TRANSCUTANEOUS ELECTRICAL NERVE

STIMULATION

PRESENTED BY YASHA ALI

BANGASH & PASHMINA KHAN
DPT BATCH II SEMESTER V
 Learning objective

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Transcutaneous electrical
nerve stimulation (TENS)
♥ It is a form of peripheral electrical nerve
stimulation through the skin.
♥ It is a non invasive modern electrical
method of managing both acute (short
term pain) and non-malignant chronic
(long term pain).
♥ TENS is an alternating low frequency
current
♥ Current generated by small batteries
♥ circuits modify the battery’s output in such
a way that it will have stimulatory effect

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TENS Parameters
• Pulse shape = monophasic, symmetrical biphasic

,asymmetrical biphasic commonly used rectangular

• Pulse width = v short , 100µs or 200µs vary 50µs to
300µs
• Frequency = as low as 2Hz or as high as 600Hz
commonly used 150Hz
• Intensity = 0 to 60 mA

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MECHANISM OF TENS
1. Melzack and Wall first to formulate the
“Gate Control Theory” 1965 Large
diameter myelinated peripheral sensory
nerves (A-Beta) respond to electrical
stimulation and inhibit the nociceptive
transmission of pain signals This occurs
in the spinal cord cause Physiological
block
2. TENS produces Presynaptic inhibition in
the dorsal horn of the spinal cord
analgesia mechanism produced by TENS
The gate usually is closed by inhibiting C
fibers from the periphery to the T cell
release of Endogenous pain control (via
endorphins, enkephalins, and
dynorphins) Direct inhibition of an
abnormally excited nerve
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 Conventional TENS /high tens

•• Conventional TENS: low-intensity, high-frequency

currents, to produce segmental analgesia;
•This mechanism is called pre-synaptic inhibition by Hi-
TENS or traditional or conventional TENS.
•Parameters :
•High frequency =100-150Hz, / 60 -100 pps
•Pulse width (duration) = 100-500 µs
•Intensity =12 and 30mA / sensory
• Dosage and timing:
•Conventional TENS is used for treatment with
recommended duration from 30 to 60 minutes

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Patient experience Electrode placement
Strong tingling non Site of pain
painful sensation with dermatomes
minimal muscle
activity
Conventional TENS /high tens

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 2- Acupuncture-like TENS /low tens
• • Acupuncture-like TENS: high-intensity,
low-frequency currents, to produce
extrasegmental analgesia;

• Parameters :
• High intensity = >30mA / motor

• Low frequency (less than 10Hz, commonly 1-5Hz)

• Pulse width (duration) =100-150µs

• The intensity is very high close to the patient

tolerance(nociceptive stimulus) to stimulate A and
C fibers leading to the release of endorphins and
encephalin.

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 Acupuncture points

Patient experience
;Strong comfortable muscle
twisting
Electrode placement Site
of pain myotome muscles
motor points Acupuncture
points a place where a small
bundle of a fibers pierce the
deep fascia to become more
superficial
Timing and dosage
Once per day for 20 to 30
minutes.
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 FURTHER CONTINUED BY

YASHA ALI BANGASH

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 3- Burst TENS /INTENSE TENS

• Burst TENS combines both conventional and

acupuncture-like TENS and therefore provides pain
relief by both routes.
• Intense TENS: high-intensity high-frequency
currents, to elicit peripheral nerve blockade, and
segmental and extrasegmental analgesia.
• Frequency : 50-200PPS
• Burst TENS consists of a ‘burst’ of pulses of 2Hz
(some times varying from 1-5Hz).
• Pulse width (duration) : 300-1000µs
• Each burst lasts for 70 ms
• as the internal frequency of the bursts is at the usual
conventional TENS frequency of 50- 100Hz, this
result in release of endorphins at the central level
which have a pain reducing effect 13
 3- Burst TENS /INTENSE
TENS
• INDICATIONS:
• Deeper-lying painful regions (myofascial pain)
• Cases of chronic pain.

• DOSAGE AND TIMING:

• 15-30 minutes to be effective and treatment can be
repeated during the same day.

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 APPLICATION AND
CONSTRUCTION OF TENS
Click icon • Application:
to add
• The device consist of two parts. One is battery and
other are conductive rubber electrodes. Conductive
rubber electrodes are covered by gel and placed on skin
in order to gain good skin contact. The electrodes are
bandaged on to the patient or fixes by adhesive tape. The
wires are connected to the electrodes.
 Electrodes can be placed over:
 Acupuncture points, motor points or trigger points.
 Area of greatest intensity of pain.
 Appropriate dermatome or spinal segment.
 Appropriate peripheral nerve.

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POSITION OF
ELECTRODES

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 INDICATIONS
ANALGESIC EFFECTS

Relief of acute pain: Relief of chronic pain

• Musculoskeletal • Phantom pain

pain • Chronic pain: e.g.
• Dysmenorrhea (rheumatoid arthritis,
osteoarthritis, etc.)
• Acute postoperative • Chronic low back pain
pain
• Trigeminal neuralgia
• acute post
traumatic pain
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NON ALGESIC EFFECTS
IMPROVED BLOOD CIRCULATION

Diabetic neuropathy
Raynaud’s disease

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CONTRAINDICATIONS
1. Undiagnosed pain. • 5. Skin lesions or wounds
(different resistance).
2. Pregnancy (especially
• 6.Over non sensation area.
first trimester)
• 7.Over infected or inflamed area
3. Heart pacemaker.
• 8.Over carotid sinus to avoid
4. Epilepsy cardiac arrhythmias

Epilepsy

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Thank you

• RREFERNCE
• Electrotherapy E-Book
• Clayton’s electrotherapy BOOK
• Articles related to electrotherapy
• Therapeutic Modalities from Injury Assessment and
Rehabilitation
• Manual of Practical Electrotherapy 20