The document outlines Transcutaneous Electrical Nerve Stimulation (TENS) as a modern, non-invasive method for pain management, which utilizes electrical currents through skin electrodes to alleviate both acute and chronic pain. It explains different TENS modalities, their mechanisms, applications, and effectiveness, such as the activation of pain suppression systems and enhancement of local circulation. Additionally, it addresses proper electrode placement and contraindications for specific medical conditions.

2. • It is the modern, non-invasive, drug free pain
management modality
• Designed to provide afferent stimulation,
• Used for relief of acute or chronic pain.
• It is a method of applying electrical current to
stimulate the nerves across the skin, mainly
to modulate pain.
• Application of pulsed wave current via
surface electrodes on the patient skin.
• Abbreviated as TNS or TENS.

4. By increasing local area circulation.
Physiological block.
Pain gait theory.
Activation of Descending pain
suppression system.

5. • Tissue injury releases chemicals at the site that
stimulates nociceptive nerve endings.
• Through peripheral nerve pain reaches spinal
cord & then from brain stem to the cortex where
pain is appreciated.
• Pain decreases if we remove chemicals from local
area by increasing local circulation.

6. • Nociceptive stimulus is carried to the cord
along:-
• C fibers (slow conducting 15 pulses per
second, non myelinated fibers)
• A delta fibers (faster 40 pulses per second,
myelinated fibers)
• If a higher frequency of stimulation is applied,
a physiological block to conduction might
occur.
Modalities
• TENS
• Interferential therapy.

7. • Postulated by Melzack & wall in 1965.
• Afferent information must pass through synapses in
the substantia gelatinosa and nucleus proprius of
the posterior horn of spinal cord, here the pain gate
works.
• If input is predominantly small diameter
nociceptive in nature then gait is open to pain.
• If large diameter afferent information (through
thermo & mechanoreceptor) is superimposed, then
gait is closed to the nociceptive stimulus.
• TENS, IF, heat, ice, massage, vibration, joint
mobilization.

8. • If nociceptive stimulus is passed through gait, it travels
through lateral spinothalmic tract up to the brainstem,
thalamus and finally to the cortex where pain is
perceived.
• As it passes the mid brain, it interacts with PAG
(periaqueductal gray) & raphe nucleus.
• Their descending neurons release endogenous opiates
(endorphin & enkephalin) which inhibit the
transmission of nociceptive stimulus at spinal cord.
• Low TENS, brief icing, transverse friction, manipulation.

9. • 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)
• .

10. •Externally applied electrical potential
from TENS must produce evolved
potentials in underlying peripheral
sensory nerve or receptor in the skin.
•Stimulus must be adequate to cause
depolarization of the nerve cell
membrane.

11. •High-rate TENS
•Low-rate TENS
•Brief intense TENS
•Burst mode TENS
•Point stimulation TENS

12. • Most common mode of TENS used in acute
or chronic pain syndrome.
• It is based on sensory level stimulation
• Activates gait control mechanism by
Stimulation of large diameter afferent fibers.
Pre-synaptic inhibition of pain carrying fibers
at substantia gelatinosa of the pain gate, by
large diameter fibers.
• Effect is rapid but transient
• i.e. no pain is felt as long as the current is on.

13. •Pulse Rate/ Frequency : 50-100Hz
•Pulse duration: 2-50µs
•Duration: 20-60min in one sitting.
•Intensity: Patient should feel a tingling,
pins and needles sensations.

14. • 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.

15. •Frequency: 1-5Hz
•Pulse duration: 150-300µs
•Duration: 20-30min in one sitting.
•Intensity: Sufficient to cause visible
muscle twitches within comfortable
tolerance level of the patient i.e.30mA.

16. •Potentially painful, intense
stimulation used to provide rapid
short term pain relief during painful
procedures like
1. Tooth extraction
2. Wound debridement
3. Dressing of wounds
4. Deep friction massage

17. •Pulse Rate: 80-150Hz
•Pulse duration: 50-250µs
•Duration: 15min.
•Amplitude= pt tolerance
•Uses: soft tissue tightness

18. • Combines the characteristics of high & low
TENS, leading to release of endogenous
opiates. (endorphin & enkephalin)
• 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.

19. •Pulse Rate: 50-100Hz, delivered in
bursts, of 1-4 pulses per second.
•Pulse duration: 50-200µs
•Duration: 15-20min.
•Intensity: comfortable with intermittent
tingling sensation.

20. •It uses a small probe to located and
noxiously stimulate trigger points
•Multiple sites can be stimulated in one
treatment
•It relieve pain by Endorphin
mediated mechanism

21. •Pulse Rate: 1-5pps
•Pulse duration: 150-300µs
•Amplitude: Strong- to patient
tolerance
•Electrode Placement: Over the pain
site; can be placed over the nearest
trigger points.

22. •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.

24. • Large main units.
• Pocket size.
• Conductive rubber electrodes covered by
conductive gel to gain good skin contact.
• Electrode positioning is an area of debate.
electrodes can be placed over:
Area of greatest intensity of pain.
Appropriate dermatome or spinal segment or
peripheral nerve.

25. •Gradual and continuous change in
one or more than one parameters of
TENS current to prevent
accommodation
•Changes in frequency or pulse width
or amplitude
•Frequency, Pulse width modulation,
Amplitude, Burst Modulation

26. • Osteoarthritis, Rheumatoid arthritis
Joint pain:
• Labor pain, Postoperative pain
Acute pain:
• Muscle spasm, Torticollis
Muscle pain:
• Spinal nerve compression
Spinal pain:
• Peripheral nerve injuries
Nerve
disorders:

27. 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.