Type of TENS Flashcards
Types of TENS
sensory level motor level noxious level sub sensory level peripheral nerve block
Sensory Level TENS
provides stimulation at or above sensory threshold but below motor
Pain theory for sensory level TENS
gate control
Sensory Level TENS Neuron stimulation
stimulation to large diameter A-beta fibers activates the SG to inhibit transmission of pain from the A delta and C
Sensory TENS pulse duration
2 - 50 usec
sensory TENS amplitude
increase to create effect (buzzing/tingling)
sensory TENS frequency
50 to 100 pps (50 pps common)
sensory TENS treatment time
20-30 minutes
can be used up to 23 hours
Modulations
BURST MODE
prevent sensory accommodation
machine changes frequency, pulse duration, amplitude, on/off times or a combination
Uses of Sensory TENS
- post-op pain
- acute pain
- labor and delivery pain
- hypersensitvity
- phantom pain
Motor level TENS
low rate or acupuncture like
creates rhythmic non-fused muscle contractions
Pain theory for motor level TENS
supraspinal mechanism (endorphin system) so can create a longer lasting effect after treatment session ends (hours)
Gate theory could also work with low amplitudes
pulse duration for Motor TENS
150-300 usec
amplitude for Motor TENS
increase until there is contraction
Frequency for Motor TENS
2-4 pps
Treatment time for Motor TENS
30-45 minutes
Modulation for Motor TENS
not important since effect on motor system
uses for Motor TENS
- chronic pain
- deep paini (visceral)
- throbbing type pain
Noxious level TENS
applied to pain fibers usually via a probe
can be applied directly to the area or to a remote area
follows acupuncture points
endorphin system
pulse duration Noxious level TENS
2 msec to 1 sec
frequency Noxious level TENS
1-6 or > 100 pps
amplitude Noxious level TENS
increase to get noxious response
treatment time Noxious level TENS
seconds to minutes
uses for Noxious level TENS
trigger points and chronic pain
Sub-sensory or Microcurrent TENS
- monophasic or direct current
- patient feels little or no sensation when on
- wound healing agen
pain theory for Sub-sensory or Microcurrent TENS
mimics bioelectric potential
Peripheral Nerve Block
can provide analgesia in order for a short painful procedure to be performed
blocks painful signal from reaching CNS via peripheral nerve
pulse duration Peripheral Nerve Block
> 150 usec
frequency Peripheral Nerve Block
50-100 pps
amplitude Peripheral Nerve Block
increase until get analgesia (higher than sensory)
may get a slight contraction
treatment time Peripheral Nerve Block
apply during procedure (usually 5-10 minutes)
Electrode Placement
-over area of pain
-proximal to site of pain
-bracket the pain
-spinal nerve root to area of pain
-distal to pain over nerve going through area
-superficial aspect of peripheral nerve to area
-motor point
-trigger point
-dermatome/myotome area
-acupuncture point
-
Diagnoses TENS may help
- Peripheral nerve injuries
- osteoarthritis
- incisional pain
- musculoskeletal trauma
- bruns
- chronic pain
Poor response to TENS
- central pain (injury to CNS)
- psychosomatic pain
- pain in a person with drug addiciton
Choosing a TENS unit
- waveform: usually biphasic symmetrical
- pulse duration: 2 usec to 1 sec
- frequency: 1 to 100 pps
- channels: at least 2
- modulation to prevent accommodation
russian current
typically use for strong muscle contractions
high frequency carrier wave throughout to penetrate tissue more effectively
interferential
high frequency carrier wave
-relies on 2 waveforms intersecting each other
interferential amplitude modulated effect
requires 4 electrodes
most commonly used in pain management
High Volt Pulsed Current
has less anodal and cathodal effects on tissue due to short PF and high voltage
wound healing
can create muscle contraction in smaller muscles
High Volt for Pain Control
can be used for pain management via sensory tens
Magnetic Stimulation
uses pulsed magnetic field to stimulate to obtain a contraction and for pain management
magnetic stimulation disadvantages & advantages
D - difficult to identify coil placement near a nerve
A - painless to patient
Neuroaxial implants for pain
dorsal column stimulators
used to control severe pain
gate theory and AB fibers are stimulated directly
Neuroaxial implants for pain
motor cortex stimulation
done but mechanisms and effectiveness are still under debate
