Saurab Sharma presented on Transcutaneous Electrical Nerve Stimulation (TENS). The objectives were to understand TENS theory, application techniques, uses, electrode placement, and precautions. TENS delivers electricity across the skin to activate nerves and provides pain relief for acute, chronic non-malignant, and palliative malignant pain. Different application techniques include high frequency, low frequency, brief intense, burst mode, and modulated TENS. Common uses are postoperative, labor, musculoskeletal, and neuropathic pain. Electrodes are placed over painful sites and precautions taken with pacemakers, malignancy, and skin conditions.
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Available
TENS Therapy Guide for Pain Relief
1. Saurab Sharma, MPT
Lecturer, KUSMS
TENS (Transcutaneous Electrical
Nerve Stimulation)
MSK II
Physiotherapy II
Electrotherapy
Lecture 1
2. Objectives of session
At the end of the class, students will be
able to:
Understand the theory of TENS
Explain the techniques of TENS
application
Identify the uses of TENS
Identify Precautions and2
3. Contents
Introduction
Features of TENS
Applications of TENS
Uses of TENS – common and uncommon
Electrode Placement
Precautions and contraindications
3
4. Introduction
Transcutaneous Electrical Nerve
Stimulation
Delivers electricity across the intact surface
of the skin to activate underlying nerves
Simple, non-invasive analgesia causing
modality
For pain- acute, chronic non-malignant
For palliative care of malignant conditions4
5. Keys principles
Outcome of treatment is based on the:
Knowledge of intent of TENS
application
Location of electrode placement
Selection of appropriate current types
Dosage
5
6. Principles of Nerve Fibre
Activation
Initially- stimulation of non-nociceptive
nerve fibres like A-alpha, A beta fibres
which have low threshold of stimulation
causing tingling
Followed by activation of A-delta and C-
fibres causing pain
6
7. Principles of Nerve Fibre
Activation
Low intensity current with pulse duration
50-500 micro seconds stimulates larger
diameter fibres (A beta) without
activation of smaller diameter fibres (A
delta and C)
Pulse duration more than 500 micro
seconds activates small diameter fibres7
8. Typical features of TENS
Pulse wave form • Monophasic
• Symmetric biphasic
• Asymmetric biphasic
Pulse amplitude
(adjustable)
1-50 mA
Pulse duration (often fixed) 50- 500 micro seconds
Frequency 1- 200 Hz
Pulse patterns Continuous
Burst
Channels Single or double channels
8
10. Techniques of TENS application:
1. Conventional or High Frequency
TENS
2. Acupuncture or Low Frequency TENS
3. Brief Intense TENS
4. Burst Mode TENS
5. Modulated TENS
10
11. Techniques of TENS application:
1. Conventional or High Frequency
TENS
2. Acupuncture or Low Frequency TENS
3. Brief Intense TENS
4. Burst Mode TENS
5. Modulated TENS
11
12. 1. Conventional /High Frequency
TENS
Paresthesia is created without motor
response
A-Beta filers are stimulated to SG
enkephlin interneuron (pure gate theory)
Applied 30 minutes to 24 hours
12
13. 1. Conventional /High Frequency
TENS
Creates the fastest relief
Relief is short lived (45 sec 1/2 life)
May stop the pain-spasms cycle
13
14. Application of High TENS
Pulse rate: high 75-100 Hz (generally
80), constant
Pulse width: narrow, less than 300 mSec
generally 60 microSec
Intensity: comfortable to tolerable
14
15. Techniques of TENS application:
1. Conventional or High Frequency
TENS
2. Acupuncture or Low Frequency TENS
3. Brief Intense TENS
4. Burst Mode TENS
5. Modulated TENS
15
16. 2. Low frequency/ Acupuncture like
TENS
Activation of descending pain
suppression pathway activating
endorphins
Longer lasting pain relief but slower to
start
Application
Frequency usually- 1-5 Hz (below
10 Hz)
Pulse width: 200-300 micro16
17. Techniques of TENS application:
1. Conventional or High Frequency
TENS
2. Acupuncture or Low Frequency TENS
3. Brief Intense TENS
4. Burst Mode TENS
5. Modulated TENS
17
18. 3. Brief, Intense TENS:
hyper-stimulation analgesia
Similar to high frequency TENS
Highest rate (100 Hz)
pulse width: 200 micro sec
Intensity to a very strong but tolerable
level
18
19. 3. Brief, Intense TENS:
hyper-stimulation analgesia
Treatment time is only 15 minutes, if
no relief then treat again after 2-3
minutes
Mono or biphasic current give a “bee
sting” sensation
Utilize motor, trigger or acupuncture
points.
