TENS.pptx
- 1. Prof. (Dr.) Nidhi Sharma Professor, MMIPR, MM (DU), Mullana-Ambala, Haryana
- 2. To provide students with knowledge and understanding of A. Mechanism of Pain B. Pain relief C. TENS feature D. Application of TENS
- 3. ď˝ TENS is a device used by physiotherapists to aid in the management of pain. ď˝ TENS delivers a low voltage electrical current to nerves via conductive pads called electrodes which are placed over specific areas of skin.
- 4. ď˝ TENS does not treat the cause of pain but acts on the perception or sensation of pain. ď˝ TENS acts in 2 main ways: ď˝ Electrical impulses block pain signals before they travel to the brain. ď˝ Triggers the release of the bodyâs own pain relieving chemicals such as endorphins.
- 5. ď˝ Pain is felt as a result of the brain's response to electrical (neural) and chemical (hormonal) changes in the body as a result of damage. ď˝ Signals from damage or injury are picked up by sensory receptors in nerve endings. The nerves then transmit the signal via the nerves to spinal cord and brain.
- 7. ď˝ In 1965, Ronald Melzack from McGill University in Montreal Canada and Patrick Wall from University College London UK, published their seminal paper which proposed a gating mechanism in the central nervous system to regulate the flow of nerve signals from peripheral nerves en-route to the brain.
- 8. ď˝ According to this Gate-Control Theory of Pain. ď˝ Activity in large diameter low threshold mechanoreceptive (touch-related) nerve fibers could inhibit the transmission of action potentials from small diameter higher threshold nociceptive (pain-related) fibers through pre and post synaptic inhibition in the dorsal horn of spinal cord. ď˝ https://www.youtube.com/watch?v=oQLFfvG M7nI
- 9. ď˝ Nociceptive fibers (A-delta and C-fibers) have a higher threshold of activation than mechanoreceptive fibers (A-beta fibers). ď˝ Ron Melzack and Patrick Wall in 1965 proposed that it would be possible to selectively stimulate mechanoreceptive fibers by titrating the amplitude of electrical currents delivered across the surface of the skin (ie TENS). ď˝ This would prevent signals from nociceptive fibers from reaching higher centres of the brain, thus reducing pain ď˝ In essence, TENS electrically rubs pain away.
- 10. ď˝ Evidence gathered from studies suggested that low frequency TENS effects may be due to release of endogenous opioids. ď˝ This explains why analgesia may persist for hours after electrical stimulation has stopped because endorphins have long lasting effects in the central nervous system. ď˝ The released opioids may generate their analgesic action at peripheral, spinal and supraspinal sites.Other neurochemicals released are GABA , adenosine, acetylcholine etc.
- 11. ď˝ 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)
- 12. ď˝ Pain can be managed in the short term using analgesics, but long-term use can be detrimental to the patient's health. ď˝ Side effects of the long use of analgesics may affect on liver, kidney or stomach. ď˝ In many cases where pain is constant, a medical practitioner or physiotherapist may recommend the use of a TENS unit. ď˝ Why TENS? Because it is safe, effective and virtually with no side effects.
- 13. ď˝ Primary use is to control pain through Gate Control Theory ď˝ May produce muscle contractions ď˝ Various methods ⌠High TENS (Activate A-delta fibers) ⌠Low TENS (release of ď ď˘-endorphins from pituitary) ⌠Brief-Intense TENS (noxious stimulation to active C fibers)
- 14. ď˝ A TENS unit provides electrical stimulation to the painful area using electrodes attached to the skin. ď˝ Some scientists say: electrical signal v nerve sensation stops v natural pain relieving substances (endorphins) v no pain messages to brain v no pain.
- 15. ď˝ Conventional TENS (low intensity, high frequency) ď˝ Acupuncture like TENS or Low TENS (high intensity, low frequency) ď˝ Brief Intense TENS (high intensity, high frequency) ď˝ Burst Mode ď˝ Modulated Conventional TENS is most commonly used technique
- 16. ď˝ Acupuncture points ď˝ Trigger points, motor points ď˝ Dermatomes, spinal segments ď˝ Areas with greatest pain intensity ď˝ Peripheral nerves ď May be horizontal or vertical ď Crossed or uncrossed
- 17. Electrodes must be positioned on healthy sensate skin which should be checked prior to application. Electrodes are positioned on relevant dermatomes so that paraesthesia can be directed into the painful area. Exceptions include : ď˝ Hyperaesthesia and mechanical allodynia because TENS may aggravate pain. ď˝ Hypoaesthesia because TENS is not effective in non sensate skin and may cause skin irritation due to accidental use of excessively high intensities. ď˝ Damaged or fragile skin eg- wounds, eczema.
- 18. Parameter High TENS Low TENS Brief-Intense TENS Intensity Sensory Motor Noxious Pulse Fq 60-100 pps 2-4 pps Variable Pulse Duration 60-100 ďsec 150-250 ďsec 300-1000ďsec Mode Modulated Modulated Burst Modulated Tx Duration As needed 30 min 15-30 min Onset of Relief < 10 min 20-40 min <15 min
- 19. HIGH TENS (COMMON PARAMETER) LOW TENS (LESS COMMOMN PARAMETER FREQUENCY : 100-150Hz FREQUENCY : 1-5Hz PULSE WIDTH : 100- 500micro sec. PULSE WIDTH : 100- 150micro sec. INTENSITY : 12-30 mA INTENSITY : 30mA
- 20. 1- Two different modes: a- Continuous (continuous stream) b- Intermittent (short bursts) ď˝ Usually the continuous mode is used but for long term treatment intermittent mode is used 2- Adjustable. ď˝ We can control three variables: a- Output voltage. b- Width of the pulses. c- Pulse rate.
