1. Transcutaneous Electric Nerve
Stimulation (TENS)
Name: Akasha Rehman Butt

2.  Features of TENS
 Types of TENS
 Application of TENS
Introductio
n

3. Definition:-
Transcutaneous electric nerve stimulation (TENS) is method of electric stimulation
that involve in pain relief by superficially excruciating sensory nerves.

4. Key principles:-
 Knowledge of intent of TENS application
 Location of electrode placement
 Selection of appropriate current type
 Dosage

5. Features of TENS
 Pulse wave form
1. Monophasic
2. Symmetric biphasic
3. Asymmetric biphasic
 Pulse amplitude :-1-50mA
(Adjustable)
 Pulse duration:-50-500 micro seconds
 Frequency:-1-200Hz
 Pulse pattern:-
1. Continuous
2. Burst
 Channels
1. Single
 Double

6. 1. Conventional TENS or high frequency TENS
2. Acupuncture like TENS or low frequency TENS
3. Brief TENS or intense TENS
4. Burst TENS
5. Modulated or modified TENS

7. Conventional of high TENS
Principle:-
Pre synaptic inhibition by pain gate mechanism by stimulating Alpha and Abeta
fibers.
Duration:–
30-60min once or twice daily
 Frequency:-50-100Hz
 Pulse width :-20-60 microseconds
 Intensity:-0-30mA
Intensity until a prickling or tingling sensation is felt

8. Acupuncture or low TENS
 Principle -This stimulates the high threshold AS and C fibres, which lead to
release of endogenous opioids and provides further sensory input from muscle
spindle afferents (chemical theory).
 Duration - 20 to 30 minutes once a day.
 Frequency - More than 100 Hz
 Pulse Width - 150 us to 250 us
 Intensity - Highest level tolerated by the patient.

9. Burst TENS
 Burst TENS is a series of pulses (i.e. a train), repeated 1-5 times a second,
commonly twice.
 Each train or burst consists of a number of individual pulses at the usual
conventional TENS frequencies of 50
Hz to 100 Hz but at higher intensity.
 It combines both the conventional and acupuncture-like
TENS and
 therefore provides pain relief by both routes.

10. Brief or Intense TENS
 Principle -Activity in cutaneous AS afferents induced by intense TENS produce
peripheral blockade of nociceptive afferent activity (Central biasing
mechanism).
 Duration - 30 to 60 minutes once or twice daily.
 Frequency - More than 100 Hz
 Pulse Width - 150 us to 250 us
 Intensity - Highest level tolerated by the patient.

11. Modulated or Modified TENS
 In modulated TENS the pulse length, frequency, and amplitudes can be
constantly and automatically varied.
 This cyclical variation is believed to prevent adaptation of the nerves to the
current (no accommodation)
 Is particularly appropriate as a variant of conventional
TENS used over long periods.

12. USES of TENS
Common conditions where TENS is used
Relief of Acute Pain:
•Post operative pain
•Labour pain
•Dysmenorrhoea
•Angina Pectoris
Relief of Chronic Pain:
•Low back pain
•Arthritic pain: RA, OA
•Myofascial pain

13. Electrode Placement
 Directly over painful sites: trigger points
 Dermatomes, Myotomes
 Accupunture points
 Spinal nerve roots
 May be crossed or uncrossed
 Horizontal or vertical

14. Contraindication
 Someone with a pacemaker
 Someone with undiagnosed pain
 Someone with a heart condition
 On head or neck of someone with epilepsy
 Cardiac conditions- arrhythmia
 Neurological conditions: epilepsy, stroke
 Non-cooperative patients
 Pregnancy
 Active infections, Skin conditions

15. Precautions
 Areas of skin irritation, damage or lesions
 Areas with impaired sensation
 Over abdominal, lumbosacral or pelvic regions during pregnancy other than for
labor/delivery
 Incompetent patients may not be able to manage the device and it must be kept
out of reach of children.
 Athletes should not be permitted to participate in sports while under the influence
of TENS analgesia

16. Thank You