T.E.N.S.

Trancutaneous Electrical Nerve

Stimulation
 General Concepts:
• An Approach to pain control
– Trancutaneous Electrical Nerve Stimulation:
– 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
– TENS stimulates afferent sensory fibers to elicit
production of neurohumneral substances such as
endorphins, enkephalins and serotonin (i.e. gate theory)
 TENS
• Indications • Precautions
– Control Chronic Pain – Can mask underlying
pain
– Management post-
– Burns or skin irritation
surgical pain
– prolonged use may result
– Reduction of post-
in muscle spasm/soreness
traumatic & acute pain
– caffeine intake may
reduce effectiveness
– Narcotics decrease
effectiveness
 TENS may be:
• high voltage
• interferential
• acuscope
• low voltage AC stimulator
• classical portable TENS unit
 Biophysical Effects
• Primary use is to control pain through Gate
Control Theory
• May produce muscle contractions
• Various methods
– High TENS (Activate A-delta fibers)
– Low TENS (release of -endorphins from pituitary)
– Brief-Intense TENS (noxious stimulation to active C
fibers)
Techniques of TENS application:
• Conventional or High Frequency
• Acupuncture or Low Frequency
• Brief Intense
• Burst Mode
• Modulated
Protocol for Various Methods of
TENS
Parameter High TENS Low TENS Brief-Intense
TENS
Intensity Sensory Motor Noxious
Pulse Fq 60-100 pps 2-4 pps Variable
Pulse 60-100 sec 150-250 sec 300-1000sec
Duration
Mode Modulated Modulated Modluated
Burst
Tx Duration As needed 30 min 15-30 min
Onset of < 10 min 20-40 min <15 min
Relief
 Conventional Tens/High
Frequency TENS
• Paresthesia is created without motor response
• A Beta filers are stimulated to SG enkephlin
interneuron (pure gate theory)
• Creates the fastest relief of all techniques
• Applied 30 minutes to 24 hours
• relief is short lives (45 sec 1/2 life)
• May stop the pain-spasms cycle
 Application of High TENS
• Pulse rate: high 75-100 Hz (generally 80),
constant
• Pulse width: narrow, less than 300 mSec
generally 60 microSec
• Intensity: comfortable to tolerance
 Set up:
• 2 to 4 electrodes, often will be placed on
post-op. Readjust parameters after response
has been established. Turn on the intensity
to a strong stimulation. Increase the pulse
width and ask if the stimulation is getting
wider (if deeper=good, if stronger...use
shorter width)
 Low Frequency/Acupuncture-
like TENS:
• Level III pain relief, A delta fibers get Beta
endorphins
• Longer lasting pain relief but slower to start
• Application
– pulse rate low 1-5ppx (below 10)
– Pulse width: 200-300 microSec
– Intensity: strong you want rhythmical
contractions within the patient’s tolerance
 Burst Mode TENS
– Carrier frequency is at a certain rate with a built in duty
cycle
– Similar to low frequency TENS
– Carrier frequency of 70-100 Hz packaged in bursts of
about 7 bursts per second
– Pulses within burst can vary
– Burst frequency is 1-5 bursts per second
– Strong contraction at lower frequencies
– Combines efficacy of low rate TENS with the comfort of
conventional TENS
Burst Mode TENS - Application
• Pulse width: high 100-200 microSec
• Pulse rate: 70-100 pps modulated to 1-5
burst/sec
• Intensity: strong but comfortable
• treatment length: 20-60 minutes
 Brief, Intense TENS: hyper-
stimulation analgesia
– Stimulates C fibers for level II pain control (PAG
etc.)
– Similar to high frequency TENS
– Highest rate (100 Hz), 200 mSec pulse width
intensity to a very strong but tolerable level
– Treatment time is only 15 minutes, if no relief then
treat again after 2-3 minutes
– Mono or biphasic current give a “bee sting” sensation
– Utilize motor, trigger or acupuncture points.
Brief Intense TENS - Application
• Pulse width: as high as possible
• Pulse rate: depends on the type of stimulator
• Intensity: as high as tolerated
• Duration: 15 minutes with conventional
TENS unit. Locus stimulator is advocated for
this treatment type, treatment time is 30
seconds per point.
 Locus point stimulator
• Locus (point) stimulators treatment occurs
once per day generally 8 points per session
– Auricular points are often utilized
• Treat distal to proximal
• Allow three treatment trails before efficacy
is determined
• Use first then try other modalities
 Modulated Stimulation:
• Keeps tissues reactive so no accommodation
occurs
• Simultaneous modulation of amplitude and
pulse width
• As amplitude is decreased, pulse width is
automatically increased to deliver more
consistent energy per pulse
• Rate can also be modulated
 Electrode Placement:
• May be over the painful sites, dermatomes,
myotomes, trigger points, acupuncture
points or spinal nerve roots.
• May be crossed or uncrossed (horizontal or
vertical
 Contraindications:
• Demand pacemakers
• over carotid sinuses
• Pregnancy
• Cerebral vascular disorders (stroke patients)
• Over the chest if patient has any cardiac
condition