04/19/2020 Misha Ansari,Pt 1

TRANSCUTANEOUS ELECTRICAL NERVE

STIMULATION

Presented by ; Dr. Gull.e.Rana Khan

DPT(KEMU)
MS-NMPT(RCRS)
TRANSCUTANEOUS ELECTRICAL NERVE
STIMULATION
 Transcutaneous electrical nerve
stimulation (TENS)

• It is a non invasive modern electrical

method of managing both acute
(short term pain) and non-malignant
chronic (long term pain).

• It is used for providing a degree of

pain relief (symptomatic) by
stimulating sensory nerves.
• TENS is an alternating current
characterized by variable phase
duration and a variable phase interval
which can be used to vary frequency .

• It is an application of a pulsed
rectangular wave current via surface
electrodes on the pt’s skin.

• Current generated by small batteries

Electrotherapy: Evidence-based Practice By Sheila Kitchen et al.Published by Elsevier Health Sciences, 2002
 TENS Parameters
• Pulse shape = monophasic, symmetrical biphasic

,asymmetrical biphasic
commonly used rectangular
• Pulse width = v short , 100µs or 200µs
vary 50µs to 300µs
• Frequency = as low as 2Hz or as high as 600Hz
commonly used 150Hz
• Intensity = 0 to 60 mA
max peak current =100mA
 Conventional TENS /high tens

Parameters :
– High frequency =100-150Hz,
– Pulse duration =100 and 500µs
– Intensity =12 and 30mA

• Intensity is turned up slowly

• Prickling or tingling
sensation is felt without
painful feeling ,tetanic
muscle contraction….Dec
intensity
• Low intensity, high frequency will
stimulate large low threshold
mechanoreceptors Aß fibers which go up
in the spinal cord without synapse and give
collateral to A and C fibers to inhibit them
• Physiological block
 HIGH TENS
• This mechanism is called pre-synaptic inhibition by Hi-TENS or
traditional or conventional TENS.
Dosage and timing:
• Conventional TENS is used for self treatment with recommended
duration from 30 to 60 minutes, once or twice a day or may be used
for all 24 hours of the day.
 2- Acupuncture-like TENS /low tens

Parameters :
High intensity = >30mA
Low frequency (less than 10Hz, commonly 1-5Hz)
Pulse duration =100-150µs

The intensity is very high close to the patient tolerance(nociceptive stimulus) to

stimulate A and C fibers leading to the release of endorphins and encephalin.
 Acupuncture points
• The acupuncture-like TENS is
applied to acupuncture point
which is considered as
a place where a small bundle of A
and sympathetic efferent fibers
pierce the deep fascia to become
more superficial
 Timing and dosage

• Once per day for 20 to 30 minutes.

• Many patients cannot tolerate the high intensity
 3- Burst TENS /INTENSE TENS

Frequency :
• Burst TENS consists of a train or ‘burst’ of
pulses of 2Hz (some times varying from 1-5Hz).
Pulse width:
• Each burst lasts for 70 ms
• And as the internal frequency of the bursts is at
the usual conventional TENS frequency of 50-
100Hz, this result in release of endorphins at
the central level which have a pain reducing
effect
• Burst TENS combines both conventional and
acupuncture-like TENS and therefore
provides pain relief by both routes.
INDICATIONS:
– Deeper-lying painful regions (myofascial pain)
– Cases of chronic pain.

DOSAGE AND TIMING:

• 15-30 minutes to be effective and treatment
can be repeated during the same day.
 4- Modulated TENS

• In modulated TENS
– Pulse width,
– Frequency
– Intensity
are all constantly and
automatically varied.
 Application of TENS
Application:
The device consist of two parts. One is battery and other are
conductive rubber electrodes. Conductive rubber electrodes
are covered by gel and placed on skin in order to gain good skin
contact. The electrodes are bandaged on to the patient or fixes
by adhesive tape. The wires are connected to the electrodes.
Electrodes can be placed over:
• Acupuncture points, motor points or trigger points.
• Area of greatest intensity of pain.
• Appropriate dermatome or spinal segment.
• Appropriate peripheral nerve.
Position of electrodes
Position of electrodes
 Indications

• ANALGESIC EFFECTS
• Relief of acute pain:
Musculoskeletal pain 
Dysmenorrhea
Acute postoperative pain and acute post traumatic
pain 
Labour pain
Bone fractures
• Relief of chronic pain
Phantom limb & Stump pain
Chronic pain: e.g. (rheumatoid arthritis,
osteoarthritis, etc.)
Chronic low back pain
Painful diabetic neuropathy
Trigeminal neuralgia
Angina
Metastatic bone pain
• NON ALGESIC EFFECTS
– IMPROVED BLOOD CIRCULATION
• Raynaud’s disease
• Diabetic neuropathy
• Reconstructive surgeries
• Healing of wounds and ulcers
 contraindications
• Undiagnosed pain.
• Pregnancy (especially first
trimester)
• Heart pacemaker.
• Eyes
• Over carotid sinus to avoid
cardiac arrhythmias.
• Over pharyngeal region to
avoid interfere with normal
breathing and swallowing.
• Skin lesions or wounds
(different resistance).
• Over non sensation area.
• With implanted hear aid.
• Over infected or inflamed
area
• Epilepsy
• Internally (mouth)
Questions…???