TENS Electrotherapy PDF
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ScribdTranslationsTENS Electrotherapy PDF
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ScribdTranslationsTENS
What is it?
Analgesia induced by transcutaneous or percutaneous neurostimulation for relief
the blockade of chronic or acute pain, practically free of side effects
adverse.
It is referred to as 'exogenous' neurostimulation when it is applied from the surface.
cutaneous as occurs in TENS, whereas when the electrodes are placed on the
interior of the organism - electrode implant - is called electrostimulation
endogenous
The stimulation with TENS is perceived by the patient at the level of the underlying area.
to the location of the electrodes, such as a bubbling sensation or contractions
fibrillar.
Fig. No. 80 Transcutaneous Electrical Stimulation Current. T.E.N.S.
Evolution of its field of action
In its early days, it was only used in the preliminary stage of
endogenous neurostimulation, a leading role that it still retains today, despite
has incorporated an increasingly broad number of uses.
It is worth highlighting the contribution of neuroelectroanalgesia for relief of
pain in patients suffering from terminal tumor disease, and with expectation of
six months of life or more, in these patients the attenuation of pain induced by
endogenous neuroelectrostimulation contributes to the reduction of the dose of
narcotic medication, which inevitably, in most cases, in
In the final stages of the disease, it is necessary to attend.
The benefit of achieving a reduction in the dosage of hypnoanalgesics should not be interpreted as
the aim of preventing 'addiction and the withdrawal syndrome' associated with it; if
but rather to allow the patient to access a better exchange with their environment
and receive from him the emotional support that is so necessary for him in such painful circumstances.
lower doses of narcotic medication, by themselves reduce the possibility of
suffer hallucinatory states that unfortunately arise as effects
not very desirable and attributable to narcotic medication.
The field of application of TENS is increasingly broad, it is used in management
from the pain associated with rheumatic disease and in pain related to trauma
of soft tissues, whether in its acute stage or in the peak sequel period.
About acute pain and the possibilities of interfering with and blocking it, it makes a
important contribution to pain relief at the wound level, in the post
immediate surgery, for example, in thoracic surgeries that are characterized by
extensive approaches. It also helps to reduce the painful manifestation of the
woman at the moment of childbirth and in instances prior to it.
TYPES AND WAVEFORMS
1- ASYMMETRIC BIPHASIC WAVE GENERATOR
Type of current:
Variable
alternate
Waveform:
Biphasic
asymmetrical
Pulse frequency:
10 Hz.
150Hz.
Duration of the impulse:
50 milliseconds
150 milliseconds.
Impulse amplitude:
80 volts (peak to peak)
Current density: 2.2 mA/cm2
2- SQUARE OR RECTANGULAR WAVE GENERATOR
Type of current:
Variable
Waveform:
Square or rectangular or trapezoidal (progressive)
Stimulation frequency: Two frequency bands:
Lower: 2 10 Hz.
High: 10 140 Hz.
Wave amplitude: 30 / 50 volts
Duration of the impulse: 40/100ms.
Output intensity: 0.70 mA. (for 100 Hz.)
Fig. no. 81 Rectangular T.E.N.S. Current
APPLICATION TECHNIQUES
The electrodes will be placed encompassing the area to be treated, or by locating them to
both sides of the region of greatest pain.
DOSAGE
INTENSITY
Minimal bubbling sensation, small pulses of low amplitude
(suitable for medium or long-term treatments)
Maximum. Sensation of fibrillar contractions, stronger pulses.
amplitude and perception of small muscle contractions.
TIME
Short duration Up to 20 minutes
2- Medium duration From 20 minutes to 2 hours
3- Long duration From 2 hours onwards, including days
FREQUENCY AND NUMBER OF SESSIONS
The total number of sessions is variable, being a therapeutic alternative that
involves few or no adverse side effects compared to other procedures, it
use all the time necessary, and as long as during it, no issues arise
complications.
In the treatment of patients with chronic pain related to rheumatic processes, with
ten sessions can achieve efficient pain control, although obviously,
The treatments should be reiterated.
The frequency of the sessions depends on the duration of each application, sessions
medium and long-term ones have longer intervals, while short-term ones
duration, can be applied twice in the same day, the most frequent applications
every other day.
