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    DR Sapna Ali Khan (PT) DPT, MSPT

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    CHANGEZ KHAN SARDAR
    TENS (transcutaneous electrical nerve stimulation) is a non-invasive pain management technique that uses low voltage electrical pulses on the skin to block pain signals sent to the brain. It works through both the endorphin theory by stimulating the release of natural pain-killing endorphins, and the gate control theory by overriding pain signals at the spinal cord. TENS comes in various modes like high rate, low rate, burst, and acupuncture-like that use different pulse frequencies and intensities to treat both acute and chronic pain conditions. It has few contraindications and can help with pain from injuries, arthritis, muscles, and nerves when applied at appropriate sites on the body.

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    DR Sapna Ali Khan (PT) DPT, MSPT

    Uploaded by

    CHANGEZ KHAN SARDAR
    119 views32 pages
    TENS (transcutaneous electrical nerve stimulation) is a non-invasive pain management technique that uses low voltage electrical pulses on the skin to block pain signals sent to the brain. It works through both the endorphin theory by stimulating the release of natural pain-killing endorphins, and the gate control theory by overriding pain signals at the spinal cord. TENS comes in various modes like high rate, low rate, burst, and acupuncture-like that use different pulse frequencies and intensities to treat both acute and chronic pain conditions. It has few contraindications and can help with pain from injuries, arthritis, muscles, and nerves when applied at appropriate sites on the body.

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    lec-12 TENS

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    TENS (transcutaneous electrical nerve stimulation) is a non-invasive pain management technique that uses low voltage electrical pulses on the skin to block pain signals sent to the brain. It works through both the endorphin theory by stimulating the release of natural pain-killing endorphins, and the gate control theory by overriding pain signals at the spinal cord. TENS comes in various modes like high rate, low rate, burst, and acupuncture-like that use different pulse frequencies and intensities to treat both acute and chronic pain conditions. It has few contraindications and can help with pain from injuries, arthritis, muscles, and nerves when applied at appropriate sites on the body.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    119 views32 pages

    DR Sapna Ali Khan (PT) DPT, MSPT

    Uploaded by

    CHANGEZ KHAN SARDAR
    TENS (transcutaneous electrical nerve stimulation) is a non-invasive pain management technique that uses low voltage electrical pulses on the skin to block pain signals sent to the brain. It works through both the endorphin theory by stimulating the release of natural pain-killing endorphins, and the gate control theory by overriding pain signals at the spinal cord. TENS comes in various modes like high rate, low rate, burst, and acupuncture-like that use different pulse frequencies and intensities to treat both acute and chronic pain conditions. It has few contraindications and can help with pain from injuries, arthritis, muscles, and nerves when applied at appropriate sites on the body.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 32

    TENS

    DR SAPNA ALI KHAN (PT)


    DPT, MSPT*
    TRANS-CUTANEOUS ELECTRICAL NERVE STIMULATION

    • Application of low frequency pulsed rectangular wave current via surface electrodes
    on the patient skin to reduce pain.
    • It is the modern, non-invasive, drug free pain management modality, designed to
    provide afferent stimulation, used for relief of acute or chronic pain.
    • Electro-analgesia
    • Abbreviated as TNS or TENS.
    APPARATUS OF TENS
    MECHANISM OF ANALGESIA

    • Endorphin Theory:
    Endorphins are transmitter substances that occur naturally in
    brain and pituitary gland. It block the pain sensation
    • Gate Control Theory:
    Pain may be blocked at various gates through which pain impulses
    travel to the brain. These gates are located at neuronal synapses in the
    spinal cord.
    PAIN

    • Unpleasant disturbed sensation


    • Subjective phenomenon.
    • Activation of nociceptors.
    • A Delta fibers: Fast conducting large diameter myelinated fibers, which
    conducts with a velocity of 5–30 m/s.
    • C-fibers: Slow conducting small diameter nonmyelinated fibers, which
    conducts with a velocity of 2–5 m/s.

    5
    6
    6
    PAIN GATE CONTROL

    • Postulated by Ron Melzack and Pat Wall in 1965.


    • Modified in 1982.
    • Afferent input is mainly through posterior root of the spinal cord and all afferent information must
    pass through synapses in the substantia gelatinosa and nucleus proprius of the posterior horn.
    • It is at this level that the pain gate operates and presynaptic inhibition by TENS works.

    7
    1. -
    PAG +
    SG T 4. Raphe nucleus

    NA + 5-HTA

    2. +
    -
    SG T
    SG T

    Nociceptive
    - +
    afferent

    3.
    Large diameter
    mechanosensitive
    afferent
    +
    -
    SG T

    8
    9
    PAIN RELIEF BY TENS

    • Alteration of the sensitivity of peripheral receptors of free nerve ending


    which conduct and transmit the nociceptive stimulation
    • Increased blood circulation may be caused by muscle contraction and
    relaxation (burst or rhythmic stimulation)
    • Blockage of A-delta and C-fibers at the 100 pps for 20min continuous
    stimulation
    • ANS is also effected by TENS frequency of about 100 pps
    CHARACTERISTICS OF TENS

    • Pulse shape: usually rectangular.


