TENS

its have some basic information about TENS

1. T.E.N.S.
(Trancutaneous Electrical
Nerve Stimulation)
Prof. Dr. M. Rajesh, PT, M.P.T(cardio), B.C.R.C
TRINITY MISSION AND MEDICAL FOUNDATION
MADURAI

2. General Concepts:
An Approach to pain control
Trancutaneous Electrical Nerve Stimulation:
Any stimulation in which a current is applied across the
skin to stimulate nerves
1965 Gate Control Theory created a great popularity of
TENS
TENS has 50-80% efficacy rate
TENS stimulates afferent sensory fibers to elicit
production of neurohumneral substances such as
endorphins, enkephalins and serotonin (i.e. gate theory)

3. TENS
Indications
Control Chronic Pain
Management post-
surgical pain
Reduction of post-
traumatic & acute pain
Precautions
Can mask underlying pain
Burns or skin irritation
prolonged use may result in
muscle spasm/soreness
caffeine intake may reduce
effectiveness
Narcotics decrease
effectiveness

4. 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 from pituitary)
Brief-Intense TENS (noxious stimulation to active C fibers)

5. Techniques of TENS
application:
Conventional or High Frequency
Acupuncture or Low Frequency
Brief Intense
Burst Mode
Modulated

6. Various Methods of TENSParameterHigh TENSLow TENS Brief-Intense
TENS
IntensitySensory Motor Noxious
Pulse Fq60-100 pps 2-4 pps Variable
Pulse
Duration
60-100 sec150-250 sec300-1000sec
Mode ModulatedModulated
Burst
Modluated
Tx DurationAs needed 30 min 15-30 min
Onset of
Relief
< 10 min20-40 min <15 min

7. Conventional Tens/High
Frequency TENS
Paresthesia is created without motor response
A Beta filers are stimulated to SG enkephlin interneuron (pure
gate theory)
Creates the fastest relief of all techniques
Applied 30 minutes to 24 hours
relief is short lives (45 sec 1/2 life)
May stop the pain-spasms cycle

8. 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 tolerance

9. Set up:
2 to 4 electrodes, often will be placed on post-op. Readjust
parameters after response has been established. Turn on the
intensity to a strong stimulation. Increase the pulse width and
ask if the stimulation is getting wider (if deeper=good, if
stronger...use shorter width)

10. Low Frequency/Acupuncture-
like TENS:
Level III pain relief, A delta fibers get Beta endorphins
Longer lasting pain relief but slower to start
Application
pulse rate low 1-5ppx (below 10)
Pulse width: 200-300 microSec
Intensity: strong you want rhythmical contractions within the
patient’s tolerance

11. Burst Mode 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
Pulses within burst can vary
Burst frequency is 1-5 bursts per second
Strong contraction at lower frequencies
Combines efficacy of low rate TENS with the comfort of
conventional TENS

12. Burst Mode TENS -Application
Pulse width: high 100-200 microSec
Pulse rate: 70-100 pps modulated to 1-5 burst/sec
Intensity: strong but comfortable
treatment length: 20-60 minutes

13. Brief, Intense TENS: hyper-
stimulation analgesia
Stimulates C fibers for level II pain control (PAG etc.)
Similar to high frequency TENS
Highest rate (100 Hz), 200 mSec pulse width intensity to a
very strong but tolerable level
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.

14. Brief Intense TENS -
Application
Pulse width: as high as possible
Pulse rate: depends on the type of stimulator
Intensity: as high as tolerated
Duration: 15 minutes with conventional TENS unit. Locus
stimulator is advocated for this treatment type, treatment time
is 30 seconds per point.

15. Modulated Stimulation:
Keeps tissues reactive so no accommodation occurs
Simultaneous modulation of amplitude and pulse width
As amplitude is decreased, pulse width is automatically
increased to deliver more consistent energy per pulse
Rate can also be modulated

16. Electrode Placement:
May be over the painful sites, dermatomes, myotomes, trigger
points, acupuncture points or spinal nerve roots.
May be crossed or uncrossed (horizontal or vertical)

17. Contraindications:
Demand pacemakers
over carotid sinuses
Pregnancy
Cerebral vascular disorders (stroke patients)
Over the chest if patient has any cardiac condition

18. THANK YOU
Prof. Dr. M. RAJESH, PT,M.P.T(cardio),B.C.R.C
TRINITY MISSIOIN AND MEDICAL FOUNDATION
MADURAI.
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