TENS - Electrical Currentsfor Pain Control

Question 1

The Acronym “TENS” = ?

TENS

Answer 1

• Transcutaneous
• Electrical
• Nerve
• Stimulation

- Notes:

• Technically describes all stimulation
• Clinically describes stimulation delivered by portable stimulators and used for pain control

Question 2

Four parts of pain cycle = ?

TENS

Answer 2

Pain Cycle:

1. Pain
2. Guarding
3. Circulatory Stasis
4. Local Ischemia

Question 3

Order of Neuron Depolarization = ?

TENS

Answer 3

Order of Neuron Depolarization:

• A-Beta : Generally 1st to be depolarized with increasing current.
• A-Alpha : Generally 2nd to be depolarized with increasing current.
• A-Delta : Generally 3rd to be depolarized with increasing current.
• A-Gamma :

Question 4

Conventional TENS

• Rationale = ?
• Pulse duration = ?
• Pulse rate = ?

TENS

Answer 4

Conventional TENS:

• Rationale = Closes the gate in dorsal horn
• Pulse duration = 50-80 us
• Pulse rate = 100-150 pps/Hz
• ONLY WORKS WHEN ON!!

• Also called “high rate”
• Electrode placement = “surround painful area”
• Pulse type = typically biphasic symmetrical
• Pain relief outlast stimulation = No
• Duration of stimulation = PRN up to 23-24 hours
• Pulse amplitude = strong, comfortable sensory

Question 5

TENS Waveform = ?

TENS

Question 6

TENS Waveform

Modulation is used to ?

TENS

Answer 6

Modulation: Utilized at times to counter “adaptation” (lower response to same stimulus)

• Amplitude modulation
• Duration modulation
• Strength-Duration modulation

Question 7

Strong, Low-Rate TENS

• Also called = ?
• Rationale = ?

TENS

Answer 7

Strong, Low-Rate TENS:

• Also called “acupuncture-like”
• Rationale = Stimulate opioid release

Question 8

Strong, Low-Rate TENS

• Rationale = ?
• Pulse duration = ?
• Pulse rate = ?
• Duration of stimulation = ?

TENS

Answer 8

Strong, Low-Rate TENS:

• Rationale = stimulate opioid release
• Pulse duration = 200-300 us
• Pulse rate = 2-10 pps
• Duration of stimulation = 20-30 minutes

• Also called “acupuncture-like”
• Electrode placement = surround the painful area
• Pulse type = typically biphasic symmetrical
• Pulse amplitude = strong, sharp muscle twitch
• Pain relief outlast stimulation = YES (3-4 hours!!)

Question 9

“Burst Mode” TENS

True or False:

• A burst (containing multiple individual pulses) may be better tolerated than a long duration pulse ?

TENS

Answer 9

“Burst Mode” TENS:

• Mimics “strong, low rate”
• A burst (containing multiple individual pulses) may be better tolerated than a long duration pulse.

Question 10

• Conventional = ? conditions
• Strong, low-rate (or burst) = ? conditions

TENS

Answer 10

• Conventional = Acute conditions
• Strong, low-rate (or burst) = Chronic conditions

Question 11

Contraindications for the use of electrical currents = ?

TENS

Answer 11

Contraindications:

• Demand pacemaker or unstable arrhythmia
• Over the carotid sinus
• Venous or arterial thrombosis or thrombophlebitis
• Pelvis, abdomen, trunk and low back area during pregnancy

Question 12

Precautions for the use of electrical currents = ?

TENS

Answer 12

Precautions:

• Cardiac disease
• Impaired mentation or impaired sensation
• Malignant tumors
• Skin irritation or open wounds
• Use caution if the muscle contractions of “strong, low rate” TENS would be painful or disrupt healing
• Patient may experience DOMS with “strong, low rate”