TENS-TRANSCUTANEOUS ELECTRICAL NERVE

STIMULATION
TAMILVANAN MANI

CONTENTS

INTRODUCTION DEFINITION PHYSIOLOGICAL BASIS GATE CONTROL THEORY OF PAIN OPIOID SYSTEM THEORY MODES OF TENS PARAMETERS OF TENS MODES ELECTRODE PLACEMENT

INTRODUCTION
Primarily used for pain reduction

Any stimulation in which a current is applied across the skin to stimulate nerves 1965 Gate Control Theory created a great popularity of TENS TENS has 50-80% efficacy rate

Only alters perception of pain

Little effect on the underlying pathology Use with other therapies that attempt to treat source of pain Manual exercise

DEFINITION

A LOW FREQUENCY ,PULSED RECTANGULAR CURRENT APPLIED THROUGH THE SURFACE ELECTRODES ON THE SKIN TO RELIVE PAIN. FREQUENCY-1-600 HZ-COMMOMLY USED FREQUENCY IS 150 HZ PULSE SHAPE - RECTANGULAR PULSE WIDTH-50 - 500 MS-MEASURED IN MICROSECONDS INTENSITY-UPTO TINGLING SENSATION FELT BY THE PATIENT

PHYSIOLOGICAL BASIS

Gate control theory postulated by Melzack and Wall in 1965,says,that pain perception is regulated by a gate which may be opened or closed, thus increasing or decreasing the pain perceived by means of other inputs from peripheral nerves.

PAIN GATE THEORY

Pain signals can be blocked at the spinal cord before they are transmitted to the brain. TENS stimulates large Ia myelinated afferent nerve fibers that stimulate the substantia gelatinosa in the spinal cord, closing the gate on pain transmission to the thalamus

OPIOID THEORY

stimulation of A-delta & C neurons, which Cause release of enkephalins (PAG). & RAN

Stimulation of A-delta & C fibers causes release of Bendorphins from the PAG
Mechanism of action similar to encephalin to block ascending nerve impulses Examples: TENS (low freq. & long pulse duration)

MODES OF TENS

CONVENTIONAL TENS/HF TENS- High-frequency, low-intensity stimulation

ACCUPUNCTIRE TENS /LF TENS- Low frequency, high intensity stimulation

BURST TENS- High frequency stimulation bursts at low frequency intervals

BRIEF,INTENSE TENS- High frequency, high intensity stimulation

COMBINED-Impulses vary in intensity and frequency Attempts to avoid neuro-habituation

PARAMETERS OF TENS MODES

PARAMETER
INTENSITY PULSE FREQUENCY PULSE WIDTH MODE

CONVENTIONAL TENS/HF TENS

SENSORY 50-100HZ 60 MS MODULATED RATE

ACCUPUNCTIRE TENS /LF TENS

MOTOR 1-5 HZ 200-300 MS MODULATED BURST

BURST TENS
MOTOR 70-100HZ 100-200 MS MODULATED BURST

BRIEF,INTENSE TENS
SENSORY & MOTOR 100HZ 200 MS

TREATMENT DURATION
ONSET OF RELIEF

30-60 MINS 1/8/24 HOUR/DAY

LESS THAN 10 MINS

20-30 MINS/DAY

15 MINS/IF NOT GET RELIEF TREAT AFTER 1-3 MINS

20-40 MINS

DURATION OF RELIEF

MINUTES TO HOURS HOURS

ELECTRODE PLACEMENT
ELECTRODE PLACEMENT STIMULATING PARAMETER/MODE

SITE OF PAIN DERMATOME & MYOTOME

CONVENTIONAL TENS ACCUPUNCTURE TENS

TRIGGER POINT,ACCUPUNCTURE POINT & MOTOR POINT

BURST TENS

PERIPHERAL NERVES

MODULATED TENS

DERMATOME

A DERMATOME IS AN AREA OF SKIN THAT IS MAINLY SUPPLIED BY A SINGLE SPINAL NERVE.

