TENS Flashcards
(160 cards)
1
Q
What are the contraindications to TENS?
A
Treating pain of unknown or unidentified origin
2
Q
What is TENS (transcutaneous electrical stimulation) ?
A
All therapeutic stimulators that deliver electrical current at the electrode/skin interface
3
Q
T/f: TENS units are small portable stimulators for pain
A
True
4
Q
What are the different muscle stimulators?
A
NMES
FES
EMS
5
Q
What is the most common use of electrotherapy?
A
Pain modulation
6
Q
TENS units are _____ and ______ treatment
A
Complementary and adjunct
7
Q
What should TENS be used as an adjunct to?
A
An exercise program and fxnal training
8
Q
T/f: TENS is safe with relatively few contraindications
A
True
9
Q
T/f: TENS is non-invasive
A
True
10
Q
Who can administer TENS?
A
PT, AT, patient once educated
11
Q
Why is self administration of TENS important?
A
Bc it empowers pts to take control of their pain management
12
Q
T/f: TENS provides relatively instantaneous pain relief
A
True
13
Q
What is the pulse duration for TENS flex it (EMSI)?
A
50-300us
14
Q
What is the frequency for TENS flex it (EMSI)?
A
2-150 Hz
15
Q
What is the waveform for TENS flex it (EMSI)?
A
Biphasic (symmetrical/assymetrical)
16
Q
What is the pulse amplitude (intensity) for TENS flex it (EMSI)?
A
0-54 mA, 0-27V at 500 ohms
17
Q
What types of output can be used with the TENS flex it (EMSI)?
A
Normal, burst, MRW, SD, BiPulse
18
Q
What are normal TENS parameters?
A
Fixed/adjustable frequency and duration
19
Q
What is burst TENS?
A
Bursts of 7 pulses, 2/sec, 100Hz fixed, duration adjustable
20
Q
What is MRW TENS?
A
Modulated rate and width
Rate and width automatically varied 50%
R/W adjustable
21
Q
What is SD TENS?
A
Strength duration, modulates intensity and pulse duration
Amplitude increases, duration decreased, vice versa
Rate and width adjustable
22
Q
What is BiPulse TENS?
A
Channel 1 fixed 4 Hz
Channel 2 fixed 100 Hz
On 1 sec off 1 sec
Duration adjustable
23
Q
At least ____% MVIC needed for TENS to be effective
A
50
24
Q
Where can electrodes be placed with TENS?
A
At the site of injury
Around or over the painful area
Over the course of the peripheral nerve
Spinal nerve roots of spinal nerve innervation the painful dermatomes of the involved region
Acupuncture/trigger points, motor points, on myotomes related to the painful area
CL mirror side
25
When would we put the electrodes for TENS on the CL mirror side?
When treating phantom limb pain
26
What are different duration of TENS that can be effective for pain?
20 min TENS
40 min TENS
60 min TENS
60 min placebo
27
How often should TENS be done for optimal pain management of OA knee pain?
5x/week for at least 2 weeks
28
What it the most optimal duration of TENS for OA of the knee?
40 min TENS for over 4 hours of relief
29
Why do we often do 15 minutes of TENS in the clinic if longer works better?
Bc of time restraints and bc 15 minutes is a billable unit
30
T/f: using TENS for pain can be just as effective as OTC NSAIDs without the GI side effects
True
31
What are the 5 modes of TENS?
Conventional TENS (sensory)
Acupuncture like TENS (AL)
Burst train TENS
Brief intense TENS
Noxious TENS
32
What type of TENS is high frequency, low intensity TENS?
Conventional TENS (sensory)
33
What is the intensity of conventional (sensory) TENS?
Low intensity (sub motor)
34
What fibers are stimulated by conventional (sensory) TENS?
A beta fibers
35
What is the sensation of conventional TENS (sensory)?
Tolerable paresthesia
36
What is the pulse duration of conventional (sensory TENS)?
50-100 us (low threshold)
Duration long as possible is ideal
37
What is the frequency of conventional (sensory) TENS?
High frequency
80-150 Hz
38
What duty cycle is conventional (sensory) TENS?
