Week 6 Electrotherapy for Pain Modulation - Sensory and Motor Level Stim Flashcards
Sensory Level TENS
AKA Conventional TENS, (high/low) rate TENS
Stimulation at or above the sensory threshold, but (above/below) the motor threshold
Electrotherapy of choice for (acute/chronic) pain
Goal: strong, but comfortable tingling sensation
Analgesia as a result of the ______ theory
Analgesia - the inability to feel pain
high; below; acute; gate control
Sensory Level TENS
Patient should have (immediate/latent) response to stimulation
Relief of sxs only while stim is (on/off)
Gate closed > sx relief
Stim stops > gate no longer closed
Electrodes placed on or near site of pain
Surround the painful area
Place directly on the sensory nerve that innervates the site of pain
The pain should return when the stim stops but people tend to have less pain after. Could be centrally mediated effects (they believe the stim has helped them and it could be mental).
immediate; on;
Sensory Level TENS
Phase/Pulse Duration: - microseconds or high carrier frequency - Hz
Amplitude: strong (tingling/twitching)
Frequency: - pps/bps/hz > up to _ pps/bps/hz
Treatment Duration: Variable
High frequency TENS – more comfortable because there is less impedance (resistance in human tissue) and if our goal is pain relief that is good to do.
Carrier frequency – characteristic of alternating current. Frequency at which AC current is coming out of the wall. Just another word we are going to have to wrap our brain around.
4-100; 4000-5000; tingling; 80-110, up to 150
Sensory level TENS
Accommodation
Sensory afferents accommodate to constant stimulus - Occurs with sensory-level stimulation
Current modulation modifies stimulation to (minimize/maximize) accommodation > maximize analgesia
One issue with sensory level TENS, is the accommodation. This is not great because it limits how much analgesia I get.
minimize
Modulation is clinically important because we use it to make the sensory level stim (more/less) effective.
more
Motor level TENS
AKA (low/high) rate TENS, burst-modulated TENS, or acupuncture-like TENS
Stimulation parameters set to produce visible muscle contractions
Electrotherapy option for (acute/subacute or chronic) pain
Goal: (tingling/twitch) contraction
Analgesia as a result of the _____ theory
Higher amplitude may activate central mechanisms
Twitching refers to motor level tens .
If your target tissue is muscle, motor tens is really useful.
The stronger the stimulation the better analgesia you get as far as the response of analgesia.
Low frequency stim is a little bit more stingy as far as sensations that you feel.
If I am using stim for pain relief for sensory and motor stim, follow the patient’s response.
low; subacute or chronic pain; gate control;
Motor Level TENS
Patient should have (immediate/latent) response
May have longer lasting analgesia [for - hrs post-tx] with (lower/higher) amplitude, attributed to activation of central descending pathways
Electrode placement > target tissue
Along the muscle fibers of the painful muscle/area- Trying to create contraction – current flow along muscle makes that easier
On areas remote from the pain, e.g. motor points or acupuncture points - No additional hypoalgesic effect using acupuncture points
Put electrodes over the muscle in question. Trying to create a muscle contraction so good idea to put the electrodes over the muscle, just makes sense that way.
immediate; longer; 2-6; higher;
Motor Level TENS
Pulse duration: - microseconds
Amplitude: strong (tingling/twitch) contraction
Frequency: - pps
Goal with motor level tens: decreasing pain in a muscle that has subacute or chronic pain
These are the electrical parameters where it is easiest to get the response you are looking for.
Feel tingling first and then turn it up to get a strong twitch contraction. Make sure to tell the pt what they should expect to feel.
200-300; strong twitch; 2-10
Motor Level TENS
Frequency: - pps
Have to do motor level tens at a (low/high) frequency in order to maintain a twitch contraction and not tetany.
2-10; low
Motor Level TENS
Treatment Duration: - minutes
Duration of analgesia:
Depending on _____ and how pt feels during tx, onset can be immediate or latent; may lasts 2-6 hours
Default to 10-15 min to start just because not enough time at the clinic
Duration of analgesia – can last longer than sensory level stim. Choose type of stim that has a long lasting response.
15-45; intensity;
High Volt Pulsed Current (HVPC)
Waveform: twin peak monophasic PC
Pulse Duration: fixed within unit (- μsec)
Frequency: Can be adjusted within indicated range > - pps
Amplitude: Can be adjusted within indicated range to patient tolerance - up to V (-_ V in battery operated units)
Polarity: positive or negative
It is a short pulse duration which allows you to achieve a high amplitude without a painful response. Comparison: accidentally touching a hot stove – strong stimulus and not necessarily PAINFUL.
Allows you to get to high intensities fairly comfortably.
Less flexible to use because you might not be able to make pulse duration long enough. Might not be a great option for anything outside of sensory level stim.
HVPC is the stim of choice for tissue healing and wound healing (it moves stuff in response to polarity). This current (HVPC) is mainly used for pain relief and wound healing.
You are getting a DC effect with HVPC, whether or not pt feels burning is pt dependent.
50-200; 1-120; 500; 300-400
Pros and Cons of HVPC
Pros:
Comfortable form of stimulation - high voltage output and short pulse duration easily overcome skin impedance
Can set frequency and amplitude to achieve desired response
Cons:
Difficult to prevent accommodation - can only increase amplitude
Got it
Interferential Current (IFC)
Current: Alternating current at fixed carrier frequency of - Hz
Waveform: Sine wave
Must have (1/2) channels/(2/4) electrodes in quadripolar (parallel/crossed) setup
Pulse duration: DON’T HAVE ONE – not pulsed current, BUT
Can use carrier frequency to calculate what it would be. Take inverse of the carrier frequency and gives area under the curve to know how long the pulse duration of one cycle will be.
Another type of current used for pain relief.
It is an AC current – comes out of the wall.
ALWAYS MUST HAVE 2 CHANNELS/4 ELECTRODES ^^^
2000-5000; 2; 4; crossed
Interferential Current (IFC)
Bipolar or Premodulated (Premod)
(1/2) channel, (2/4) electrodes
NO crossing of current on the patient
Interference pattern performed inside the unit
Most IFC can choose premodulated to do a bipolar setup potentially for a (smaller/larger) treatment area.
1; 2; smaller
Interferential Current (IFC)
Comfortable form of stimulation due to (low/high) carrier frequency can overcome skin resistance easily
Set beat frequency and amplitude to achieve desired response
Sweep and scan modes can help reduce accommodation
Sweep = is a (amplitude/frequency) modulation Scan = is a (amplitude/frequency) modulation
high;
