TENS

DR SAPNA ALI KHAN (PT)

DPT, MSPT*
TRANS-CUTANEOUS ELECTRICAL NERVE STIMULATION

• Application of low frequency pulsed rectangular wave current via surface electrodes
on the patient skin to reduce pain.
• It is the modern, non-invasive, drug free pain management modality, designed to
provide afferent stimulation, used for relief of acute or chronic pain.
• Electro-analgesia
• Abbreviated as TNS or TENS.
APPARATUS OF TENS
MECHANISM OF ANALGESIA

• Endorphin Theory:
Endorphins are transmitter substances that occur naturally in
brain and pituitary gland. It block the pain sensation
• Gate Control Theory:
Pain may be blocked at various gates through which pain impulses
travel to the brain. These gates are located at neuronal synapses in the
spinal cord.
PAIN

• Unpleasant disturbed sensation

• Subjective phenomenon.
• Activation of nociceptors.
• A Delta fibers: Fast conducting large diameter myelinated fibers, which
conducts with a velocity of 5–30 m/s.
• C-fibers: Slow conducting small diameter nonmyelinated fibers, which
conducts with a velocity of 2–5 m/s.

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PAIN GATE CONTROL

• Postulated by Ron Melzack and Pat Wall in 1965.

• Modified in 1982.
• Afferent input is mainly through posterior root of the spinal cord and all afferent information must
pass through synapses in the substantia gelatinosa and nucleus proprius of the posterior horn.
• It is at this level that the pain gate operates and presynaptic inhibition by TENS works.

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 1. -
PAG +
SG T 4. Raphe nucleus

NA + 5-HTA

2. +
-
SG T
SG T

Nociceptive
- +
afferent

3.
Large diameter
mechanosensitive
afferent
+
-
SG T

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 PAIN RELIEF BY TENS

• Alteration of the sensitivity of peripheral receptors of free nerve ending

which conduct and transmit the nociceptive stimulation
• Increased blood circulation may be caused by muscle contraction and
relaxation (burst or rhythmic stimulation)
• Blockage of A-delta and C-fibers at the 100 pps for 20min continuous
stimulation
• ANS is also effected by TENS frequency of about 100 pps
 CHARACTERISTICS OF TENS

• Pulse shape: usually rectangular.

• Pulse Width/duration: Measured in microseconds (µs), & is often fixed
at 100 µs or 200 µs, can vary from 50-300 µs.
• Frequency: can be as low as 2 Hz or as high as 600 Hz.
• Intensity: can be varied from 0-60 mA
 TYPES OF TENS
• High rate TENS
• Low rate TENS
• Brief intense TENS
• Burst mode TENS
• Point stimulation TENS
• Modulated TENS
HIGH RATE TENS OR CONVENTIONAL TENS

• Most common mode of TENS used in acute or chronic pain syndrome.

• It is based on sensory level stimulation
• Activates gait control
• Effect is rapid but transient
 PARAMETERS OF HIGH RATE TENS

• Pulse Rate: 50-100 Hz

• Pulse duration: 2-50 µs
• Duration: 20-60 min in one sitting for 8 hrs if required.
• Intensity: Patient should feel a tingling, pins and needles sensations,
often b/w 12-30 mA.
 LOW RATE TENS OR ACUPUNCTURE LIKE TENS

• This is acupuncture like strong low frequency stimulus, used in relief of

chronic pain.
• It is based on motor-level stimulation
• Modulation of pain is through activation of Descending pain suppression
system.
• Effect is relatively slow but lasts longer i.e. more than hours after the
treatment.
• Uses: Relief of chronic pain, hypo sensitive areas e.g. diabetic
neuropathy.
 PARAMETERS OF LOW RATE TENS
• Pulse Rate: 1-5 Hz
• Pulse duration: 150-300 µs
• Duration: 20-30 min in one sitting.
• Intensity: Sufficient to cause visible muscle twitches within comfortable
tolerance level of the patient i.e.30 mA.
• Frequency: once or twice a day.
 BRIEF INTENSE TENS
• Potentially painful, intense stimulation used to provide rapid short term
pain relief during painful procedures
• Relief of pain is temporary.
• Uses: to suppress pain during painful procedures.
 PARAMETERS OF BRIEF INTENSE TENS
• Pulse Rate: 80-150 Hz
• Pulse duration: 50-250µs
• Duration: 15 min.
• Intensity: strong to the level of pain threshold
• Frequency: as required
 BURST MODE TENS
• Combines the characteristics of high & low TENS, leading to release of
endogenous opiates.
• The stimulation is well tolerated by patients, even on prolonged
application, with slower onset of pain relief as compared to low TENS.

• Uses: suitable for relief of chronic muscle spasm or a combination of

MSK and neurogenic pain of chronic nature, e.g. sciatic syndrome.
 PARAMETERS OF BURST MODE TENS
• Pulse Rate: 50-100 Hz, delivered in bursts, of 1-4 pulses per second.
• Pulse duration: 50-200 µs
• Duration: 15-20 min.
• Intensity: comfortable with intermittent tingling sensation.
• Frequency: as required
HYPER STIMULATION OR
POINT STIMULATION TENS

• It uses a small probe to located and noxiously stimulate acupuncture or

trigger points
• Multiple sites can be stimulated in one treatment
• It relieve pain by Endorphin mediated mechanism
PARAMETERS OF POINT STIMULATION TENS

• Pulse Rate: 1-5 pps

• Pulse duration: 150-300 µs
• Amplitude: Strong- to patient tolerance
• Electrode Placement: Over the pain site; can be placed over the nearest
motor-points & trigger points.
PARAMETERS FOR OPTIMAL STIMULATION

• An optimal stimulation or site should be:

Strong enough to stimulate the CNS.
Suitable for proper placement of electrodes, free of bony or hairy area.
Segmentally related to the source, as well as the site of pain.
Anatomically distinct , like specific spinal segment or the nerve.
 APPLICATION OF TENS
• Large main units.
• Pocket size.
• Conductive rubber electrodes covered by conductive gel in order to gain
good skin contact.
• Electrode positioning is an area of debate. electrodes can be placed
over:
Acupuncture points, motor points, trigger points.
Area of greatest intensity of pain.
Appropriate dermatome or spinal segment or peripheral nerve.
 INDICATIONS
• Joint pain:
Osteoarthritis, Rheumatoid arthritis

• Acute pain:
Postoperative pain

• Muscle pain:
Muscle spasm, Torticollis

• Spinal pain:
Spinal nerve compression

• Nerve disorders:
Peripheral nerve injuries
 CONTRA-INDICATION FOR TENS
• Cardiac pacemakers
• Over chest wall of cardiac patient.
• Over eyes, larynx, pharynx, over mucosal membrane.
• Over head and neck of a patient with the recent history of stroke or epilepsy.
• Unit should not be immersed in liquid substances
• Areas of venous or arterial thrombosis
• Neoplasm (malignancy)
• Stimulation over the eyes
• Pain of unknown etiology
MOTOR POINTS OF BACK
MOTOR POINT OF BACK
 REFERENCES
• Clayton’s Electrotherapy
• Electrotherapy by Muhammad Salabat Khan
• Text book of electrotherapy by Jagmohan singh
THANK YOU