Continuous duty cycle
39
How long is the treatment time for conventional (sensory) TENS?
20-30 minutes or longer with activity
40
When is the onset of relief for conventional (sensory) TENS?
10-20 min
41
How long does pain relief last with conventional (sensory) TENS?
30 minutes
42
What is the most common use of conventional (sensory) TENS?
Acute and post op pain
43
What is often the first mode of TENS trialed?
Conventional (sensory) TENS
44
What fibers are targeted by conventional (sensory) TENS?
A beta fibers
45
How does conventional (sensory) TENS elicit pain relief?
By stimulating a beta fibers, it releases enkephalin into the DH for short duration pain relief
46
T/f: conventional (sensory) TENS provides pain relief when the ES is on and shortly after
True
47
Bc a beta fibers accomodate quickly to stimulation, what do we need to do with conventional (sensory) TENS?
Adjust intensity as needed
Use modulated amplitude, rate, duration
48
Acupuncture like (AL) TENS (rhythmical/motor TENS) is _____ frequency, _____ intensity TENS
Low, high
49
What is the intensity of AL TENS?
High to produce strong, tolerable muscle contractions
50
Why do we want a high intensity with AL TENS?
To produce strong, tolerable muscle contraction
51
What is the pulse duration of AL TENS?
Long
200-400 us
52
What is the frequency of AL TENS?
Low frequency
<10Hz
Usually 1-4 Hz to mimic acupuncture needle turning
53
Why is AL TENS frequency so low?
To mimic the needle oscillation of acupuncture
54
Why is AL TENS frequency so low?
To mimic the needle oscillation of acupuncture
55
What is the duty cycle of AL TENS?
Continuous
56
How long is the treatment time for AL TENS?
30 min
57
When does the onset of pain relief start with AL TENS?
Within 15-30 min
58
What is the duration of relief of AL TENS?
2-6 hours
59
What is AL TENS used to treat?
Sub acute and chronic pain
60
Where should the electrodes be placed with AL TENS?
At the trigger/acupuncture points
Myotomes related to their pain
61
What fibers are targeted by AL TENS?
A alpha and A beta fibers
62
How does AL TENS induce pain relief?
Stimulation of a beta and a alpha fibers releases endogenous opioids, inhibits pain through descending mechanisms and increases serotonin in the SC
63
What are some conditions that indicate use of AL TENS?
Non specific LBP
RA
DJD
peripheral neuropathy
Peripheral nerve injury
Phantom limb pain
64
What is burst train TENS?
A combo of conventional and acupunture like TENS
65
What level should the intensity reach in burst train TENS?
Motor level
66
What is the frequency of burst train TENS?
High frequency trains (100 Hz) delivered at low frequency (1-4Hz)
67
What is the pulse duration of burst train TENS?
Long
About 200us
68
What form of TENS produces a more comfortable motor contraction than AL TENS?
Burst train TENS
69
What is treated with burst train TENS?
Subacute pain and trigger points
70
How is acute post op pain treated with TENS?
With conventional (sensory) TENS
71
How can subacute pain be treated with TENS?
With burst train TENS, or AL TENS
72
How may chronic pain be treated with TENS?
AL TENS
73
How may trigger points be treated with TENS?
With burst train TENS, Brief intense TENS (to numb), or with noxious TENS
74
What does brief intense TENS do?
Causes short local hyperalgesia (nerve block)
75
What is the intensity of brief intense TENS?
Highest tolerable by the patient
76
What is the frequency for brief intense TENS?
High
100-150 Hz
77
What is the pulse duration for brief intense TENS?
Longest pulse duration
150-300us
78
How long is the treatment time for brief intense TENS?
5-10 minutes
79
What is brief intense TENS used for?
Minor painful procedures: dressing changes, debridement, suture removal, painful TE, mobs, myofascial trigger point release
80
What is type of TENS is difffuse noxious inhibitory control (DNIC)?
Noxious TENS
81
What is the intensity of noxious TENS?
Max tolerable
82
What is the phase duration for noxious TENS?
Long
>1ms
83
What is the frequency of noxious TENS?
Low (2-7Hz) and high (100-150 Hz)
84
What is a point stimulator in noxious TENS?
