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TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION

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TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION

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    1. TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION Transcutaneous electrical nerve stimulation (TENS) is a non invasive method of electrical stimulation through intact skin and primarily aims to provide a degree of pain relief by specifically exciting peripheral nerves .

    2. Types of TENS Conventional TENS (Hi TENS)

    3. Conventional TENS (high frequency, short pulse, low intensity) Usually use stimulation at a relatively high frequency (90 - 130Hz) and employ a relatively short pulse duration (60-100 sec). The stimulation is delivered at sensory level intensity. Hi TENS is effective in treatment of acute pain of superficial nature.

    4. Acupuncture (Lo) TENS

    5. Acupuncture TENS (low frequency, long pulse, high intensity) Use stimulation at low frequency (2-4Hz) with long pulse duration (200-250 sec). The stimulation is delivered at motor level intensity, As it provokes visible muscle contraction. Lo TENS is effective in treatment of chronic pain of damaged deep tissues

    6. Burst Mode TENS

    7. Burst TENS (low frequency trains or bursts consists of high frequency, high intensity, short pulse) It is conventional TENS, but delivered in the Burst mode therefore interrupting the stimulation outflow at rate of 2-3 bursts/ sec. Each burst consists of a number of individual pulses at high frequency and short pulse duration as conventional TENS but with high stimulation intensity, and burst duration is (300-1000 sec). For some patients this is by far the most effective approach to pain relief.

    8. Uses of TENS Acute and chronic post operative pain Acute and chronic myofascial pain Acute and chronic pain associated with musculoskeltal disorders and soft tissues injuries as low back pain, arthritis, Neurologic pain as in post-herpetic neuralgia, trigeminal neuralgia, and peripheral nerve injuries. Stump and phantom pain

    9. Mechanism of action for pain inhibition 1- Hi TENS activates the pain gait mechanism by selectively stimulates large low threshold A beta sensory fibers, which causes presynaptic inhibition of C fibers and reduces the transmission of the noxious stimulus from the c fibers, through the spinal cord and hence on to the higher centers.

    10. Lo TENS stimulates the A delta fibers which respond preferentially to a much lower rate of stimulation (in the order of 2-5 Hz), which will activate the opioid mechanisms, and provide pain relief by causing the release of an endogenous opiate (encephalin) in the spinal cord which will reduce the activation of the noxious sensory pathways.

    11. Burst TENS stimulates both nerve types at the same time. In this instance, the higher frequency stimulation output (typically at about 100Hz) is interrupted (or burst) at the rate of about 2 - 3 bursts per second. When the machine is on, it will deliver pulses at the 100Hz rate, thereby activating the A beta fibers and the pain gate mechanism, but by virtue of the rate of the burst, each burst will produce excitation in the A delta fibers, therefore stimulating the opioid mechanisms.

    12. Other recent uses of TENS Muscle strength Improve cutaneous blood flow Wound healing Fracture healing (non-united fracture)

    13. Parameters used in TENS unit ParameterRange Intensity0-100 mA Pulse frequency1-150 pps Pulse duration10-500 sec Waveform Balanced asymmetric biphasic square

    14. Parameters used in TENS unit The pulses delivered by TENS stimulators vary but tend to be balanced asymmetrical biphasic modified square DC component, thus minimizing any skin reactions due to the build up of electrolytes under the electrodes.

    16. A modulation mode may be available which employs a wave pulses. The biphasic nature of the pulse means that there is usually no net method of making the pulse output less regular and therefore minimizing the accommodation effects which are often encountered with this type of stimulation.

    17. Some machines offer a dual channel output - i.e. two pairs of electrodes can be stimulated simultaneously.

    18. Types of Electrodes The most commonly used electrodes are of carbon silicone which are coated with a conductive gel prior to attachment to the skin. There are several other electrode types available now (including the metal mesh with solid conductive gel, which are self adhesive.

    19. Electrode placement : Over the painful site, or trigger point which is the most commonly used technique with pain caused by soft tissues injuries. Acupuncture point proximal and distal to the painful area. The acupuncture points can be located by their lower skin resistance stimulation of it can be effective in alleviating pain.

    20. Electrode placement : Over the same dermatome. In case the pain is distributed across a large area with no definite trigger point or when the surface area of the affected area is inaccessible. Peripheral nerves. The effect of TENS can be maximized if the nerve involved in the transmission of pain can be identified and stimulated. Electrodes are placed in the line of the nerve where it is particularly superficial. This method is effective in treatment of neurologic pain.

    21. Electrode placement :

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