TENS=Transcutaneous electrical nerve stimulator

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TENS=In this high frequency and low intensity nerve stimulator is applied. • Tens is mainly used for the symptomatic management of acute and chronic pain,However,TENS is also used in palliative care to manage pain caused by metastatic bone diseases and neoplasm. • most widely used.

TECHNIQUE OF TENS. 1= High Frequency Tens Create the fastest relief. Relief for short lived. Activate A delta fibre May stop the pain-spasms cycle 2= Low Frequency Tens. Longer lasting pain relief but slower to start. Releease B delta fibre. Frequency= 1 to 10 Hz. Pulse width= 200-300 micro. 3= Brief Intensity current( Noxious) Similar to high frequency tens. Highest rate 100 Hz. Pulse= 200 micro sec. Intensity is strong but tolerate level. 4= Burst Tens. Similar to low frequency frequency = 70-to 100 Hz. 7 burst per second.

USES OF TENS. Primary use to control the pain through pain gate theory:_ Reduce muscles spasms may produce muscles contraction,muscles contraction and various conditions

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PAIN GATE THEORY. • Given in 1965 by Ronald melzack. • Two type of nerve fibres carry pain sensation. A- delta fibre=myelinated, thicker, faster conduction of impulses than C fibre, carries pain as soon as stimulus is given and no pain is seen after stimulus has been removed. C fibre= Non- myelinated, thinnes,carries pain even after stimulus has been removed prostaglandins irritate C fibres.

* Pain gate mechanism:_ The gate control theory of pain asserts that non painful, input closes the nerve “gates” to painful input,which prevents pain sensation from travelling to central nervous system.

INDICATION OF TENS postoperative pain,Low back pain,neck pain,shoulder pain,knee pain,Labour pain, arthritis pain,Dental pain,orofacial pain,Trauma like fractures ribs and minor medical procedure.

CONTRAINDICATION OF TENS. Pacemaker, malignancy, pregnancy active infection,skin condition,cardiac condition,non cooperative patients.

PHYSIOLOGICAL EFFECT OF TENS. •According to pain gate theory pain which is transmitted by small unmylinated fibre may be inhibited by stimulating thick mylinated fibre.

MODE OF APPLICATION OF ELECTRODES. • Electrodes placed across the area of pain. •Dermatome= Electrodes can be placed at the nerve root of nerve suppliying the area of pain. •On the nerve= where the nerve is supergicial e.g= For median nerve= On the cubital fossa For radial nerve= On the cubital fossa and lateral edicondyle. For the ulnar nerve= On the medial edicondyle. • For Accupuncture point = A little buttom TENS can be placed at nerve root of the nerve supplying the area of pain.

* USES OF TENS IN OBSTETIC AND GYANECOLOGY. = Pain during childbirth can be decrrased using TENS.

# Caesarian section=( caesarian baby). • TENS can be used to decreased pain post delivery • Frequency= 80 to 120 Hz Pulsed width= 150 micro second. •Treatment is given for 1 hour in every 4 hours • Amplitude = Comfortable.

# Morning sickness • mother might be feel like vomating,nausea in the morning. •TENS can be used to reduce morning sickness •TENS is placed on right acromion process( 1 electrodes)and 2 nd electrodes is placed on the hokee point( b/w the thumb and index finger ) • Treatment= Everyday 30 min.

#Dysmenorhea( pain during menstruation). •TENS is placed on lumbosacral region paraeventrally to reduce pain of mensturation.This can be given ever before the menstrual cycle start.