A small diameter probe with high current density
85
What fibers are triggered in noxious TENS?
C fiber and sometimes A delta (harder to stimulate)
86
How long is noxious TENS usually?
No more than 5 minutes
87
What condition was shown in a case study to have 5 months of pain relief with noxious TENS?
Achilles tendinopathy
88
What is noxious TENS used to treat?
Trigger points and acupuncture points
89
What is the treatment time for noxious TENS?
30 sec, 8-10 points per treatment session
90
Electrophysical agents modulate through ______ and ______ mechanisms
peripheral and central
91
What are the peripheral mechanisms of TENS?
Decreased nociceptors mechanical sensitivity
Peripheral opioid receptors
92
TENS effects are mediated via activation of peripheral _____ receptors
Opioid
93
What are the spinal level mechanisms of TENS?
Gate control theory
DH neurons
94
How does TENS work through Gate control theory?
TENS stimulate large diameter afferent activity (a beta) that inhibits central nociceptive transmission, resulting in decreased pain
95
How does TENS work on the DH neurons?
TENS decreases inflammation induced DH neuron sensitization
TENS alters level of NTs GABA and glycine, though to be involved in inhibition of nociceptive traffic
96
What are the supraspinal mechanisms that TENS works through?
Endogenous analgesia
Placebo analgesia
97
How does TENS create endogenous analgesia?
TENS stimulates descending inhibitory activity via the PAG and RVM has anti nociceptive effects mediated via opioidergic pathways
98
T/f: TENS induced analgesia is blocked by opioids
True
99
Is it possible that TENS induced analgesia could result from the therapeutic ritual of using the TENS unit?
Yes
100
T/f: TENS is never used in the recovery room
False, it can be used within 48 hours in the recovery room
101
When pain ______ appetite ______
Decreases, increases (or vice versa)
102
T/f: TENS is not an effective analgesic to be used during birth
False, it has been shown to make severe pain less likely
103
What is a particularly difficult to treat disease that TENS can help decrease pain and increase muscle power for?
RA of the hand
104
Can we use TENS on cancer patients?
Yes, if they are cleared by the attending
105
T/f: TENS can reduce pain that lasts 2 months and improve QOL in pts with cancer
True
106
What are the benefits of TENS for phantom limb pain?
Decreased duration, degree, and area of pain
Increased appetite and sleep
107
Can TENS be used for migraines
Yes
108
What is analgesic tolerance?
A decrease in analgesic effectiveness with repeated use of a given therapeutic method
109
Repeated stim of opioid receptors by repeated opioid drug or TENS can lead to what?
Analgesic tolerance
110
What is cross tolerance?
Treatment backfires after prolonged use bc the system will become depleted of endorphins and serotonin
111
If using TENS for weeks and no longer getting an effect, what should be done?
Take a break
112
Low frequency TENS induced tolerance results in _______ ________ of Mu receptors in the SC
Cross tolerance
113
High frequency induced analgesic tolerance results in ______ ______ at delta opioid receptors in the SC
Cross tolerance
114
Opioid users are non-responders to _____ _____TENS
Low frequency
115
Bc opioid users aren’t respondent to low frequency TENS, what do we have to do?
Use high/low mix
116
T/f: non opioid users respond to both high and low frequency TENS
True
117
Pts can develop tolerance to TENS within ____ days
4
118
How can we prevent tolerance in TENS?
Simultaneous administrations of low and high frequency TENS in the same session
Alternating administrations of high and low frequency TENS on subsequent sessions
Increase intensity by 10% each day
By using mixed frequency motor intensities
119
How does caffeine interact with TENS?
Caffeine is a competitive adensosine antagonist and may interfere with TENS effectiveness is over 100mg
120
What is the best way to get a response with TENS?
High intensity (strong yet tolerable)
121
The greatest analgesia is achieved with the _____ sensory dose
Highest
122
T/f: doses at the sensory threshold or below will be ineffective
True
123
When does TENS produce the greatest effect?
While the unit is on and immediately after treatment
124
Is it better to use TENS with or without activity?
With activity bc it has minimal effects on resting pain
125
How does TENS help with pain physiology?