- 21. Continuous Mode: ď˝ Output Voltage: Adjustable from 12V to 80V. ď˝ Pulse Rate: Adjustable from 4.6Hz to 410Hz. ď˝ Pulse Width: Adjustable between 70 and 320 Âľs. Intermittent Mode : ďą Duty cycle: 24% at 1.2Hz
- 22. ď˝ Paresthesia is created without motor response ď˝ A Beta filers are stimulated to SG enkephalin interneuron (pure gate theory) ď˝ Creates the fastest relief of all techniques ď˝ Applied 30 minutes ď˝ relief is short lived (45 sec 1/2 life) ď˝ May stop the pain-spasms cycle
- 23. ď˝ Pulse rate: high 75-100 Hz (generally 80), constant ď˝ Pulse width: narrow, less than 300 mSec generally 60 microSec ď˝ Intensity: comfortable to tolerance
- 24. ď˝ 2 to 4 electrodes, often will be placed on post-opp. Readjust parameters after response has been established. ď˝ Turn on the intensity to a strong stimulation. Increase the pulse width and ask if the stimulation is .getting wider
- 25. ď˝ Level III pain relief, A delta fibers get Beta endorphins ď˝ Longer lasting pain relief but slower to start ď˝ Application ⌠pulse rate low 1-5ppx (below 10) ⌠Pulse width: 200-300 microSec ⌠Intensity: strong you want rhythmical contractions within the patientâs tolerance
- 26. ⌠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
- 27. ď˝ Pulse width: high 100-200 microSec ď˝ Pulse rate: 70-100 pps modulated to 1-5 burst/sec ď˝ Intensity: strong but comfortable ď˝ treatment length: 20-60 minutes
- 28. ⌠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 âbee stingâ sensation ⌠Utilize motor, trigger or acupuncture points.
- 29. ď˝ Pulse width: as high as possible ď˝ Pulse rate: depends on the type of stimulator ď˝ Intensity: as high as tolerated ď˝ Duration: 15 minutes with conventional TENS unit. Locus stimulator is advocated for this treatment type, treatment time is 30 seconds per point.
- 30. ď˝ Locus (point) stimulators treatment occurs once per day generally 8 points per session ⌠Auricular points are often utilized ď˝ Treat distal to proximal ď˝ Allow three treatment trials before efficacy is determined ď˝ Use first then try other modalities
- 31. ď˝ Keeps tissues reactive so no accommodation occurs ď˝ Simultaneous modulation of amplitude and pulse width ď˝ As amplitude is decreased, pulse width is automatically increased to deliver more consistent energy per pulse ď˝ Rate can also be modulated
- 32. ď˝ May be over the painful sites, dermatomes, myotomes, trigger points, acupuncture points or spinal nerve roots. ď˝ May be crossed or uncrossed (horizontal or vertical
- 35. ď˝ Musculoskeletal pain : ďź Acute postoperative pain and acute post traumatic pain. ďź Chronic pain eg. OA, RA ďź Chronic low back pain ďź Painful diabetic
- 36. ď˝ Someone with a pacemaker ď˝ Someone with undiagnosed pain ď˝ Someone with a heart condition ď˝ On head or neck of someone with epilepsy ď˝ On the eyes ď˝ Over mucosal surface ď˝ Using electrode on infected skin ď˝ Electrode should not be placed near carotid artery in anterolateral region of neck.
- 37. ď˝ Areas of skin irritation, damage or lesion ď˝ Areas with impaired sensation ď˝ Over abdominal, lumbosacral or pelvis regions during pregnancy other than for labor/ delivery. ď˝ Tissues vulnerable to hemorrhage or hematoma.
- 38. ď˝ Safe ď˝ Portable ď˝ Inexpensive ď˝ Can use it your self ď˝ Non painful
- 39. ď˝ Ensure machine is switched off before applying and removing electrodes Use only the gel designed for TENS as this improves the current passing through the skin. ď˝ Self adhesive electrodes can also be used ď˝ Slowly turn up intensity until definite but comfortable sensation is felt . ď˝ You will feel a tingling or prickling sensation under the areas of the electrodes .
- 40. >You may need to further increase the intensity in the one session as the body âaccommodatesâ or gets used to the sensation ď˝ Avoid increasing the intensity to the point where definite muscle movement happens ď˝ It is useful to keep a diary about the different settings you used and electrode positioning and what effect there was on pain .
- 41. ď˝ Over skin that has decreased sensation ď˝ Over the heart or at the front of neck ď˝ If you have a cardiac pacemaker ď˝ Over broken skin or red areas ď˝ Over scars or wounds ď˝ Over metal implants ď˝ Over abdomen if pregnant
- 42. ď˝ Wash and dry skin before use. ď˝ Check skin under electrodes after use of TENS for irritation and redness. If this happens STOP using TENS and consult your physiotherapist. ď˝ Gel must be reapplied to electrodes if using TENS for greater than 1 hours continuously.
- 43. ď˝ Wash electrodes with soap and water after use ď˝ Keep electrodes clean and dry . ď˝ Self-adhesive electrodes should be cleaned and placed on backing sheet between use . ď˝ Remove electrode leads from TENS unit and wipe clean on a regular basis . ď˝ Battery will need replacing on a regular basis in battery based TENS mechins.
- 44. THANK YOU