    • Pulse Width/duration: Measured in microseconds (µs), & is often fixed
    at 100 µs or 200 µs, can vary from 50-300 µs.
    • Frequency: can be as low as 2 Hz or as high as 600 Hz.
    • Intensity: can be varied from 0-60 mA
    TYPES OF TENS
    • High rate TENS
    • Low rate TENS
    • Brief intense TENS
    • Burst mode TENS
    • Point stimulation TENS
    • Modulated TENS
    HIGH RATE TENS OR CONVENTIONAL TENS

    • Most common mode of TENS used in acute or chronic pain syndrome.


    • It is based on sensory level stimulation
    • Activates gait control
    • Effect is rapid but transient
    PARAMETERS OF HIGH RATE TENS

    • Pulse Rate: 50-100 Hz


    • Pulse duration: 2-50 µs
    • Duration: 20-60 min in one sitting for 8 hrs if required.
    • Intensity: Patient should feel a tingling, pins and needles sensations,
    often b/w 12-30 mA.
    LOW RATE TENS OR ACUPUNCTURE LIKE TENS

    • This is acupuncture like strong low frequency stimulus, used in relief of


    chronic pain.
    • It is based on motor-level stimulation
    • Modulation of pain is through activation of Descending pain suppression
    system.
    • Effect is relatively slow but lasts longer i.e. more than hours after the
    treatment.
    • Uses: Relief of chronic pain, hypo sensitive areas e.g. diabetic
    neuropathy.
    PARAMETERS OF LOW RATE TENS
    • Pulse Rate: 1-5 Hz
    • Pulse duration: 150-300 µs
    • Duration: 20-30 min in one sitting.
    • Intensity: Sufficient to cause visible muscle twitches within comfortable
    tolerance level of the patient i.e.30 mA.
    • Frequency: once or twice a day.
    BRIEF INTENSE TENS
    • Potentially painful, intense stimulation used to provide rapid short term
    pain relief during painful procedures
    • Relief of pain is temporary.
    • Uses: to suppress pain during painful procedures.
    PARAMETERS OF BRIEF INTENSE TENS
    • Pulse Rate: 80-150 Hz
    • Pulse duration: 50-250µs
    • Duration: 15 min.
    • Intensity: strong to the level of pain threshold
    • Frequency: as required
    BURST MODE TENS
    • Combines the characteristics of high & low TENS, leading to release of
    endogenous opiates.
    • The stimulation is well tolerated by patients, even on prolonged
    application, with slower onset of pain relief as compared to low TENS.

    • Uses: suitable for relief of chronic muscle spasm or a combination of


    MSK and neurogenic pain of chronic nature, e.g. sciatic syndrome.
    PARAMETERS OF BURST MODE TENS
    • Pulse Rate: 50-100 Hz, delivered in bursts, of 1-4 pulses per second.
    • Pulse duration: 50-200 µs
    • Duration: 15-20 min.
    • Intensity: comfortable with intermittent tingling sensation.
    • Frequency: as required
    HYPER STIMULATION OR
    POINT STIMULATION TENS

    • It uses a small probe to located and noxiously stimulate acupuncture or


    trigger points
    • Multiple sites can be stimulated in one treatment
    • It relieve pain by Endorphin mediated mechanism
    PARAMETERS OF POINT STIMULATION TENS

    • Pulse Rate: 1-5 pps


    • Pulse duration: 150-300 µs
    • Amplitude: Strong- to patient tolerance
    • Electrode Placement: Over the pain site; can be placed over the nearest
    motor-points & trigger points.
    PARAMETERS FOR OPTIMAL STIMULATION

    • An optimal stimulation or site should be:


    Strong enough to stimulate the CNS.
    Suitable for proper placement of electrodes, free of bony or hairy area.
    Segmentally related to the source, as well as the site of pain.
    Anatomically distinct , like specific spinal segment or the nerve.
    APPLICATION OF TENS
    • Large main units.
    • Pocket size.
    • Conductive rubber electrodes covered by conductive gel in order to gain
    good skin contact.
    • Electrode positioning is an area of debate. electrodes can be placed
    over:
    Acupuncture points, motor points, trigger points.
    Area of greatest intensity of pain.
    Appropriate dermatome or spinal segment or peripheral nerve.
    INDICATIONS
    • Joint pain:
    Osteoarthritis, Rheumatoid arthritis

    • Acute pain:
    Postoperative pain

    • Muscle pain:
    Muscle spasm, Torticollis

    • Spinal pain:
    Spinal nerve compression

    • Nerve disorders:
    Peripheral nerve injuries
    CONTRA-INDICATION FOR TENS
    • Cardiac pacemakers
    • Over chest wall of cardiac patient.
    • Over eyes, larynx, pharynx, over mucosal membrane.
    • Over head and neck of a patient with the recent history of stroke or epilepsy.
    • Unit should not be immersed in liquid substances
    • Areas of venous or arterial thrombosis
    • Neoplasm (malignancy)
    • Stimulation over the eyes
    • Pain of unknown etiology
    MOTOR POINTS OF BACK
    MOTOR POINT OF BACK
    REFERENCES
    • Clayton’s Electrotherapy
    • Electrotherapy by Muhammad Salabat Khan
    • Text book of electrotherapy by Jagmohan singh
    THANK YOU

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