9 percutaneous electrical nerve stimulation

1. DR. SUBHANJAN DAS, PT
Subhanjan_82@yahoo.com
+91 8967549104
Dry Needling Instructor
MPT (Musculoskeletal & Sports)
Assoc. Prof., BIMLS, Burdwan

2. Also in the series
 http://www.slideshare.net/SubhanjanDas/introduction-to-dry-needling
 http://www.slideshare.net/SubhanjanDas/2-brief-hisory-of-needling
 http://www.slideshare.net/SubhanjanDas/3-superficial-dry-needling
 http://www.slideshare.net/SubhanjanDas/4-indications-of-dry-needling
 http://www.slideshare.net/SubhanjanDas/6-dangers-of-dry-needling
 http://www.slideshare.net/SubhanjanDas/7-physiologic-background-of-dry-
needling
 http://www.slideshare.net/SubhanjanDas/8-dn-vs-acupuncture
 http://www.slideshare.net/SubhanjanDas/9-electroacupuncture
 http://www.slideshare.net/SubhanjanDas/10-legalities-involved-in-dry-needling

3.  One of the advantages of DN is that physical therapists
can easily combine the needling procedures with
electrical stimulation.
 Several terms have been used to describe electrical
stimulation through dry needling, including
percutaneous electrical nerve stimulation (PENS),
percutaneous electrical muscle stimulation,
percutaneous neuromodulation therapy, and
electroacupuncture (EA)

4.  Electrical stimulation via needle is almost exclusively
given for pain relief.
 Using the needles as electrodes offers many
advantages over more traditional transcutaneous
nerve stimulation (TENS)

5. Advantage
skin impedence is bypassed
Current is directly delivered to exact location of pain
Both A delta and A beta system is engaged,giving better
analgesia
several studies have also demonstrated that PENS
provided more pain relief and improved functionality
than TENS.

6. parameters
Frequencies between 2 and 4 Hz with high intensity are
commonly used in nociceptive pain conditions and
may result in the release of endorphins and
enkephalins.
For neuropathic pain, it is recommended to use currents
with a frequency between 80 and 100 Hz, which are
thought to affect release of dynorphin, GABA, and
galanin

7. Electrode placement
Many conventions exist.
 the negative electrode is usually placed in the MTrP
and the positive in the taut band but outside the MTrP
 Elorriaga recommended inserting two converging
electrodes in the MTrP, while Mayoral del Moral et al
suggested inserting the electrodes at both sides of
an MTrP inside the taut band

8. Equipment
 Specific electroacupuncture
machines are available.
 A standard battery operated
machine can be used with
add on crocodile electrode
 Chu developed an electrical
stimulation modality that
automatically elicits LTRs,
which she referred to as
“electrical twitch-obtaining
intramuscular stimulation” or
ETOIMS

9. Precaution
 Strong responder
 Voltage fluctuation