E - Stim Pain Control

segmental tens types (2)

high rate tens

conventional tens

suprasegmental tens (5)

low rate tens

acupuncture like tens

noxious tens

motor level tens

burst tens

segmental tens theory

pain relieving by activated non-nociceptor A beta sensory nerve. A beta inhibits transmission of pain signals at spinal cord level (gate control) occurring at that segment

suprasegmental tens theory

control pain by stimulating production and release of opioids, occurring above the segment

segmental

acute pain

take end off sub acute or chronic

mask uncomfortable interventinos

suprasegmental

subacute or chronic pain

acute pain - electrode placement

do NOT use if contraction would be contraindicated

Segmental summary

suprasegmental summary

comparing segmental vs suprasegmental

commercial modes

hvps

lvps

tens

premodulated

• polyphasic pulsed current

  • carrier frequency measured in kHz

• developed to allow 2 electrode IFC

• preset is segmental pain control (80-150 Hz)

• use normal sizes, not small or cut down

internal premodulation science

generates low medium-frequency currents, frequency chosen by difference between to equaling desired level

internal mixing premodulation science

mixes two frequencies internally, combines two frequencies into one

premodulated current carries the therapeutic beat frequency

sent out through single channel

premodulated single current delivered via

two electrodes

premod vs russian

ifc science

• generates two separate frequency current

  • channel 1 4000, channel 2 4100

• current intersect where electrode pairs overlap

• intersection creates beat frequency of 100 Hz

beat frequency

number of cycles per second

phase duration ifc

duration of one phase of waveform

ifc math

2500 hz = 5000 phases

1 sec / 5000 phases = .0002

phase duration = 200 microsec

icf vs premodulation

ifc over premod?

allows one to cover large areas

the modulations typically available are nice to have

default mode

habits

tens treatment

resulted in less pain in short / long term

more than placebo

useful when meds aren’t an option or need to be limited

setting frequency no evidence better

based on comfort and goals

tens + standard care

gave better relief than standard along

worked well paired with meds, pt, or both

tens is a helpful add on

tens safety

no serious injuries

minor side effects (skin irritation, temporary soreness, mild discomfort)

very safe, especially compared to many medications

tens neuropathic

reduces pain in neuralgia, spinal cord

chronic LBP

tens after surgery

reduces pain at rest, immediately after surgery

lower morphine use

decreaes nausea, dizziness, and itching

helps knee ROM

summary

electrotherapy can reduce pain, not address the problem

facilitate capacity, not 3 x/week for 4 weeks

short term effect 2 weeks