Types of Electrical Stimulation in Pain Management
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Questions and Answers

What is the typical frequency range for Conventional TENS?

  • 20-60 pps
  • 50-100 pps
  • 75-150 pps (correct)
  • 1-10 pps

Acupuncture-like TENS uses high frequency pulses.

False (B)

How long does pain relief typically last after Conventional TENS stimulation?

20 minutes

Endorphins are produced by the __________ gland.

<p>pituitary</p> Signup and view all the answers

Match the following types of TENS to their characteristics:

<p>Conventional TENS = Fast onset of pain relief (5-10 min) Acupuncture-like TENS = Provides several hours of pain relief (4-6 hrs) Brief Intense TENS = Used for painful procedures for 15 min Interferential Current (IFC) = Biphasic balanced waveform</p> Signup and view all the answers

What is the expected duration of a Typical Acupuncture-like TENS treatment?

<p>20-60 minutes (A)</p> Signup and view all the answers

IFC uses a single channel to deliver current.

<p>False (B)</p> Signup and view all the answers

Which waveform is commonly used in Neuromuscular Electrical Stimulation (NMES) for muscle strengthening?

<p>Biphasic symmetrical (C)</p> Signup and view all the answers

What is the main purpose of the 'sweep' feature in Interferential Current therapy?

<p>to modulate frequency and prevent accommodation</p> Signup and view all the answers

Brief Intense TENS uses ________ frequency and long duration pulses.

<p>high</p> Signup and view all the answers

Iontophoresis uses alternating current (AC) to deliver medications into the body.

<p>False (B)</p> Signup and view all the answers

What technique allows TENS to stimulate multiple sensory nerve fibers?

<p>Gate Control Theory (B)</p> Signup and view all the answers

What is the recommended dosage range for iontophoresis?

<p>40-80 ma-min</p> Signup and view all the answers

The therapeutic effect of iontophoresis is based on the ______ selected.

<p>drug</p> Signup and view all the answers

What common medication is delivered via iontophoresis for pain management?

<p>Lidocaine (A)</p> Signup and view all the answers

The alkaline reaction occurs under the anode during iontophoresis.

<p>False (B)</p> Signup and view all the answers

What is a common use of Russian stimulation in a clinical setting?

<p>strengthening</p> Signup and view all the answers

Neuromuscular Electrical Stimulation is referred to as ______ when used to enhance functional activity.

<p>FES</p> Signup and view all the answers

Match the following types of stimulation with their primary application:

<p>Iontophoresis = Drug delivery NMES = Muscle strengthening HVPC = Wound healing DC = Stimulating denervated muscles</p> Signup and view all the answers

What is the effect on the skin that is expected after removing electrodes used in iontophoresis?

<p>Redness under active electrode (D)</p> Signup and view all the answers

Flashcards

Conventional TENS

High-frequency, short-duration pulses (75-150 pps) used for managing acute pain. Amplitude adjusted to sensory response only. Relieves pain fast (5-10 minutes), but relief is short-lived (20 minutes).

Acupuncture-like TENS

Low-frequency, long-duration pulses (1-10 pps) used for chronic pain. Amplitude adjusted to generate motor twitches. Longer lasting pain relief (4-6 hours).

Brief Intense TENS

High-frequency, long-duration pulses used for short-term pain relief (usually during procedures). Amplitude adjusted for strong paresthesia or motor response.

Interferential Current (IFC)

Pain relief technique using two different frequencies of biphasic, balanced sinusoidal current. Produces pulses from current mixing (beats).

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Quadripolar Electrode Placement (IFC)

Four electrodes used for IFC, arranged in an X pattern to create current mixing in targeted tissue.

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Bipolar (Premodulated) Electrode Placement (IFC)

Two electrodes used for IFC, currents mixing is pre-done in the machine, no x-pattern required.

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Sweep (IFC)

Modulating the frequency of IFC pulses to prevent patient accommodation to treatment.

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Gate Control Theory

Pain and sensory info is relayed to the spinal cord and then to the brain. Stimulating faster sensory nerves (by TENS) closes the "gate" to pain signals, while allowing the sensory info (tingling sensation) through.

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Endorphin Theory

Endorphins (body's natural opiates) are released by pain, exercise, acupuncture, and other stimuli. They inhibit pain transmission and last for hrs (4-6).

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Pain Management

TENS used to control acute and chronic pain, and other forms of therapy used.

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NMES Waveforms

Biphasic symmetrical (balanced) or Biphasic asymmetrical (unbalanced) waveforms are used to activate innervated muscles for strengthening.

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NMES/FES

NMES is used for muscle strengthening, while FES enhances functional activity.

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Iontophoresis Current Type

Iontophoresis uses direct current (DC) to deliver drugs into the body based on charges repelling.

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Iontophoresis Dosage

Dosage ranges from 40-80 mA-minutes. Rx time varies based on current selected.