AREA DESIGNATED FOR STIMULATION
1- In the painful area or point
2- At a distance:
a- In the projection area
b- In the same cutaneous dermatome
c- According to the acupuncture points
MODALITIES OF T.E.N.S.
T.E.N.S. Conventional Type.
This type of T.E.N.S. features a high frequency but with low intensities.
Frequency is from 75 to 100 Hz. Duration of the stimulus is from 50 to 125 ms.
These parameters allow us to stimulate the afferent fibers of group II, (fibers
thick A 'Beta' and Gamma'), (touch and muscle tone respectively.
Slight paresthesias occur without causing muscle contraction, but let us have
present that if the electrodes are placed on a motor point, they will produce
contractions when relatively high intensities are used, the effect
the analgesic thus obtained is especially due to the mechanisms of
spinal segmentation...
The analgesia obtained in this way is immediate, but of relatively short duration.
that is to say a couple of hours after the treatment.
This therapeutic modality of T.E.N.S. does not allow its application when desired.
stimulate long and medium-duration periods.
T.E.N.S. type acupuncture
In this case, and unlike the previous one, it presents a low frequency and intensities.
high.
Its frequency is from 1 to 4 Hz.
The duration of the stimulus is 200 to 300 ms.
With these characteristics and these values of frequency and duration of the stimulus, it
allows us to stimulate the nociceptive fibers of groups III and IV, (fine A fibers)
"Delta" and "C"), (pain, temperature, and pressure) as well as small fibers
motorcycles.
This modality of T.E.N.S. gives us the possibility to place the electrodes on the
myotoma related to the area of pain, where they will occur, just like in
previous case, paresthesias and due to the intensity of work muscle contractions,
that theoretically should not exceed the threshold or limit of tolerance of
patient. Its application is indicated for short periods of application.
Burst T.E.N.S. or T.E.N.S. of wave trains
They present a frequency of 1 to 4 Hz. With wave trains of a frequency
internal of 100 Hz.
This modality of TENS is a mix of conventional TENS and acupuncture TENS.
where a low-frequency basic current is emitted.
This type of T.E.N.S. was developed by Eriksson, Sjòlund & Nielsen in 1979 as
consequence of the results obtained in experiences with electro-acupuncture
China.
They discovered that when high-frequency series of electrical stimuli were
emitted at low frequency through an acupuncture needle, the patients
they could tolerate the intensity of the stimulus necessary to produce the strong
muscle contractions, much better than when individual impulses were
emitted through a needle.
PRECAUTIONS
1- Avoid using it on irritated or lacerated skin areas.
2- Avoid its use in patients with marked susceptibility to stimulation
electric.
3- Avoid, when receiving medium or long-term treatment, the
handling of high-power tools, due to the interference they cause and because of
the possibility of causing displacements of the electrodes.
4- Interrupt the treatment until a proper identification and correction of
all the unpleasantness that arose during the time allocated for the application,
It is generally due to insufficient spreading of the gel and/or inadequate
electrode attachment about to cause skin irritation upon use
prolonged from that same place. The correction of this defect fundamentally rectifies
this problem.
COMPLICATIONS
1- Frequent skin irritation in medium and long-lasting applications.
(Eliminated by rearranging the electrodes)
2- Allergic reaction to the coupling medium -conductive gel-. It is reversed by proceeding to
select another product, otherwise do not proceed with the practice.
The equipment comes in various sizes; however, the portable equipment powered
for batteries are the most frequently used and the only ones with possibilities for the
long-term treatments.
Regarding the characteristics of the pulses they emit, type and shape of the wave,
amplitude or height of the impulse and frequency of impulses in the unit of time
there are some differences, depending on the brand of the instrument manufacturing,
but the basic emission, generating tactile stimulation, is equivalent in them,
different accessories are presented according to the equipment to be used.
The patient should be instructed on the possibilities of use and on management.
team performance, especially in those with a long application period.
CONTRAINDICATIONS
1- Patients with demand pacemakers.
2- Do not apply in the area adjacent to the glottis (possible airway spasm)
aerials)
3- Do not apply in the area of gestational commitment, as it has not yet been demonstrated.
the possible fetal damage or risk.
4- Do not apply to hemorrhagic areas.
Bibliography
Amer-Cuenca, J. J. (2010). Programming and application of electrical nerve stimulation
transcutaneous (TENS): evidence-based clinical practice guideline. Physical Therapy, 32(6), 271-278.