19
20. Techniques of TENS application:
1. Conventional or High Frequency
TENS
2. Acupuncture or Low Frequency TENS
3. Brief Intense TENS
4. Burst Mode TENS
5. Modulated TENS
20
21. 4. Burst TENS
Carrier frequency is at a certain rate with a
built in duty cycle
Similar to low frequency TENS
Carrier frequency of 70-100 Hz packaged
in bursts of about 7 bursts per second
21
22. 4. Burst TENS
Pulses within burst can vary
Burst frequency is 1-5 bursts per second
Strong contraction at lower frequencies
Combines efficacy of low TENS with the
comfort of conventional TENS
22
24. Techniques of TENS application:
1. Conventional or High Frequency
TENS
2. Acupuncture or Low Frequency TENS
3. Brief Intense TENS
4. Burst Mode TENS
5. Modulated TENS
25
25. 5. Modulated Stimulation:
Keeps tissues reactive so no
accommodation occurs
Simultaneous modulation of amplitude
and pulse width; Frequency can also be
modulated
As amplitude is decreased, pulse width
is automatically increased to deliver
more consistent energy per pulse26
26. Contents
Introduction
Features of TENS
Applications of TENS
Uses of TENS – common and
uncommon
Electrode Placement
Precautions and contraindications
27
28. Biophysical Effects
Primary use is to control pain through
Gate Control Theory
May produce muscle contractions
Various methods
High TENS (Activate A-delta fibers)
Low TENS (release of -endorphins)
Brief-Intense TENS (noxious
stimulation to active C fibers)
29
29. Common conditions where TENS is
used
Relief of Acute Pain:
Post operative pain
Labour pain
Dysmenorrhoea
Angina Pectoris
Orofascial pain, dental procedures
Physical trauma- fracture ribs, minor
medical procedures
30
30. Common conditions where TENS is
used
Relief of Chronic Pain:
Low back pain
Arthritic pain: RA, OA
Myofascial pain
Neuropathic pain- trigeminal neuralgia,
phantom pain, post-herpes pain
Cancer pain
CRPS (Complex Regional Pain
syndrome)
31
31. Other conditions where TENS is
used
Non-analgesic effects:
Reducing symptoms of Alzheimer’s
dementia
Neuromuscular stimulating effects
Faecal and urinary incontinence
Antiemetic effects:
Morning sickness, motion sickness, post
chemotherapy, nausea due to other drugs
Improving blood flow
Wound healing/ Fracture healing
Raynaud’s disease
32
37. Summary
Uses of TENS
Application/ Types of TENS
Precautions/ Contraindications
38
38. References
Tim Watson. Electrotherapy: Evidence Based
Practice. 2008. Churchill Livingstone. 12th
edition.
Joseph Kahn. Principles and Practice of
Electrotherapy. 2000. Churchill Livingstone.
4th Edition.
John Low, Ann Reed. Electrotherapy
Explained. Principles and Practice.
Butterworth Heinemann. 3rd Edition.
Forster and Palastanga. Clayton’s
Electrotherapy Theory and Practice. Aitbs
Publishers. 9th edition
39