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Iontophoresis Procedure

Patient preparation includes skin cleaning and drug polarity matching, electrode saturation with ion/saline solution and gradual current increase.

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Iontophoresis Skin Monitoring

Skin checks for irritation and burns are crucial every 3-5 minutes, and after removing electrodes.

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DC Muscle Stimulation

DC is used to stimulate denervated muscle membranes, maintaining their health until nerve recovery.

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HVPC Pulses

High-voltage pulsed current (HVPC) uses short, monophasic pulses.

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HVPC Therapeutic Use

HVPC is often used to heal wounds, reduce edema, and sometimes provide sensory stimulation as it is often used for both sensory and therapeutic purposes.

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Russion Stimulation

Russian NMES uses biphasic balanced AC current in bursts to strengthen muscles.

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Study Notes

Types of Electrical Stimulation

  • Conventional TENS:

    • High frequency (75-150 pulses per second), short duration pulses.
    • Amplitude adjusted to sensory response only.
    • Worn several hours (6 hrs on, 1 hr off) for pain management during activities and acute pain.
    • Fast onset of pain relief (5-10 minutes), but short-lasting relief (20 minutes).
    • Mechanism (Gate Control Theory): Stimulates sensory nerves faster than pain nerves, closing the pain gate in the spinal cord while allowing sensory signals (tingling/buzzing) to the brain.

  • Acupuncture-like TENS:

    • Low frequency (1-10 pulses per second), long duration pulses.
    • Amplitude adjusted for motor twitch.
    • 20-60 minute treatments provide 4-6 hours of pain relief.
    • Often used for chronic pain.
    • Mechanism (Endorphin Theory): Stimulates endorphin release, which are long-lasting pain inhibitors. Endorphins released by the pituitary, and active for 4-6 hours.

  • Brief Intense TENS:

    • High frequency, long duration pulses.
    • Amplitude adjusted to strong paresthesia or motor response.
    • 15-minute treatments, often used during painful procedures.

Interferential Current (IFC)

  • Waveform: Biphasic, balanced, sinusoidal (mixing of 2 different frequencies currents).

  • Use: Pain relief only.

  • Mechanism: Intersection of 2 channels with different frequencies produces “beats.”

  • Electrode Placement:

    • Quadripolar: 4 electrodes (2 channels), creating and X pattern around the painful area. Required for IFC to mix currents at the targeted tissue.
    • Bipolar (Premodulated): 2 electrodes (1 channel) surrounding the area. Current mixing occurs within the machine.

  • Advantages: Ability to treat multiple areas simultaneously and areas where 4 electrodes are not feasible.

  • Unique Parameters:

    • Sweep: Modulates frequency (1-10-75-150 beats per second) to prevent accommodation.
    • Scan: Modulates amplitude to increase treatment area size.

Neuromuscular Electrical Stimulation (NMES)

  • Waveforms: Biphasic symmetrical (balanced) or Biphasic asymmetrical (unbalanced).
  • Use: Muscle activation and strengthening, can be referred to as functional electrical stimulation (FES) for enhancement of function
  • Specific type: Russian stimulation (biphasic balanced AC, in bursts) used frequently in clinics for strengthening.

Iontophoresis

  • Mechanism: Uses direct current (DC) to deliver medication through skin pores and hair follicles. Based on the principle that like charges repel.
  • Therapeutic effect: Dependent on the drug used.
  • Dosage: 40-80 mA-minutes. Treatment time varies based on current.
  • Procedure:
    • Patient allergy assessment.
    • Clean skin with soap or alcohol.
    • Polarity set matching the drug.
    • Saturate active pad with medication, dispersive with saline (electrode width away).
    • Gradually increase intensity to tolerated levels, monitor every 3-5 minutes.
    • Electrode removal and inspection; redness under the active electrode is normal.
    • Treatments every other day. Therapeutic effect in 3-5 treatments.
  • Risks: Acidic (anode) or alkaline (cathode) reactions can cause irritation/burns. Most electrodes are buffered to lower the risk. Common medications: Dexamethasone (-) for inflammation, Lidocaine (+) for pain.

Direct Current (DC)

  • Use: Stimulate muscle membranes in denervated muscles to maintain viability until nerve regrowth. Example, Bell's Palsy.
  • Ability: Highest Threshold device to stimulate muscle membranes as it accumulates charge.

High Voltage Pulsed Current (HVPC)

  • Waveform: Monophasic pulses of very short duration
  • Unique Therapeutic Applications & Polarity: Healing of wounds and reduction of acute edema. Generally monopolar, can be bipolar. Sensory stimulation.

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Description

Explore the different types of electrical stimulation used in pain management, including Conventional and Acupuncture-like TENS. This quiz covers the mechanisms and effectiveness of each method, focusing on their frequency, duration, and specific applications for acute and chronic pain. Test your knowledge on how these techniques can significantly impact pain relief.

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