Welcome!
Pain Management
Without the effect
of DRUGS

NexWave
Confidential
Presentation Overview
Basics of Electrotherapy
Different Types of Modalities
Theories of Pain Control
Electrotherapy – Ind...
Electrical impulses are sent through electrodes placed
on the skin
Electrodes are placed over nerve centers near or over
t...
Types of Electrotherapy
Modalities
Transcutaneous Electrical Nerve Stimulation (TENS)
Typically delivered between 1 Hz and...
TENS Current
TENS current is typically
delivered between 1 Hz and 250
Hz.

With TENS and NMES
Stimulation, sensation is fe...
Interferential Current

4,010 Hz minus 4000 Hz = 10 Hz
4000 Hz

4010 Hz

When the fixed and adjustable frequencies
combine...
Neuromuscular Electrical
Stimulation (NMES)

NMES is usually delivered between
25Hz and 80Hz
Stimulation is delivered at a...
TENS Versus Interferential
Current (IFC)
TENS Versus IFC
IFC is believed to penetrate to deeper tissues than TENS because
...
How Electrotherapy
Controls Pain
There are two theories of pain control:
Gate Control – Mild continuous high
frequency ele...
The Gate Control
Theory
• Pain stimuli travels along the
small diameter, slow conducting
nerve fibers to the spinal cord
w...
The Endorphin Release
Theory
The Endorphin Release theory is based on the presence of natural
opiates in the body.
These o...
Product Training Overview
NexWave
-Interferential Mode
-NMES Mode
-Marketing Materials
-Clinical documentation
Specific Tr...
NexWave – Product training

Features & Benefits

Indications for Use

Product Operation & Programming

Confidential
NexWave – Patient Locations
Rehabilitation Clinics
Physiotherapists & Doctors

Pain Management
Post Surgery or Injury

Spo...
NexWave – Indications for Use
Transcutaneous Electrical Nerve Stimulation (TENS)
Management and symptomatic relief of chro...
NexWave – Clinical Benefits
Product Features & Benefits
3 Modalities in 1 Device
TENS, IFC, and NMES

Microprocessor contr...
NexWave – Safety & Compliance

Built in Compliance Meter
Records number of treatments and treatment time
Documents patient...
NexWave Programing
On/Off and Modality Selection
1. Press on/off Button Once
to Turn Device On

2. Press labeled Button to...
NexWave Programming
Selecting the Mode
5. To select the desired mode,
continue to pressing Mode button

6. Must unlock bef...
NexWave Programing
Intensity & Treatment Time Setting
7. + (up) to Increase Intensity

8. Press the Timer button and selec...
NexWave Programing
Compliance Meter
9. Screen Demonstrates All
information

10. Device is Now Programmed and
Ready to Star...
NexWave Operation
Electrode Set-up
1. Connect Leadwires to Electrodes
While Electrodes are Still on Plastic

Tip: It is ea...
NexWave Operation
Electrode Placement
2. Place the Electrodes Over the Treatment Site.

IFC
Placement

TENS
Placement

TEN...
NexWave - Operation
Connect The Leads
3. Connect Lead wires to Device

Important: Make Sure Lead wires are
Inserted Comple...
NexWave - Operation
Start Treatment
4. Press Up Button to Set Desired
Stimulation Level

Important: Stimulation Should be ...
NexWave - IFC Modes
Low High Mode:

Channel 2 Freq. Sweeps between 4001 Hz and
4128 Hz every 15 sec. Channel 1 remains set...
NexWave - IFC Modes

Low:

Channel 2 Freq. Sweeps between 4001 Hz and
4010 Hz every 15 sec. Channel 1 remains set at 4000 ...
NexWave - IFC Modes
Combo consists of three 2 minute cycles which repeat
over the duration of the treatment:

Combo:

1st ...
NexWave - TENS Programs
Sweep
TENS frequency decreases from 125 Hz to 11Hz
over 4 seconds. During this period the Pulse Wi...
NexWave - TENS Programs

