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What is the Gate Control Theory of pain?
Activation of nerves that carry vibration, stretching and mechanoreception inhibit the transmission of noxious (pain) signals from the spinal cord to the pain
What is interferential ES?
ES delivered through two set of electrodes from separate channels that interest
The result of interacted waves is pulses or beats
Beat frequency is equal to the difference between two frequencies
What happens when intersecting interreferential ES waves are in the same phase?
It causes higher amplitudes
What happens when intersecting interferential ES waves are in opposite phases?
It causes lower amplitudes
Why is interreferential believed to be more comfortable than other forms of ES?
A lower amplitude current is perceived at the skin while higher amplitude waves are working at deeper tissues
What is interferential current used to treat?
Used to decrease pain associated with inflammation and ischemia
What is a TENS unit used for?
Used to modulate pain
What is the most common wave form used with a conventional TENS unit?
Biphasic
What is a conventional TENS?
Shorter duration, higher frequency pulses
Comfortable sensation without ms contractions
Stimulates A-beta nerves (inhibits transmission of pain)- look at the chart
Gating only occurs when TENS is applied
Tries to interrupt the pain-spasm-pain cycle
What is a low-rate/acupuncture-like TENS unit?
Small amount of motor nerves are stimulated to produce contractions and A-delta fibers (quick pain) are stimulated briefly - look at the chart!
This causes a release of endogenous opioids which bind to opiate receptors in the brain (works like morphine)
How long does low-rate/acupuncture-like TENS control pain?
4-5 hours after a 20-30 min session (4.5 hrs is the half-life of endogenous opioids)
What is a burst mode TENS?
Composed of a series of pulses delivered in groups
Delivered with a preset frequency and duration
Works through the same mechanism as low-rate TENS
Fig13-1, pg 259
What wave forms can be used with a TENS unit?
Pulsed biphasic - TENS
Interferential current - alternating
Pulsed monophasic (modulated) - high voltage pulsed current - alternating current used for pain
Where are the electrodes placed when using a TENS unit?
On or around the area
For interferential, the channels must intersect
What is the pulsed duration/wave length for conventional TENS?
50-80 microseconds to depolarize A-beta fibers
What is the pulse duration/wave length of the low-rate TENS unit?
200-300 microseconds to depolarize motor nerves and A-delta fiber
What is the frequency of a convential TENS unit?
100-150 pps
Same for burst but administered in 10 bursts per second
What is the frequency of a low-rate/acupuncture TENS unit (or burst)?
2-20 pps
How is a TENS unit applied?
No on:off, it is continuous
What should the current amplitude be when using TENS (or IFES)?
Whatever the patient can tolerate - should be gentle (MODERATELY GENTLE)
What should the sensation be like when using low-rate TENS?
Small motor twitch or stinging
What is the treatment time for a conventional TENS unit?
Can be continuous
What is the treatment time for a low-rate/acupuncture TENS unit?
20-30 min ever 2 hours
What is the treatment time for IFES TENS?
20-30 min and often combined with ice or MHP
What form of ESTIM is usually often combined with MHP or ice pack.
IFES (for 20-30 min)
What type sensation should conventional TENS and IFES produce?
A gentle sensation