ES FOR PAIN RELIEF (TENS & IFC)

TENS: Electrical stimulators capable of delivering __ currents, for __ PN fibers through the skin using __

pulsed; depolarizing; surf. electrodes

By Melzack and Wall (1965)

Gate Control Theory (GCT)

Which fibers are nociceptors

A delta and C

Which fibers are responsible for transmission of noxious stimuli

A delta and C

Which fibers are inhibitory to SG

A delta and C

Which fibers render the gates open

A delta and C

Which fibers are mechanoreceptors

A beta

Which fibers are facilitatory to SG

A beta

Which fibers render the gates closed

A beta

What is the Descending Pathway Inhibitory Tract (DPIT) also known as

AKA Endogenous Opiate System / Endorphin release

How does the Endogenous Opiate System / Endorphin release work

Injury -> pain impulse -> SpC -> brain -> releases endorphins & enkephalins

Enkephalins

block pain signals @ SpC

Endorphins

block pain signals @ brain stem

Modes of Application of ES for Pain Relief

Conventional TENS

Acupuncture-like TENS

Brief-intense Stimulation

Hyper-stimulation

Burst Mode TENS

Interferential Current (IFC)

AKA High-rate TENS

Conventional TENS

Conventional TENS uses __ -duration __-freq pulses to prod __ sensation w/o __ to modulate acute pain (GCT)

short; high; comfortable; m. contraction

Conventional TENS occurs at what level

Sensory ONLY

Conventional TENS: intensity is modulated until

pt feels a comfortable sensation (MILD)

Conventional TENS: Stimulus is modulated to prevent __

accommodation (used to it)

Conventional TENS: Waveform (acc to Michlovitz)

Mono/Biphasic PC

Conventional TENS: Waveform (Clinical)

Biphasic PC

Conventional TENS: Pulse freq (acc to cameron)

100-150 pps

Conventional TENS: Pulse freq (Clinical)

80-110 pps/Hz

Conventional TENS: Pulse duration (acc to cameron)

50-80 usec

Conventional TENS: Pulse duration (Clinical)

50-150 usec

Conventional TENS: Intensity

Comfortable, tingling sensation (NO TWITCH)

Conventional TENS: Tx time

20-30 mins (20 in lab)

AKA Low-rate TENS

Acupuncture-like TENS

Acupuncture-like TENS: Repetitive stimulation of motor n.s to produce __

brief repetitive m. contractions/twitches

Acupuncture-like TENS: Stimulation of __ fibers to produce __ (DPIT)

A-delta; brief sharp pain

Acupuncture-like TENS: Stimulates both __ and __

motor and sensory

Acupuncture-like TENS: Waveform (Michlovitz)

Mono/Biphasic PC

Acupuncture-like TENS: Waveform (Clinical)

Biphasic PC

Acupuncture-like TENS: Pulse freq (cameron)

2 - 10 pps

Acupuncture-like TENS: Pulse freq (Clinical)

<10 pps / Hz

Acupuncture-like TENS: Pulse duration (Cameron)

200-300 usec

Acupuncture-like TENS: Pulse duration (Clinical)

150 usec

Acupuncture-like TENS: Intensity

Visible muscle twitches (motor); brief sharp pain (sensory)

Acupuncture-like TENS: Time

20-45 min. (stick with 20)

Combining sensory TENS & motor TENS

Brief-intense Stimulation (has twitch)

Brief-intense stimulation: Sensory TENS parameter

high freq, short pulse duration

Brief-intense stimulation: Motor TENS parameter

low freq., long pulse duration

Brief-intense stimulation: Intensity up to __

pt's max tolerance (DPIT)

Brief-intense stimulation: Waveform (Michlovitz)

Mono/Biphasic PC

Brief-intense stimulation: Waveform (Clinical)

Biphasic PC

Brief-intense stimulation: Pulse freq (Michlovitz)

High; approx 100 pps

Brief-intense stimulation: Pulse freq (Clinical)

80-110 pps / Hz

Brief-intense stimulation: Pulse duration (Michlovitz)

Long; >150 usec

Brief-intense stimulation: Pulse duration (Clinical)

150 usec

Brief-intense stimulation: intensity

Visible strong muscle twitches (motor)

