This document discusses T.E.N.S. (Transcutaneous Electrical Nerve Stimulation), a non-invasive pain management technique. It stimulates nerves under the skin to reduce pain signals according to the gate control theory. T.E.N.S. has efficacy rates of 50-80% for controlling chronic and acute pain, such as post-surgical or injury pain. Different T.E.N.S. techniques like high frequency, low frequency, and brief intense stimulation are described along with their parameters and applications. Placement of electrodes and contraindications are also covered.

1. T.E.N.S.
(Trancutaneous Electrical
Nerve Stimulation)
Prof. Dr. M. Rajesh, PT, M.P.T(cardio), B.C.R.C
TRINITY MISSION AND MEDICAL FOUNDATION
MADURAI

2. General Concepts:
 An Approach to pain control
 Trancutaneous Electrical Nerve Stimulation:
 Any stimulation in which a current is applied across the
skin to stimulate nerves
 1965 Gate Control Theory created a great popularity of
TENS
 TENS has 50-80% efficacy rate
 TENS stimulates afferent sensory fibers to elicit
production of neurohumneral substances such as
endorphins, enkephalins and serotonin (i.e. gate theory)

3. TENS
 Indications
 Control Chronic Pain
 Management post-
surgical pain
 Reduction of post-
traumatic & acute pain
 Precautions
 Can mask underlying pain
 Burns or skin irritation
 prolonged use may result in
muscle spasm/soreness
 caffeine intake may reduce
effectiveness
 Narcotics decrease
effectiveness

4. Biophysical Effects
 Primary use is to control pain through Gate Control Theory
 May produce muscle contractions
 Various methods
 High TENS (Activate A-delta fibers)
 Low TENS (release of -endorphins from pituitary)
 Brief-Intense TENS (noxious stimulation to active C fibers)

5. Techniques of TENS
application:
 Conventional or High Frequency
 Acupuncture or Low Frequency
 Brief Intense
 Burst Mode
 Modulated

6. Various Methods of TENS
Parameter High TENS Low TENS Brief-Intense
TENS
Intensity Sensory Motor Noxious
Pulse Fq 60-100 pps 2-4 pps Variable
Pulse
Duration
60-100 sec 150-250 sec 300-1000sec
Mode Modulated Modulated
Burst
Modluated
Tx Duration As needed 30 min 15-30 min
Onset of
Relief
< 10 min 20-40 min <15 min

7. Conventional Tens/High
Frequency TENS
 Paresthesia is created without motor response
 A Beta filers are stimulated to SG enkephlin interneuron (pure
gate theory)
 Creates the fastest relief of all techniques
 Applied 30 minutes to 24 hours
 relief is short lives (45 sec 1/2 life)
 May stop the pain-spasms cycle

8. Application of High TENS
 Pulse rate: high 75-100 Hz (generally 80), constant
 Pulse width: narrow, less than 300 mSec generally 60
microSec
 Intensity: comfortable to tolerance

9. Set up:
 2 to 4 electrodes, often will be placed on post-op. Readjust
parameters after response has been established. Turn on the
intensity to a strong stimulation. Increase the pulse width and
ask if the stimulation is getting wider (if deeper=good, if
stronger...use shorter width)

10. Low Frequency/Acupuncture-
like TENS:
 Level III pain relief, A delta fibers get Beta endorphins
 Longer lasting pain relief but slower to start
 Application
 pulse rate low 1-5ppx (below 10)
 Pulse width: 200-300 microSec
 Intensity: strong you want rhythmical contractions within the
patient’s tolerance

11. Burst Mode TENS
 Carrier frequency is at a certain rate with a built in duty
cycle
 Similar to low frequency TENS
 Carrier frequency of 70-100 Hz packaged in bursts of
about 7 bursts per second
 Pulses within burst can vary
 Burst frequency is 1-5 bursts per second
 Strong contraction at lower frequencies
 Combines efficacy of low rate TENS with the comfort of
conventional TENS

12. Burst Mode TENS - Application
 Pulse width: high 100-200 microSec
 Pulse rate: 70-100 pps modulated to 1-5 burst/sec
 Intensity: strong but comfortable
 treatment length: 20-60 minutes

13. Brief, Intense TENS: hyper-
stimulation analgesia
 Stimulates C fibers for level II pain control (PAG etc.)
 Similar to high frequency TENS
 Highest rate (100 Hz), 200 mSec pulse width intensity to a
very strong but tolerable level
 Treatment time is only 15 minutes, if no relief then treat
again after 2-3 minutes
 Mono or biphasic current give a “bee sting” sensation
 Utilize motor, trigger or acupuncture points.

14. Brief Intense TENS -
Application
 Pulse width: as high as possible
 Pulse rate: depends on the type of stimulator
 Intensity: as high as tolerated
 Duration: 15 minutes with conventional TENS unit. Locus
stimulator is advocated for this treatment type, treatment time
is 30 seconds per point.

15. Modulated Stimulation:
 Keeps tissues reactive so no accommodation occurs
 Simultaneous modulation of amplitude and pulse width
 As amplitude is decreased, pulse width is automatically
increased to deliver more consistent energy per pulse
 Rate can also be modulated

16. Electrode Placement:
 May be over the painful sites, dermatomes, myotomes, trigger
points, acupuncture points or spinal nerve roots.
 May be crossed or uncrossed (horizontal or vertical)

17. Contraindications:
 Demand pacemakers
 over carotid sinuses
 Pregnancy
 Cerebral vascular disorders (stroke patients)
 Over the chest if patient has any cardiac condition

18. THANK YOU
Prof. Dr. M. RAJESH, PT,M.P.T(cardio),B.C.R.C
TRINITY MISSIOIN AND MEDICAL FOUNDATION
MADURAI.
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