- post-op pain - acute pain - labor and delivery pain - hypersensitvity - phantom pain

- chronic pain - deep paini (visceral) - throbbing type pain

Type of TENS Flashcards by Kaila Williams

Types of TENS

sensory level 
motor level 
noxious level 
sub sensory level 
peripheral nerve block

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Sensory Level TENS

provides stimulation at or above sensory threshold but below motor

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Pain theory for sensory level TENS

gate control

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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

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Sensory TENS pulse duration

2 - 50 usec

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sensory TENS amplitude

increase to create effect (buzzing/tingling)

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sensory TENS frequency

50 to 100 pps (50 pps common)

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sensory TENS treatment time

20-30 minutes

can be used up to 23 hours

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Modulations

BURST MODE

prevent sensory accommodation

machine changes frequency, pulse duration, amplitude, on/off times or a combination

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Uses of Sensory TENS

post-op pain
acute pain
labor and delivery pain
hypersensitvity
phantom pain

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Motor level TENS

low rate or acupuncture like

creates rhythmic non-fused muscle contractions

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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

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pulse duration for Motor TENS

150-300 usec

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amplitude for Motor TENS

increase until there is contraction

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Frequency for Motor TENS

2-4 pps

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Treatment time for Motor TENS

30-45 minutes

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Modulation for Motor TENS

not important since effect on motor system

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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