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    Tens

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    Paul Vk
    Transcutaneous Electrical Nerve Stimulation (TENS) is a non-invasive method of pain relief using low-voltage electrical currents. TENS works by activating the body's natural pain-relieving mechanisms through the stimulation of nerves under the skin. It can help reduce pain by activating the gate control theory of pain and stimulating the release of endorphins. TENS uses different waveforms, frequencies, pulse widths, and intensities to target different nerve fibers and pain mechanisms. Common types of TENS include conventional high frequency TENS and acupuncture-like low frequency TENS. TENS is a generally safe method of pain relief but has some contraindications for certain medical conditions and precautions regarding proper electrode placement

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    Tens

    Uploaded by

    Paul Vk
    468 views28 pages
    Transcutaneous Electrical Nerve Stimulation (TENS) is a non-invasive method of pain relief using low-voltage electrical currents. TENS works by activating the body's natural pain-relieving mechanisms through the stimulation of nerves under the skin. It can help reduce pain by activating the gate control theory of pain and stimulating the release of endorphins. TENS uses different waveforms, frequencies, pulse widths, and intensities to target different nerve fibers and pain mechanisms. Common types of TENS include conventional high frequency TENS and acupuncture-like low frequency TENS. TENS is a generally safe method of pain relief but has some contraindications for certain medical conditions and precautions regarding proper electrode placement

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    Transcutaneous Electrical Nerve Stimulation (TENS) is a non-invasive method of pain relief using low-voltage electrical currents. TENS works by activating the body's natural pain-relieving mechanisms through the stimulation of nerves under the skin. It can help reduce pain by activating the gate control theory of pain and stimulating the release of endorphins. TENS uses different waveforms, frequencies, pulse widths, and intensities to target different nerve fibers and pain mechanisms. Common types of TENS include conventional high frequency TENS and acupuncture-like low frequency TENS. TENS is a generally safe method of pain relief but has some contraindications for certain medical conditions and precautions regarding proper electrode placement

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    468 views28 pages

    Tens

    Uploaded by

    Paul Vk
    Transcutaneous Electrical Nerve Stimulation (TENS) is a non-invasive method of pain relief using low-voltage electrical currents. TENS works by activating the body's natural pain-relieving mechanisms through the stimulation of nerves under the skin. It can help reduce pain by activating the gate control theory of pain and stimulating the release of endorphins. TENS uses different waveforms, frequencies, pulse widths, and intensities to target different nerve fibers and pain mechanisms. Common types of TENS include conventional high frequency TENS and acupuncture-like low frequency TENS. TENS is a generally safe method of pain relief but has some contraindications for certain medical conditions and precautions regarding proper electrode placement

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 28

    TENS

    Definition
    Transcutaneous Electrical Nerve
    Stimulation (TENS) is a method of
    electrical stimulation which primarily aims
    to provide a degree of pain relief
    (symptomatic) by specifically exciting
    sensory nerves and thereby stimulating
    either the pain gate mechanism and/or
    the opioid system.

    Mechanism of Action
    Possible Pain Relieving Mechanisms;
    Activation of pain-gating mechanisms.
    Stimulation of the descending pain
    suppression system and endogenous opiate
    mechanisms.
    The Central Biasing Theory
    Removal of the substances which
    stimulate
    pain nerve endings from within the
    damaged area

    Pain Pathway
    A and C fibres
    that carry noxious
    sensory
    information
    A fibres carry
    non-noxious
    stimuli

    The pain gate mechanism

    (Melzack and Wall, 1985)

    Opiate-mediated control
    Endogenous opioids
    Endorphins
    Dynorphins
    Enkephalins

    Neurophysiology background:
    The brain can secrete its own analgesic
    substance such as endorphins to modulate
    pain.
    Endorphins are neuropeptides that act on
    the CNS and peripheral nervous system to
    reduce pain.
    They have the similar
    pharmacological
    effect as morphine.

    Local vasodilatation
    The Central Biasing Theory:
    The motivational affective mechanism
    of
    the limpic system explains emotional
    responses to pain. The body uses past
    experiences with pain to judge the
    intensity/severity of current pain
    Removes pain causing anti inflammatory
    agents.

    Parameters used for TENS


    Waveforms
    Frequency or Rate
    Pulse width or Duration
    Amplitude or Intensity

    Waveforms
    Square / rectangular
    Instantaneous rise
    Less skin irritating as
    approaches sine wave
    form
    For nerve damage
    associated with pain
    pathology
    For hypersensitive
    and
    chronic pain patients
    Delayed, long-lasting
    analgesia

    Triangular / spike
    Rapidly rising, but
    not
    More skin
    instantaneous
    irritating
    frequent
    thereforemovement
    requires of
    electrodes or shorter
    treatment times to avoid
    skin irritation
    For acute pain
    or
    Immediate,
    short
    resistant
    tissue
    lasting
    pain relief

    Frequency or Rate
    High Frequency (80-120):
    Large myelinated fibers respond effective > 100Hz
    Immediate relief of pain
    Acute pain
    Low Frequency (1-20):
    Small unmyelinated fibers respond effectively at
    <100Hz
    Increase endorphin production, thus analgesia
    following stimulation
    Chronic pain

