TECHNIQUES OF TENS APPLICATION

CONVENTIONAL MODE TENS Description Pulse Width Pulse Rate Amplitude provide comfortable tingling sensation at submotor level most frequently used mode of stimulation also called High Rate Conventional TENS 50-125 s (or pulse duration <0.200ms) 50-100 pps submotor; produce only comfortable paresthesia LOW FREQUENCY MODE TENS also called acupuncture like TENS stimulates both motor & sensory nerves in area of pain or segmentally related myotome analgesia is naloxone reversible 200-500 s (or 0.2 to 0.3 ms) 1-5 pps strong enough to elicit a muscle contraction BURST MODE TENS use combination of high and low frequency pulses BRIEF INTENSE MODE TENS

200-500 s at 1-5 bursts/sec 70-100 pps strong enough to produce muscle contraction

250 s (or > 0.3 ms) 110 pps (150 pps according to Gersh) to tolerance for maximum paresthesia; usually to point that muscle fasciculation, tetany occurs instant pain relief by decreasing conduction along Type A-delta and Type C pain nerve fibers (conduction block) get a brief, profound analgesia while doing an uncomfortable procedure like wound debridement very fast acting comfortable practically no carry over treatment length of 15 min. too short for chronic pain management electroanalgesia greatest when electrodes placed over major superficial peripheral nerves which may not be well tolerated higher intensities perceived as annoying acute & chronic pain adjunct to deep friction massage (remove discomfort of massage); to joint mobilization, to wound debridement & dental work

Frequency Purpose & Effects

pain relief with pain inhibition at spinal cord level by stimulating the large diameter Type A-beta afferent fibers comfortable fast acting useful for both acute & chronic pain no motor response may be used 24 hours carry-over period (pain-free period after stopping TENS) short thus give only temporary relief adaptation common

pain relief with pain inhibition at hypothalamus level

same as low frequency mode TENS

Advantages

Disadvantages

longer carry over period so have longer duration analgesia less adaptation

long carry over period more comfortable than low frequency mode TENS

Indications

acute & chronic pain

have motor response which may be uncomfortable or annoying not suitable for acute pain due to muscle contraction treatment limited to 1 hour to avoid muscle fatigue or soreness onset of analgesia delayed, often 20-30 min acute or chronic pain

same as for low frequency mode TENS

acute & chronic pain

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CONVENTIONAL MODE TENS Contraindications Precautions pacemakers pregnancy over carotid sinus, laryngeal or pharyngeal muscles, eyes and mucosal membranes not used while operating hazardous machinery for external use only keep out of reach from children skin irritation at electrode placement sites MI and arrythmia patients intensity or amplitude increased to point where paresthesia felt without motor stimulation turn off unit before removing electrodes applied at or near painful area or over segmentally related dermatome LOW FREQUENCY MODE TENS same same BURST MODE TENS BRIEF INTENSE MODE TENS same as conventional TENS

same

same

same as conventional TENS

Application Guidelines

recommend start with conventioanl mode for first 10-20 min. then shift to low frequency TENS for next 20-40 min. done only once daily applied to skin overlying a motor nerve, a motor point, the painful area or in a segmentally related MYOtome once daily

electrode placed surrounding or proximal to side of potential pain

15 min treatment time only since mechanism of action is theoretically maintaining a conduction block of the nerve membrane stimulate only for 15 min. then rest if this is to be repeated since muscle fatigue will occur

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MODULATION MODE TENS Description multimodulation or combination modulation amplitude, pulse width and frequency cyclically modulate with varying combinations same as conventional mode TENS less nerve adaptation comfortable fast acting no motor response may be used for 24 hours short carry over some patients find the constantly changing stimulation annoying acute or chronic pain same as conventional mode TENS STRENGTH-DURATION MODE TENS unit adjusts amplitude to pulse width based on an approximate strengthduration curve thus providing maximum nerve firing in response to an external stimulus amplitude & pulse width individualized to patient reduce adaptation that occur with constant stimulus decreased nerve adaptation comfortable fast acting no motor response may be used 24 hours short carry over HYPERSTIMULATION Type of neuromodulation where noxius input used to control pain

Purpose & Effects Advantages

Disadvantages

activate analgesia system in brainstem fast onset analgesia effectiveness seen immediately small active electrode useful in areas not conducive to large electrodes unpleasant noxious stimulation may not be tolerated by patient acute or chronic pain same as conventional mode TENS use small diameter point-probe active electrode so that current density here high & this adds to the noxious input 250s to 10ms 1 to 4 pps one that produces the maximum tolerable level of noxious input

Indications Contraindications Application Guidelines Pulse Width Pulse Rate Amplitude

acute or chronic pain same as conventional mode TENS