TENS Flashcards
What is the purpose of EStim?
To transmit an electrical signal through the skin that will stimulate appropriate nerve fibers that will result in pain relief
What is TENS?
Transcutaneous Electrical Nerve Stimulation
Gate Theory of Pain
Pain stimuli travels along #1 neuron to the Substantia Gelatinosa in the dorsal horn synapse with #2 neuron that travels and crosses the Spinothalmic Tract and synapses with #3 neuron from the Thalamus to the Cerebral Cortex
Pain Response
Stimulus travels down the Corticospinal Tract for motor response. Blocking pain messages is done through stimulation and release of various opiates in the CNS. Those opiates affects the ascending pathways.
How does pain response to Conventional TENS?
TENS activates large Ab nerve fibers that facilitate the release of interneuron enkephalins in the Substantia Gelatinosa to block pain fibers input to the transmission cell during pre synaptic inhibition
How is pain blocked?
Via EStim by closing gate to pain fibers input
Parameters= high PR (80-100) short PW (50-70)
What three areas release opiates?
Pituitary, periaqeductal gray, and Raphe Nucleus
Which opiates does Raphe Nucleus release?
Serotonin, Adrenocorticotropic Hormones, norepinephrine, dopamine
Where is the Raphe Nucleus found?
Pons and Medulla
Where is the PAG found?
Midbrain
Beta endorphins are produced where?
Primarily in the anterior pituitary stimulate Ad and C pain fibers via twitch muscle contraction
Parameters= PR (1-5) PW (200)
Internal Microscopic changes to increase pain
Decrease circulation, oxygen supply, lymphatic clearing, nutrient supply
Increase metabolism, muscle fatigue, inflammation, edema
Positioning of electrodes
Primary sites of pain
- nerve roots adjacent to spinal column
- along course of peripheral nerve
- related motor of trigger acupuncture points
- points of lowest electrical resistance
Advantages to using EStim
Valid method of pain control Efficient and easy Non invasive to skin Portable Biologically safe
Indications
Acute and chronic pain Edema Wound care Muscle strengthening Circulation peripheral disorder Impaired ROM Muscle dystrophy Pain
What is tic doloureaux?
Painful trigeminal neuralgia
Chronic Conditions treated by EStim
Lbk, neck pain, herpes zoster, tic doloureaux, headaches, DJD, Cancer, arthritis
Contraindications
Demand pacemaker, over carotid sinus, over any structure that crosses the uterus- pregnancy, cancerous malignancy, thrombosis, crossing the phrenic nerve , H/O cardiac disease
Precautions
Secure electrodes, gradually increase intensity, do not change PR or PW while the unit is ON, do not increase PR or PW with high intensity
Pulse rate TWITCH
1-10 ops
Pulse rate TETANY
> 15-200 pps
Beta Endorphins release
2-5 pps
Pulse rate NON FATIQUEING TETANY
50-100 pps
Pulse rate FATIQUEING TETANY
80-100 pps up to 5000
Pulse rate NEUROMUSCULAR REEDUCATION
50 pps
Pulse rate MUSCLE SPASM
100 pps or 80-120pps sensory intensity
How is PW measured?
In microseconds
What is peak current?
Peak current is highest amount of milliamps that can be delivered at peak wave
What is average current?
Is the average amount of electrical current being delivered during session can be seen on the meter
What is the PW for enervated muscles
300 Milliseconds
What is normal or comfortable range for PW
20-200 microseconds
Shorter PW requires what?
Higher intensity PR
Define interpulse?
A period between pulse of phase where there is no current delivered
Wider PW result in what?
Deeper stimulation
How do you increase average current?
Increase:
current intensity
Pulse duration
Pulse rate
Higher peaks ability
Ability to reach and affect deeper structures as long as the conductivity of tissue remains the same– no bone in way
What is optimal peak current
Lowest peak level that can achieve response
What is pulse rate
Is the amount of pulses being different at a certain period normally measured in seconds
If you increase PR what else increase?
Average current
Good cycle for motor stimulation ?
1:5 rise and decay
100 pps FATIQUEING muscle at what timeframe?
1-2 minutes so rise and decay time is needed
Pulse charge or phase charge
Amount of electrical energy delivered to tissue with each pulse of phase
Pulse charge is measured how?
In microcoullombs
Formula for microcoullomb
Phase charge times number of phases time number of pps
Weak stimulator
12-15 microcoullombs
Moderate microcoullomb
20-25 microcoullombs