LMD – Low Modulated
The Frequency sweeps from 66.7 to 100 Hz 100 µs
and back again over 12 sec. P...
NexWave – TENS Programs
Modulate
The frequency shifts between 66 and 100 Hz at an
interval of 6 seconds. The Pulse Width w...
NexWave – NMES Programs

Preset 10 sec. ON -10 sec. OFF
Preset 20 sec. ON -10 sec. OFF
Preset 30 sec. ON -10 sec. OFF
Bene...
Low Back Neurostimulation System
Conductive Garment Description
Allows Patient to Place Electrodes on Lower
Back Without A...
Distribution Materials

Communication Materials
International Web page
Device Specs
“Getting Started” Pages
Electrotherapy...
Physician & Physiotherapist
Supporting Research on Electrotherapy for
Pain Management
Defines TENS mechanism of
pain contr...
Thank You
www.painezee.com

Confidential
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ZMPCZM016000.10.01 Nexwave clinical presentaion from Painezee

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ZMPCZM016000.10.01 Nexwave clinical presentaion from Painezee

  1. 1. Welcome! Pain Management Without the effect of DRUGS NexWave Confidential
  2. 2. Presentation Overview Basics of Electrotherapy Different Types of Modalities Theories of Pain Control Electrotherapy – Indications for use Zynex NexWave Product Training Confidential
  3. 3. Electrical impulses are sent through electrodes placed on the skin Electrodes are placed over nerve centers near or over the area of pain The impulses block pain by stimulating the nerve fibers and/or activating the release of endorphins Confidential
  4. 4. Types of Electrotherapy Modalities Transcutaneous Electrical Nerve Stimulation (TENS) Typically delivered between 1 Hz and 250 Hz Indicated for chronic and acute pain relief Interferential Current (IFC) Typically delivered between 4,000 Hz and 5,000 Hz Indicated for chronic and acute pain relief, edema reduction, increase circulation Neuromuscular Electrical Nerve Stimulation (NMES) Typically delivered between 25 Hz and 80 Hz Indicated for muscle disuse atrophy, muscle re-education, muscle spasm reduction, increase ROM Confidential
  5. 5. TENS Current TENS current is typically delivered between 1 Hz and 250 Hz. With TENS and NMES Stimulation, sensation is felt directly under the electrodes Confidential
  6. 6. Interferential Current 4,010 Hz minus 4000 Hz = 10 Hz 4000 Hz 4010 Hz When the fixed and adjustable frequencies combine (heterodyne), they produce the desired signal frequency (Interference frequency or beat frequency). 10 Hz 4,010 Hz IFC uses a fixed carrier frequency of 4,000 Hz per second and also a second adjustable frequency of 4,001-4,250 Hz per second. 4,000 Hz IFC is concentrated at the point of intersection between the electrodes. This concentration occurs deep in the tissues as well as at the surface of the skin Confidential
  7. 7. Neuromuscular Electrical Stimulation (NMES) NMES is usually delivered between 25Hz and 80Hz Stimulation is delivered at a much higher intensity (mA) than IFC or TENS Electrodes are placed over muscle motor points to facilitate a muscle contraction instead of at a sensor or muscle twitch like IFC or TENS Confidential
  8. 8. TENS Versus Interferential Current (IFC) TENS Versus IFC IFC is believed to penetrate to deeper tissues than TENS because the current is concentrated at the point of intersection between the electrodes. This concentration occurs deep in the tissues as well as at the surface of the skin, reaching to greater depths and over a larger volume of tissue than TENS Capacitive skin resistance decreases as pulse frequency increases. For example, at a frequency of 4,000 Hz capacitive skin resistance is eighty times lower than with a frequency of 50 Hz (in TENS range) Confidential
  9. 9. How Electrotherapy Controls Pain There are two theories of pain control: Gate Control – Mild continuous high frequency electrical stimulation (>20PPS) blocks the pain signal traveling to the brain Endorphin Release – Strong but comfortable low frequency electrical stimulation at a muscle twitch (<=10PPS) causes the body to release its own pain relieving substances called endorphins Confidential
