PHYSICAL AGENTS &

ELECTROTHERAPY (OPT 2203):

TENS
PHYSICAL AGENTS &
ELECTROTHERAPY (LEC OR LAB) PAIN PATHWAYS
TENS Spinothalamic Tract
- Sharp, discriminative, relatively localized pain
Spinoreticulothalamic Tract
OUTLINE - Diffuse, poorly localized somatic & visceral pain

I. Pain
II. TENS

I. PAIN
PAIN THEORIES
Specificity Theory
- Each sensory modality is subserved by morphologically specific
nerve endings
- Pain is a specific sensation that is triggered when specific skin
receptors are stimulated
Pattern Theory
- The pattern of stimulation of nerve ending determine wherther the
brain will interpret the stimuli as pain
Gate Control Theory
- “Noxious stimuli carried by A-delta and C fibers are blocked by
sensory input along A-beta fibers. Efforts to treat pain are often
directed to stimulating the large A-beta fibers” (Michlovitz)

II. TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION

Rationale
- Gate Control Theory
- Release of natural opiates
- Vasodilation
- Accupuncture
Modes
- Conventional
Biochemical Theories - Strong Low-rate
- Substance P vs. Endorphins & Enkephalins - Brief Intense
- Imbalance of Dopaminergic and Serotoninergic substances - Pulse-Burst
- Acetylcholine, Histamine, Bradykinin, Prostaglandin, Capaicin, - Modulated
- Hyperstimulation

____________________________________________________________

Conventional TENS
- High-rate frequency (10-
100pps)
- Low amplitude
- Pulse duration: 500-
100μsec

Potassium Ions

TRANSCRIBERS | SANTOS, D. / 2020 | Page 1

 PHYSICAL AGENTS &
ELECTROTHERAPY (OPT 2203):
TENS
Strong Low-Rate
- AKA ‘accupuncture-like’
- High Amplitude
- Low Frequency (1-4pps)
- Pulse Duration: 100-300μsec

Brief-Intense
- High-rate (above 100pps)
- High-width (above 200μsecs)
- Intensity as high as patient can tolerate

Pulse-Burst
- AKA ‘pulse-train’
- High-rate (100pps) administered in
bursts at a low-rate (1-4pps)
- Pulse duration: 50-200μsecs

Hyperstimulation
- Long pulse duration
(500msecs)
- Frequency: 1-4pps
- Most noxious type of
TENS

ELECTRODE PLACEMENT
 Proximal to area of pain
 Bracketing area of pain
 One on pain site, other on nerve root
 Distal to area of pain
 Crisscross placement

Indications Contraindications Precautions

- Acute pain - Demand-type - Over the eyes
- Chronic pain pacemakers - Anterior neck area
- Phantom limb pain - Over the carotid - Cardiac diseases
- Post-operative pain sinus - Epilepsy
- Obstetric pain - Pregnancy - Mucosal surfaces
- Cardiopulmonary - CVA/ CNS disorders
pain - Incompetent patients
- Neurological pain - Dependency on the
device
- Skin breaks

TRANSCRIBERS | SANTOS, D. / 2020 | Page 2