Tens Lecture

7/28/2019 Tens Lecture

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T.E.N.S.

Trancutaneous Electrical Nerve

Stimulation


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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 rateTENS stimulates afferent sensory fibers to

elicit production of neurohumneral substances

such as endorphins, enkephalins and serotonin

(i.e. gate theory)


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TENS

Indications

Control Chronic Pain

Management post-surgical pain

Reduction of post-

traumatic & acute pain

Precautions

Can mask underlying

pain Burns or skin irritation

prolonged use may

result in muscle

spasm/soreness caffeine intake may

reduce effectiveness

Narcotics decrease

effectiveness


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TENS may be:

high voltage

interferential

acuscope

low voltage AC stimulator

classical portable TENS unit


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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)


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Techniques of TENS application:

Conventional or High Frequency

Acupuncture or Low Frequency

Brief Intense

Burst Mode

Modulated


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Protocol for Various Methods of

TENSParameter High TENS Low TENS Brief-Intense

TENS

Intensity Sensory Motor Noxious

Pulse Fq 60-100 pps 2-4 pps Variable

Pulse

Duration60-100 sec 150-250 sec 300-1000sec

Mode Modulated Modulated

Burst

Modluated

Tx Duration As needed 30 min 15-30 min

Onset of

Relief

< 10 min 20-40 min


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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


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Application of High TENS

Pulse rate: high 75-100 Hz (generally 80),

constant

Pulse width: narrow, less than 300 mSecgenerally 60 microSec

Intensity: comfortable to tolerance


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Set up:

2 to 4 electrodes, often will be placed on

post-op. Readjust parameters after response

has been established. Turn on the intensityto a strong stimulation. Increase the pulse

width and ask if the stimulation is getting

wider (if deeper=good, if stronger...useshorter width)


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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 patients tolerance


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Burst Mode TENSCarrier frequency is at a certain rate with a built

in duty cycle

Similar to low frequency TENS

Carrier frequency of 70-100 Hz packaged inbursts of about 7 bursts per second

Pulses within burst can vary

Burst frequency is 1-5 bursts per secondStrong contraction at lower frequencies

Combines efficacy of low rate TENS with the

comfort of conventional TENS


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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


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Brief, Intense TENS: hyper-

stimulation analgesiaStimulates C fibers for level II pain control

(PAG etc.)

Similar to high frequency TENSHighest 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.


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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.


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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


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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


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Contraindications:

Demand pacemakers

over carotid sinuses

Pregnancy

Cerebral vascular disorders (stroke patients)

Over the chest if patient has any cardiac

condition

Tens Lecture

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