  10. 10. The Gate Control Theory • Pain stimuli travels along the small diameter, slow conducting nerve fibers to the spinal cord where they are transmitted to the brain (A-delta, C fibers) • The pain stimuli carried by the small diameter fibers can be inhibited by stimulating the large diameter, fast conducting, sensory nerve fibers (A-beta fibers). • The application of TENS to the Abeta fibers “closes a gate” in the spinal column which prevents the pain stimuli from reaching the brain On-set of pain relief is immediate, but pain returns shortly after treatment Confidential
  11. 11. The Endorphin Release Theory The Endorphin Release theory is based on the presence of natural opiates in the body. These opiates, which act as the body’s natural pain suppressor, are produced in the pituitary gland as beta endorphins and in the spinal cord as enkephalins. Stimulation of the sensory nerves promotes the release of these opiates. These endorphins then bind to specific receptor sites in the central and peripheral nervous system where they block the perception of pain. Electrical stimulation applied at or below 10 Hz at a muscle twitch has shown to produce endorphins. On-set of pain relief is slower (20 minutes), but pain relief can last for hours after treatment Confidential
  12. 12. Product Training Overview NexWave -Interferential Mode -NMES Mode -Marketing Materials -Clinical documentation Specific Treatments Confidential
  13. 13. NexWave – Product training Features & Benefits Indications for Use Product Operation & Programming Confidential
  14. 14. NexWave – Patient Locations Rehabilitation Clinics Physiotherapists & Doctors Pain Management Post Surgery or Injury Sports Medicine Sports Clinics & Sports Teams Work Job Site Doctors Worker pain relief while on the job Confidential
  15. 15. NexWave – Indications for Use Transcutaneous Electrical Nerve Stimulation (TENS) Management and symptomatic relief of chronic intractable pain, post-traumatic and post-surgical pain Interferential Current (IFC) Management and symptomatic relief of chronic intractable pain, post-traumatic and post-surgical pain Neuromuscular Electrical Stimulation (NMES) Relaxation of muscle spasms Prevention and retardation of disuse atrophy Increase of local blood circulation Muscle rehabilitation and re-education Maintaining and increasing range of motion Confidential
  16. 16. NexWave – Clinical Benefits Product Features & Benefits 3 Modalities in 1 Device TENS, IFC, and NMES Microprocessor controlled Integrity of waveform is maintained under extreme conditions Allows for a small design for portability Digital Display Displays Modality mA output treatment Timer information Program for desired waveform Confidential
  17. 17. NexWave – Safety & Compliance Built in Compliance Meter Records number of treatments and treatment time Documents patient usage to help with coverage and substantiate compliance Unlock/Lock Button After 20sec the units locks to prevent accidental changes in stimulation & settings Dual Power: 9V and A/C Adapter Works on 220/110 and saves battery life Battery can be installed either direction Confidential
  18. 18. NexWave Programing On/Off and Modality Selection 1. Press on/off Button Once to Turn Device On 2. Press labeled Button to Enter Modality: IFC TENS NMES Confidential
  19. 19. NexWave Programming Selecting the Mode 5. To select the desired mode, continue to pressing Mode button 6. Must unlock before any changes can be made Confidential
  20. 20. NexWave Programing Intensity & Treatment Time Setting 7. + (up) to Increase Intensity 8. Press the Timer button and select a Treatment Time (10 – 90 min.) or “Continuous” for No Timer Confidential
  21. 21. NexWave Programing Compliance Meter 9. Screen Demonstrates All information 10. Device is Now Programmed and Ready to Start Treatment Confidential
  22. 22. NexWave Operation Electrode Set-up 1. Connect Leadwires to Electrodes While Electrodes are Still on Plastic Tip: It is easier to connect leadwires to the electrodes before placing the electrodes over the treatment site Confidential