By increasing central inhibition and reducing central excitability
By targeting people with altered pain processing
126
How can TENS help fibromyalgia patients?
By increasing the pain threshold and restoring central inhibition
127
What is the best stimulation intensity for TENS to be most effective?
Amplitude should be increased until the patient report strongest tolerable paresthesia
128
Only _____ intensities promote significant hypoalgesia
Stronger
129
During treatment, we must ask patient about _____ ______ frequently to make sure paresthesia is felt
Sensory habituation
130
If a patient is experiencing sensory habituation, what should we do?
Increase the amplitude until strong tolerable paresthesia is felt
131
How can electrodes be placed for max effectiveness of conventional (sensory) TENS?
Around the site of pain (box it out)
If unsuccessful, try peripheral nerve, spinal root, CL, or dermatomal distribution
132
How can electrodes be placed for max effectiveness of AL TENS?
Over the muscle belly at the site of pain
If unsuccessful, try motor units, trigger points at site of pain, CL positions, myotomal distribution
133
How can electrodes be placed for max effectiveness of brief intense TENS?
Straddle the site of pain
If unsuccessful over the main nerve bundle
134
Conventional TENS should be used for ____ minutes
>30 minutes, 40-60 minutes
135
How often should conventional (sensory) TENS be used?
As often as needed taking breaking every hour or so
136
AL TENS should be used for ____ minutes
15-20 minutes initially and progress to 30 minutes
137
How often should AL TENS be used?
30 minutes at a time as needed with rest period to avoid muscle fatigue
138
Brief intense TENS should be used no more than ___ minutes initially and progress to ____ minutes
5, 15
139
What are common user problems with TENS?
Connectivity
Fitting
Visibility of the device
Availability
Sensation
Settings
140
How long does it take to develop tolerance to TENS?
4 days
141
What is typically the life time of uses we can get out of a set of electrode pads with TENS?
~10-12 applications
142
How do we know we have used the correct intensity?
If the patient can still feel it after removing the TENS
143
How can we prevent tolerance of TENS?
Simultaneous administration of low and
high frequency TENS in same session.
Alternating administration of high an low
frequency TENS on subsequent sessions.
Increasing intensity by just 10% per day.
Using mixed frequency with motor
intensities.
144
145
What are normal TENS parameters?
Produces continuous train of impulses
No interruption in stimulus parameters
Frequency adjustable 2-150 Hz
Duration adjustable 50-300 us
146
What are the burst TENS parameters?
Burst of seven pulses
There are two burst delivered per second continuously
Frequency fixed @ 100 Hz
Pulse Duration adjustable 50-300 us.
147
What is modulated rate and width (MRW) TENS?
The pulse rate and width are automatically varied in a cycle
During the first 0.5 second period, the width decreases 50% of original setting, during the next 0.5 second period the rate decreases 50% of its original setting
Total cycle time one second
148
What is MRW used for?
Pain modulation or when a pt has tried TENS before and it didn’t work
149
150
What is modulated intensity and width (SD) TENS?
Alternately modulates intensity and pulse width
Intensity is always increasing while width decreasing and vice-versa
Intensity modulates 62.5% of max., width modulates 67%
Total cycle time 6 seconds
151
What are the parameters for Bi-pulse TENS?
Channel one fixed 4 Hz
Channel 2 fixed 100 Hz
Duration fully adjustable 50-300 us
Stimulation is burst on for one second burst off one second.
152
153
What is the frequency and duration used for high frequency normal TENS?
120 Hz
100usec
154
155
What is the frequency and duration used for low frequency normal TENS?
2 Hz
300usec
156
What is the frequency and duration used for burst TENS?
Frequency fixed at 100Hz
Duration 100-300usec
157
What is the frequency and duration used for MRW TENS?
150Hz
300usec
158
What is the frequency and duration used for high frequency SD TENS?
100 Hz
100usec
159
What is the frequency and duration used for low frequency SD TENS?
4 Hz
300 usec
160
What is the frequency and duration used for bi-pulse TENS?
200usec
Channel one frequency fixed at 4Hz
Channel two frequency fixed at 100Hz
