1. Welcome!
Pain Management
Without the effect
of DRUGS
NexWave
Confidential

2. Presentation Overview
Basics of Electrotherapy
Different Types of Modalities
Theories of Pain Control
Electrotherapy – Indications for use
Zynex NexWave Product Training
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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. 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
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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
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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
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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
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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. 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
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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. 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
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12. Product Training Overview
NexWave
-Interferential Mode
-NMES Mode
-Marketing Materials
-Clinical documentation
Specific Treatments
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13. NexWave – Product training
Features & Benefits
Indications for Use
Product Operation & Programming
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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
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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. 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
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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
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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
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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
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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
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21. NexWave Programing
Compliance Meter
9. Screen Demonstrates All
information
10. Device is Now Programmed and
Ready to Start Treatment
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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
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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. NexWave - Operation
Connect The Leads
3. Connect Lead wires to Device
Important: Make Sure Lead wires are
Inserted Completely
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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
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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. 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. 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. 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. 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. 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. 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. 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. Distribution Materials
Communication Materials
International Web page
Device Specs
“Getting Started” Pages
Electrotherapy Studies
Power Point Presentations
Confidential

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. Thank You
www.painezee.com
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