DEFINITION By definition any stimulating device which delivers

• DEFINITION • By definition, any stimulating device which • delivers electrical currents across the intact surface of the skin is TENS,

Types of TENS • Convential TENS ( HI TENS) • High frequency(90 -130) • Short pulse duration( 60 -100 micro sec)

Acupuncture Like TENS (AL TENS) or (low TENS) • Low frequency( 2 -4 Hz) • Long pulse duration ( 200 -250 micro sec)

Intense TENS The aim of intense TENS is to activate small diameter Aδ cutaneous afferents by delivering TENS over peripheral nerves arising from the site of pain at an intensity which is just tolerabl to the patient

Burst mode TNES: • It is conventional TENS but delivered in burst mode • Frequency ( 2 -3 burst per sec )

Mechanisms of action • Peripheral mechanisms

Segmental mechanisms • Conventional TENS produces analgesia predominantly by a segmental mechanism whereby activity generated in Aβ fibres inhibits ongoing activity in second-order nociceptive (pain related) neurons in the dorsal horn of the spinal cord • ( Gate control theory)

Extrasegmental mechanisms • TENS-induced activity in small diameter afferents has also been shown to produce extrasegmental analgesia through the activation of structures which form the descending paininhibitory pathways, such as periaqueductal grey (PAG), nucleus raphe magnus and nucleus raph • (endogenous opiate theory)

indications • Pain management • (acute and chronic pain, neurologic pain, phantom pain) • Muscle strength • Improve circulation • Wound healing • Fracture healing • Reduction of edema

contraindication • 1)Arterial disease • -the stimulatory effect of the current could produce emboli • 2) Deep Vein Thrombosis • -in the acute phase, it is possible to dislodge thrombi or increase the inflammation of the phlebitis • 3) Infective conditions • • • 4) Pregnant Uterus -5) Danger of haemorrhage 6) Malignant tumors -7) Artificial pacemakers -8) Dermatological conditions