Brief-intense stimulation: Time

<15 min

Brief-intense stimulation: Pretreatment

Sensory assessment

Checking of area

Blanching

AKA Point stimulation / electroacupuncture

Hyperstimulation

How is hyperstimulation applied

using a probe electrode over acupuncture points

Hyperstimulation: pain relief via:

DPIT

Hyperstimulation: waveform (Michlovitz)

Monophasic PC

Hyperstimulation: waveform (Clinical)

Monophasic PC

Hyperstimulation: Pulse freq (Michlovitz)

Low: 1-5 pps

High: 100 pps

Hyperstimulation: Pulse freq (Clinical)

80-110 pps / Hz

Hyperstimulation: Pulse duration (Michlovitz)

Long: ≥1250 usec up to 1 sec

Hyperstimulation: Pulse duration (Clinical)

150 usec

Hyperstimulation: Intensity

Highest tolerated painful stimulus (noxious)

Hyperstimulation: Time

30-60 sec to each point

Burst Mode TENS: stimulation

delivered in bursts

Burst mode TENS: pain relief

via DPIT

Burst mode TENS: Waveform (Michlovitz)

Mono/Biphasic PC

Burst mode TENS: Waveform (Clinical)

Biphasic PC

Burst mode TENS: Pulse freq (Cameron)

10 bursts

Burst mode TENS: Pulse freq (Clinical)

<10 pps or Hz

Burst mode TENS: Pulse duration (Cameron)

100-300 usec

Burst mode TENS: Pulse duration (Clinical)

150 usec

Burst mode TENS: Intensity

Visible muscle contraction (motor)

Burst mode TENS: Time

20-30 min

Application of alternating-medium freq currents (1,000-10,000 Hz), which are slightly out of phase, through the tissues that is amplitude-modulated to low-freq. current

Interferential Current (IFC)

Interferential Current (IFC): Application of __ freq currents __ (value) , which are slightly __, through the tissues that is amplitude-modulated to __ current

alternating-medium ; 1,000-10,000 Hz; out of phase; low-freq.

What is IFC for

Pain relief

Ms. reeducation

Improving Circulation

Enhancing healing process

IFC: Low Frequency Current

1-1k Hz

• Minimum freq. required for evoking tetanic muscle contraction

• Causes high skin resistance

IFC: Medium Frequency Current

1,000-10,000 Hz

Causes lower skin resistance

IFC: High Frequency Current

10,000 Hz

Thermal effects

Types of interference waves

constructive and destructive

Type of interference: Both waves are completely out of phase

Destructive

Type of interference: Cancels out each other

Destructive

Type of interference: Summate = 0

Destructive

Type of interference: No freq produced

Destructive

Type of interference: Slightly out of phase

Constructive

Type of interference: Summates

Constructive

Type of interference: Builds up or constructs wave freq

Constructive

Amplitude-modulated current

Beat Frequency/ Amplitude-modulation frequency (AMF)

Types of frequency

Carrier/base freq

Beat freq

Types of frequency: Lesser freq. of 2 interfered original AC

Carrier/base freq

Sensory application

4kHz

Motor application

2kHz

Types of frequency: Diff bw 2 original ACs; typically bw 1-200 Hz

Beat freq

2 types of beat frequency

Constant Beat Frequency / Selective Beat Frequency

Variable Beat Frequency / Automatic / Sweep Beat Frequency

Constant diff bw the 2 circuits

Constant Beat Frequency / Selective Beat Frequency

Freq. bw the 2 circuits varies w/i preselected ranges (modulated type to address accommodation: loss of sensation)

Variable Beat Frequency / Automatic / Sweep Beat Frequency

Modes of Application (IFC): Types of ICF

Quadripolar Static Mode / Two-Circuit Static Interference Field

Quadripolar Scanning Mode / Two-Circuit Scanning Interference Field

Premodulated Mode / Exogenous / Bipolar Method

Hexipolar Mode / Three-Circuit IFC

Quadripolar Static Mode / Two-Circuit Static Interference Field: Red is for __ Black is for __

Anode

Cathode

Quadripolar Static Mode / Two-Circuit Static Interference Field: Which pads are active

All

Quadripolar Static Mode / Two-Circuit Static Interference Field: Where is electrical stimulus felt

approx 45º (static)