  23. 23. NexWave Operation Electrode Placement 2. Place the Electrodes Over the Treatment Site. IFC Placement TENS Placement TENS or NMES Placement Important: When Using IFC, Electrodes Must be Crisscrossed. Confidential
  24. 24. NexWave - Operation Connect The Leads 3. Connect Lead wires to Device Important: Make Sure Lead wires are Inserted Completely Confidential
  25. 25. NexWave - Operation Start Treatment 4. Press Up Button to Set Desired Stimulation Level Important: Stimulation Should be Set to a Strong, but Comfortable Sensation Confidential
  26. 26. NexWave - IFC Modes Low High Mode: Channel 2 Freq. Sweeps between 4001 Hz and 4128 Hz every 15 sec. Channel 1 remains set at 4000 Hz Lumbar – Lower Back Pain Current should cross where most of the stimulation is delivered in the area of the pain. Placement must allow for surgical site, density of tissue and nerve position. IFC Placement Confidential
  27. 27. NexWave - IFC Modes Low: Channel 2 Freq. Sweeps between 4001 Hz and 4010 Hz every 15 sec. Channel 1 remains set at 4000 Hz Current should cross where most of the stimulation is delivered in the area of the pain. Placement must allow for surgical site, density of tissue and nerve position. IFC Placement Confidential
  28. 28. NexWave - IFC Modes Combo consists of three 2 minute cycles which repeat over the duration of the treatment: Combo: 1st cycle – Low Mode 2nd cycle – High mode where channel 2 sweeps between 4064 Hz 4000 Hz. Both channels are cycled on and off At 6 sec. intervals. 3rd Cycle- Muscle Mode: Frequency of channel 2 is fixed at 4064 Hz, and channel 1 is fixed at 4000. Both channels are Cycled on and off at 6 sec. intervals. IFC Placement Confidential
  29. 29. NexWave - TENS Programs Sweep TENS frequency decreases from 125 Hz to 11Hz over 4 seconds. During this period the Pulse Width adjusts 120 to µs to 300 µs. Then frequency is increased from 1 to 10 Hz over 2 sec, the pulse width remains at 300 µs. The increased from 11 Hz to 125 Hz over a 4 sec. span. During this same time the Pulse Width is decreased from 300 µs to 120 µs. Benefits: Sweep allows for gate block (quick onset of relief) and Endorphins Release (long Carry-over) in one program Confidential
  30. 30. NexWave - TENS Programs LMD – Low Modulated The Frequency sweeps from 66.7 to 100 Hz 100 µs and back again over 12 sec. Pulse Benefits: Quick on set of relief No modulation may result in accommodation Confidential
  31. 31. NexWave – TENS Programs Modulate The frequency shifts between 66 and 100 Hz at an interval of 6 seconds. The Pulse Width will also shift during the 6 seconds interval. The default Pulse Width is 225µsec. and when the frequency is at it’s minimum, the Pulse Width is at it’s maximum and visa versa. Benefits: Quick onset of relief Modulation helps prevent accommodation Comfortable massaging sensation Confidential
  32. 32. NexWave – NMES Programs Preset 10 sec. ON -10 sec. OFF Preset 20 sec. ON -10 sec. OFF Preset 30 sec. ON -10 sec. OFF Benefits Both channels are On and Off at the same time Muscles Strengthening Increase ROM Muscle re-education Confidential
  33. 33. Low Back Neurostimulation System Conductive Garment Description Allows Patient to Place Electrodes on Lower Back Without Assistance Electrodes Stay on Garment When Removed from Body for Easy Reapplication Product Positioning Pain Management Physical Therapy Compatible Devices: TruWave TENS NexWave IF8100 IFC Confidential
  34. 34. Distribution Materials Communication Materials International Web page Device Specs “Getting Started” Pages Electrotherapy Studies Power Point Presentations Confidential
  35. 35. Physician & Physiotherapist Supporting Research on Electrotherapy for Pain Management Defines TENS mechanism of pain control Establishes benefits of electrotherapy as an adjunctive pain control option Gives Support to electrotherapy by referencing research with copy of abstracts on back Target market is Interventional Pain Management Specialist Confidential
  36. 36. Thank You www.painezee.com Confidential

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