06-05: TENS, Biphasic

Question 1

TENS

Answer 1

• Transcutaneous electric nerve stimulation

- Commonly used as E-Stim for pain management, but term covers more than just that type

Question 2

Primary application - TENS

Answer 2

• Pain management
• Gate Theory = Sensory, tingling, no contraction (short term)
• Endogenous Opiates = Muscle contraction (long term)

Question 3

Indications for TENS

Answer 3

• Post-op pain
• During labor and delivery
• Bone fractures
• Chronic pain
• Trigeminal neuralgia
• Phantom pain
• Antiemetic effects (nausea)
• Improved blood flow

Question 4

Contraindications for TENS

Answer 4

• Cardiac pacemaker
• Epilepsy
• First trimester of pregnancy
• Over pregnant uterus
• Anterior transcervical area

Question 5

General parameters - TENS

Answer 5

• Pulse Duration: 20-400 microsec
• Pulse Frequency: 1-200 Hz
• Current Amplitude: 0.1-120 mA

Question 6

Conventional TENS

Answer 6

• Frequency: 50-150 Hz (high)
• Duration: 20-100 microsec (short)
• Amplitude: 10-30 mA (low)
• Stimulate thick fibers to inhibit pain (thin) fibers
• Uses short duration, high frequency current with low amplitude (high for sensory, below motor threshold)
• Avoid painful area
• Use when performing ADLs
• 30 min. Rx
• Incorporates GT

Question 7

Acupuncture-like TENS

Answer 7

• Frequency: 1-4 Hz (low)
• Duration: 100-200 microsec (long)
• Amplitude: 30-80 mA (Mod - mm twitch)
• Place on muscle you want to activate
• Pain relief lasts for several days
• Longer pain relief, not used during ADLs, interferes with task
• 20-45 min. Rx
• Incorporates EOT

Question 8

Pulse Burst

Answer 8

• Frequency: 70-100 Hz/burst
• Duration: 40-75 microsec
• Amplitude: 30-60 mA

Question 9

Brief Intense (High-Intensity)

Answer 9

• Frequency: 70-100 Hz/burst
• Duration: 150-200 microsec (long)
• Amplitude: 30-60 mA (moderate)
• Paresthesia
• 15 min. Rx

Question 10

Waveforms

Answer 10

• Monophasic Pulsatile (above)
• Biphasic Pulsatile (above/below)
• Spiked square, rectangular, Sinusoidal

Question 11

Electrode placement

Answer 11

Site of nerve root, trigger point (in place of friction massage), acupuncture site, key point of pain

Question 12

Documentation of TENS treatment

Answer 12

• Type of TENS
• Frequency, Pulse Duration, Amplitude
• Units of measure
• Location (specific so can be reproduced - Ex: Bilateral @ C5)
• Time of treatment
• How many electrodes (monopolar, bipolar, quadripolar)