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

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

20 minutes

Endorphins are produced by the __________ gland.

pituitary Signup and view all the answers

Match the following types of TENS to their characteristics:

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 Signup and view all the answers

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

20-60 minutes Signup and view all the answers

IFC uses a single channel to deliver current.

False Signup and view all the answers

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

Biphasic symmetrical Signup and view all the answers

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

to modulate frequency and prevent accommodation Signup and view all the answers

Brief Intense TENS uses ________ frequency and long duration pulses.

high Signup and view all the answers

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

False Signup and view all the answers

What technique allows TENS to stimulate multiple sensory nerve fibers?

Gate Control Theory Signup and view all the answers

What is the recommended dosage range for iontophoresis?

40-80 ma-min Signup and view all the answers

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

drug Signup and view all the answers

What common medication is delivered via iontophoresis for pain management?

Lidocaine Signup and view all the answers

The alkaline reaction occurs under the anode during iontophoresis.

False Signup and view all the answers

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

strengthening Signup and view all the answers

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

FES Signup and view all the answers

Match the following types of stimulation with their primary application:

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

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

Redness under active electrode Signup and view all the answers

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.