CSkills 2 - Electrical Currents for Pain Control

What is TENS

The use of transcutaneous electrical stimulation to modulate pain

How does TENS modulate pain

Through gate control and stimulating the endogenous opioid system

How does TENS utilize pain gating

Inhibition of A-beta fibers and inhibiting nociceptive input at the spinal cord

Conventional TENS utilizes what kind of frequency

High frequency

What are the characteristics of conventional (high rate) TENS

- Short duration (50-80us)

- High frequency (100-150pps)

Conventional TENS is most effective while

Stimulation is applied

Short duration, high frequency pulses at a current amplitude produces

A comfortable sensation without muscle contraction

Low rate TENS utilizes

Low frequency pulses (2-10pps) at an intensity high enough to produce motor contraction

Low rate TENS causes stimulation of

Motor nerves

The brief, repetitive muscle contractions or twitches from low rate TENS stimulates

Opioid production/release

Acupuncture-like TENS increses current intensity beyond

Muscle contraction to stimulate nociceptive A-delta fibers

Acupuncture-like TENS is effective for

4-5 hours after

Acupuncture-like TENS should be limited to

<30 minutes due to DOMS

Burst mode TENS delivers

Stimulation in bursts or packages with a number of pulses in each burst

Burst mode work by the same mechanism as

Low-rate TENS

What amplitude should be used with burst mode TENS

To visible contraction

What is the duration of burst mode TENS treatment

20-30 minutes

Burst mode TENS may be more effective than low rate TENS since

More current is being delivered leading to greater endorphin release

TENS can reduce

Analgesic medication intake

How does TENS help with post-op pain

It can help to reduce it

What kinds of chronic pain can TENS help with

- Knee conditions (OA)

- Diabetic neuropathy

- Chronic LBP

What is electroacupuncture

Placement of electrodes on the skin overlying acupuncture points

What is interferential current

A variation of AC waveforms

IFC is produced by

Interference of 2 medium frequency ACs with slightly different frequencies

The lower of the 2 frequencies in IFC is the

Carrier frequency

IFC is generally more

Comfortable

What is a premodulated current

A variation of AC waveforms

Premodulated current utilizes

Medium frequency range with sequentially increasing and decreasing current amplitude

Premodulated current is produced from

A single current and 2 electodes

Compared to IFC, premodulated current

Is easier to set up, but does not have the same benefits of delivering lower currents across across skin and over a larger area

What are the contras for ES for pain control

- PASTA SAUCE

- Muscle contraction may disrupt healing

What are the precautions for ES for pain control

- MBA CHIME

- May cause delayed onset muscle soreness

- Educate patient to avoid aggravating activities if using TENS

- Pregnancy during labor and delivery (may use for pain control)

Electrode placement is most common

Around the painful area

What are the parameters of conventional tens

- 100-150 pps

- 50-80 us

- Sensory amplitude

- Whenever there is pain

What are the parameters of low-rate TENS

- <10 pps

- 200-300 us

- Small muscle contraction amplitude

- Maximum 20-30 min every 2 hours