief Intense Indications

A
  • Rapid onset, short term p! relief during painful procedures (burns)
  • Wound-debridement
  • Deep friction massage
  • Joint mobilization
  • Passive stretching
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9
Q

ES: TENS - Brief Intense Parameters

A
  • Onset of p! relief: -
  • Amplitude: to patient tolerance
  • Pulse Rate: 80-150 pps
  • Pulse Duration: 50-250 microseconds
  • Mode: continuous
  • Duration of Tx: 15 minutes
  • Duration of p! Relief: temporary (30-60 minutes)
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10
Q

ES: TENS - Burst Mode Indications

A

Combines characteristics of high and low rate TENS. Stimulates endogenous opiates (current is more tolerable)

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11
Q

ES: TENS - Burst Mode Parameters

A
  • Onset of p! relief: Similar to low rate
  • Amplitude: comf intermittent parasthesia
  • Pulse Rate: 50-100 pps,in bursts of 1-4 pps
  • Pulse Duration: 50-200 microseconds
  • Mode: continuous
  • Duration of Tx: 20-30 min
  • Duration of p! Relief: long-lasting (hours)
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12
Q

ES: TENS - Hyperstimulation (point) Indications

A

Uses small probe to locate and noxiously stimulate acupuncture or trigger points. Multiple points per treatment

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13
Q

ES: TENS - Hyperstimulation (point) Parameters

A
  • Onset of p! relief: similar to acupuncture
  • Amplitude: strong, to patient tolerance
  • Pulse Rate: 1-5 pps
  • Pulse Duration: 150-300 microseconds
  • Mode: -
  • Duration of Tx: 15 to 30 second increments
  • Duration of p! Relief: long lasting
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14
Q

ES: TENS - Modulation Mode

A

Modulate other TENS modes to prevent neural/perceptual adaptation. Can change frequencies, intensities or pulse durations by 10+ % 1-2 times per second

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15
Q

ES: TENS - Electrode Placement

A
  • Acupuncture site,
  • dermatome distribution of involved nerve,
  • over painful site,
  • proximal or distal to pain site,
  • segmentally related myotomes,
  • trigger points.
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16
Q

ES: TENS - Indications

A
  • Pain modulation through activation of central inhibition of pain transmission (Gate theory)
  • Pain modulation through descending pathways generating endogenous opiates
17
Q

ES: TENS - Contraindications

A
  • Pt w/ demand type pacemaker or over chest w/ cardiac dx
  • NOT applied over:
    • eyes,
    • larygneal/pharyngeal ms,
    • head or neck following CVA
    • Epilepsy
    • mucosal membranes