Module 11: Powerpoint 1

How is pain described as a human experience in rehabilitation?

Pain is a complex human experience and a cardinal sign of inflammation, indicating tissue injury. Individuals may compartmentalize or overwork through pain, but clinically pain signals that tissue damage or dysfunction has occurred and requires appropriate management.

Which nerve fibers transmit pain and how do they differ?

A-delta fibers transmit fast, sharp pain, while C-fibers transmit slow, deep, dull, or aching pain. These nociceptive fibers carry noxious stimuli to the central nervous system.

How does the gate control theory explain pain modulation?

Stimulation of fast-conducting A-beta sensory fibers (touch and pressure) can inhibit transmission from slower A-delta and C-fibers at the spinal cord level, effectively reducing the perception of pain.

What is the difference between analgesia and anesthesia?

Analgesia refers to the reduction or absence of pain without loss of consciousness, while anesthesia refers to a loss of sensation or numbness, often induced pharmacologically or through nerve damage.

What is paresthesia?

Paresthesia is an abnormal sensation such as tingling, prickling, or numbness without an identifiable stimulus.

How does sensory-level electrical stimulation reduce pain?

Sensory analgesia produces a tingling sensation that activates A-beta fibers, blocking nociceptive input and reducing pain perception.

Where can electrodes be placed to achieve sensory analgesia?

Electrodes may be placed around the painful site, along the dermatome, along the cutaneous nerve distribution, or superficial to the nerve trunk supplying the painful area.

What parameters are used for sensory analgesia?

Typical parameters include a pulse rate of 30–150 pps, pulse duration of 50–100 microseconds, and amplitude sufficient to produce tingling without muscle contraction.

How does electrical stimulation activate the endogenous opiate system?

Low-frequency electrical stimulation can trigger the release of endogenous opioids, such as endorphins and enkephalins, which reduce pain perception centrally.

What parameters are used to stimulate the endogenous opiate system?

Rates of 1–5 pps, pulse durations of 200–300 microseconds, and amplitudes sufficient to produce a muscle twitch are used, with treatment times of 30–45 minutes.

What patient-related factors influence ES for pain management?

Patient expectations, education, realistic goals, prior experience with ES, and use of narcotic pain medications all influence effectiveness.

What are major contraindications for ES in pain management?

Contraindications include demand-type pacemakers, carotid sinus application, epilepsy, direct application over eyes, malignancy (except palliative use), and decreased sensation.

What precautions should be observed?

Patients with cardiac disease should be monitored closely, and ES should not be used over open wounds or over lumbar/abdominal regions during early pregnancy.

Can ES be used during pregnancy or terminal illness?

During labor, ES may reduce lumbar pain in uncomplicated pregnancies but must be used cautiously. ES may be used for palliative pain relief in terminal cancer with informed consent.

Why are motor points and trigger points often used?

Motor points and trigger points have decreased resistance to electrical current, allowing more effective stimulation and improved pain relief.

How do acupuncture points relate to ES?

Acupuncture points exhibit low resistance and may be used to achieve diffuse sensory analgesia.

How is diffuse sensory analgesia achieved?

Two channels with four electrodes are placed in a criss-cross pattern around the painful area, often incorporating acupuncture points to enhance effectiveness.

How is ES integrated into pain management plans?

ES can reduce resting pain, decrease pain during therapeutic exercise, and manage acute pain flare-ups, improving patient participation.

What are the parameters and characteristics of conventional TENS?

Conventional TENS uses rates of 30–150 pps, pulse durations of 50–100 microseconds, sensory-level amplitude, and provides pain relief only during stimulation.

How does acupuncture-like TENS differ from conventional TENS?

It uses low frequencies (2–4 pps), longer pulse durations (100–300 microseconds), motor-level amplitudes causing twitching, and provides longer-lasting pain relief.

When is brief intense TENS used?

It uses high frequencies and amplitudes near motor level for short durations to minimize pain during painful procedures.

What characterizes noxious TENS?

It uses very high tolerated amplitudes with small probe electrodes to stimulate specific points, producing discomfort to suppress pain during procedures.