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1

Types of TENS

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

2

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

4

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

5

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

11

Motor level TENS

low rate or acupuncture like

creates rhythmic non-fused muscle contractions

12

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

13

pulse duration for Motor TENS

150-300 usec

14

amplitude for Motor TENS

increase until there is contraction

15

Frequency for Motor TENS

2-4 pps

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Treatment time for Motor TENS

30-45 minutes

17

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

19

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

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pulse duration Noxious level TENS

2 msec to 1 sec

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frequency Noxious level TENS

1-6 or > 100 pps

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amplitude Noxious level TENS

increase to get noxious response

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treatment time Noxious level TENS

seconds to minutes

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uses for Noxious level TENS

trigger points and chronic pain

25

Sub-sensory or Microcurrent TENS

-monophasic or direct current

-patient feels little or no sensation when on

-wound healing agen

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pain theory for Sub-sensory or Microcurrent TENS

mimics bioelectric potential

27

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

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pulse duration Peripheral Nerve Block

>150 usec

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frequency Peripheral Nerve Block

50-100 pps

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amplitude Peripheral Nerve Block

increase until get analgesia (higher than sensory)

may get a slight contraction