    Pulse width or Duration


    Pulse width

    Indications

    50s

    Large myelinated fibers (sensory


    touch)

    100 - 150s

    Normal neuromuscular system

    200 s

    Small myelinated fibers

    200 - 300 s

    Patients with neurological damage

    Amplitude or Intensity
    TENS units intensity ranges form 1 mA
    to 100 mA
    TENS is only effective when the patient
    actually feels the stimulus
    Patients need to increase the intensity
    when the body accommodates to the
    stimulus (when they dont feel the
    stimulation anymore)
    Dying batteries can cause fading
    intensities

    Types of TENS
    Conventional TENS or High Frequency TENS
    Acupuncture-like TENS (AL-TENS) or Low
    Frequency TENS
    Brief TENS or Intense TENS
    Burst TENS
    Modulated TENS or Modified TENS

    Conventional or High TENS


    Frequency - 50 Hz to 100 Hz
    Pulse Width - 20 s to 60 s
    Intensity - (0 mA to 30 mA).
    The intensity until a prickling or tingling
    sensation is felt.
    Principle -Presynaptic inhibition by pain
    gate mechanism by stimulating A and
    A fibres.
    Duration - 30 to 60 minutes once or
    twice daily.

    Acupuncture or Low TENS


    Frequency - 1 Hz to 4 Hz
    Pulse Width - 150 s to 250 s
    Intensity - 30 mA to 60 mA.
    applied to acupuncture points or motor points of
    muscle in the segmentally related myotome.
    Principle -This stimulates the high threshold A
    and C fibres, which lead to release of
    endogenous opioids and provides further sensory
    input from muscle spindle afferents (chemical
    theory).
    Duration - 20 to 30 minutes once a day.

    Brief or Intense TENS


    Frequency - More than 100 Hz
    Pulse Width - 150 s to 250 s
    Intensity - Highest level tolerated by the
    patient.
    Principle Activity in cutaneous A
    afferents induced by intense TENS
    produce peripheral blockade of
    nociceptive afferent activity (Central
    biasing mechanism).
    Duration - 30 to 60 minutes once or
    twice daily.

    Burst TENS
    Burst TENS is a series of pulses (i.e. a
    train), repeated 1-5 times a second,
    commonly twice.
    Each train or burst consists of a number
    of individual pulses at the usual
    conventional TENS frequencies of 50 Hz
    to 100 Hz but at higher intensity.
    It combines both the conventional and
    acupuncture-like TENS and
    therefore provides pain relief by both
    routes.

    Modulated or Modified TENS


    In modulated TENS the pulse length,
    frequency, and amplitudes can be
    constantly and automatically varied.
    This cyclical variation is believed to
    prevent adaptation of the nerves to the
    current (no accommodation)
    is particularly appropriate as a variant of
    conventional TENS used over long periods.

    Electrode Placement

    Electrode Placement

    Electrode Placement

    The position of electrodes and electrical characteristics of TENS


    when used to manage labour pain

    Electrode Placement

    12/10/2014

    Contraindication
    Someone with a pacemaker
    Someone with undiagnosed pain.
    Someone with a heart condition
    On head or neck of someone with epilepsy
    Someone with venous or arterial thrombosis or
    thrombophlebitis
    Someone with indwelling phrenic nerve or
    urinary bladder stimulators
    Near operating diathermy device

    Contraindication
    Around the head
    On the eyes
    Over mucosal surfaces
    Using electrodes on infected skin
    Electrodes across the chest of a patient with
    cardiac disease
    Electrodes should not be placed near carotid
    artery in the anterolateral region of the neck.
    There is a potential risk that stimulation at this
    site might cause heart block by exciting the
    vagus nerve.

    Precautions
    Areas of skin irritation, damage or lesions
    Areas with impaired sensation
    Over abdominal, lumbosacral or pelvic regions
    during pregnancy other than for labor/delivery
    Tissues vulnerable to hemorrhage or hematoma
    Athletes should not be permitted to participate in
    sports while under the influence of TENS
    analgesia
    Extreme caution is needed with patients taking
    narcotic medication or who are known to have
    hyposensitive areas.

    Precautions
    Incompetent patients may not be able to
    manage the device and it must be kept out of
    reach of children.
    For patients with diagnosed malignancies that
    have been diagnosed as terminal, TENS can be
    used for pain control with informed consent of
    the patient.
    Otherwise, TENS should not be used when
    malignancies are present.

    References
    1.Tim Watson.
    http://www.electrotherapy.org/modality/transcutaneous-electricalnerve-stimulation-tens
    2.http://www.answers.com/topic/pain-1
    3.http://www.david.curtis.care4free.net/painrev.htm
    4.Transcutaneous Electrical Nerve Stimulation. McGill Lecture Notes January 22nd, 2002
    5.Mark Johnson. Transcutaneous electrical nerve stimulation (TENS).
    P 259-286
    6.Foster A, Palastanga N. Claytons electrotherapy,9th edition, AITBS
    Publishers, pp 100- 106
    7.Singh Jagmohan. Textbook of Electrotherapy, 2 edition, 2012;pp
    129 - 133

    THANK YOU

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