2. Features of TENS
Types of TENS
Application of TENS
Introductio
n
3. Definition:-
Transcutaneous electric nerve stimulation (TENS) is method of electric stimulation
that involve in pain relief by superficially excruciating sensory nerves.
4. Key principles:-
Knowledge of intent of TENS application
Location of electrode placement
Selection of appropriate current type
Dosage
6. 1. Conventional TENS or high frequency TENS
2. Acupuncture like TENS or low frequency TENS
3. Brief TENS or intense TENS
4. Burst TENS
5. Modulated or modified TENS
7. Conventional of high TENS
Principle:-
Pre synaptic inhibition by pain gate mechanism by stimulating Alpha and Abeta
fibers.
Duration:–
30-60min once or twice daily
Frequency:-50-100Hz
Pulse width :-20-60 microseconds
Intensity:-0-30mA
Intensity until a prickling or tingling sensation is felt
8. Acupuncture or low TENS
Principle -This stimulates the high threshold AS 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.
Frequency - More than 100 Hz
Pulse Width - 150 us to 250 us
Intensity - Highest level tolerated by the patient.
9. 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.
10. Brief or Intense TENS
Principle -Activity in cutaneous AS afferents induced by intense TENS produce
peripheral blockade of nociceptive afferent activity (Central biasing
mechanism).
Duration - 30 to 60 minutes once or twice daily.
Frequency - More than 100 Hz
Pulse Width - 150 us to 250 us
Intensity - Highest level tolerated by the patient.
11. 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.
12. USES of TENS
Common conditions where TENS is used
Relief of Acute Pain:
•Post operative pain
•Labour pain
•Dysmenorrhoea
•Angina Pectoris
Relief of Chronic Pain:
•Low back pain
•Arthritic pain: RA, OA
•Myofascial pain
13. Electrode Placement
Directly over painful sites: trigger points
Dermatomes, Myotomes
Accupunture points
Spinal nerve roots
May be crossed or uncrossed
Horizontal or vertical
14. Contraindication
Someone with a pacemaker
Someone with undiagnosed pain
Someone with a heart condition
On head or neck of someone with epilepsy
Cardiac conditions- arrhythmia
Neurological conditions: epilepsy, stroke
Non-cooperative patients
Pregnancy
Active infections, Skin conditions
15. 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
Incompetent patients may not be able to manage the device and it must be kept
out of reach of children.
Athletes should not be permitted to participate in sports while under the influence
of TENS analgesia