EACH OF THESE NERVES RELAYS SENSATION (INCLUDING PAIN) FROM A PARTICULAR REGION OF SKIN TO THE BRAIN.

MYOTOME

EACH NERVE ROOT COMING FROM THE SPINAL CORD SUPPLIES A SPECIFIC GROUP OF MUSCLES.

ACCUPUNCTURE POINT

ARE LOCATIONS ON THE BODY THAT ARE THE FOCUS OF ACUPUNCTURE, ACUPRESSURE,

MOTOR POINT

A POINT AT WHICH A MOTOR NERVE ENTERS A MUSCLE

TRIGGER POINT

TRIGGER POINTS, ALSO KNOWN AS TRIGGER SITES OR MUSCLE KNOTS, ARE DESCRIBED AS HYPERIRRITABLE SPOTS IN SKELETAL MUSCLE THAT ARE ASSOCIATED WITH PALPABLE NODULES IN TAUT BANDS OF MUSCLE FIBERS.

INDICATIONS

ACUTE AND CHRONIC PAIN

REMODELLING OF BONE AND TISSUE

ANTIEMETIC EFFECT - Effective against vomiting and nausea LABOR AND DELIVERY

INCESION AND SCAR PAIN

ACUTE AND CHRONIC PAIN

ACUTE & CHRONIC PAIN
ACUTE, NEUROGENIC,POSTOPERATIVE, OBSTETRIC PAIN AND CHRONIC PAIN

ANTIEMETIC EFFECT

ANTIEMETIC EFFECT-MORNING SICKNESS(VOMITING & NAUSEA)-CHEMOTHERAPY PLACEMNT OF ELECTRODES -RIGHT SIDE ONLY ACROMION TIP AND HOKU(WEB SPACE BETWEEN THUMB AND INDEX FINGER) FREQUNCY 80-120 HZ PULSE WIDTH- 150MS MIMIMAL INTENSITY 30 MIN EVERY MORNING

BONE HEALING

REMODELLING OF BONE AND TISSUE

NON UNITED FRACTURE

PLACEMENT OF ELECTRODES POP-PROXIMAL AND DISTAL TO THE CAST 2 ELECTRODES PLACED WITH 15 CM APART 4 ELECTRODES CROSS PATTERN 2 ELECTRODES SANDWITH PATTERN

FREQUENCY-120HZ PULSE WIDTH 300MS INTENSITY LOWEST BARELY SENSED BY PATIENT TIME DURATION - 1 HOUR

LABOR AND DELIVERY

DURING LABOR PROXIMAL 2 ELECTRODE AT LEVEL OF T8 DISTAL 2 ELECTRODE PLACED AT THE LEVEL OF T8 TO L1 FREQUENCY-80-120HZ PULSE WIDTH 150 MS INTENSITY LOWEST
POST CESAREAN PAIN

INCISIONAL AND SCAR PAIN

TREATED AS ACUTE PAIN PLACEMENT OF ELECTRODE -2.5 CM AWAY FROM THE INCESION AREA 4 ELECTRODES CROSS PATTERN FREQUENCY-80-120HZ PULSE WIDTH 150 MS INTENSITY MINIMAL

CONTRAINDICATIONS & PRECAUTIONS

PACEMAKER-Contracting the heart muscles, to regulate the beating of the heart
HEART DISEASE OR DYSRHYTHMIAS- irregular heartbeat UNDIAGNOSED PAIN EPILEPSY -Epileptic seizures (colloquially a fit) are brief episodes of "abnormal excessive or synchronous neuronal activity in the brain PLACEMENT OVER CAROTID SINUS PLACEMENT OVER PHARYNGEAL AREA FIRST THREE MONTHS OF PREGNANCY

ANESTHETIC SKIN & OPEN SKIN LESION

ELECTRODE PLACEMNTS

ANKLE LIGAMNET INJURY

KNEE PAIN

BACK PAIN AND SCAITICA

WRIST PAIN

CARPAL TUNNEL SYNDROME

UPPER EXTREMITY PAIN

ELBOW PAIN