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Do not use transcutaneous electrical nerve stimulation (TENS) with a patient who has decreased cognition, a patient who is unable to understand instructions, a patient who has epilepsy, or a patient who has loss of sensation at or around the treatment area.
Never place TENS electrodes:
Do not remove the electrodes until the TENS unit is off to avoid electrocution.
Use caution when using TENS with a patient who has sensitive skin, including dermatitis and eczema.
TENS is a physical agent modality used to treat pain. TENS provides electrical stimulation with modulated current directed at peripheral nerves through electrode placement.undefined#ref10">10 Therapists use TENS to reduce pain to prepare patients for functional activities. Indications for use of TENS include patients with acute or chronic pain (e.g., postoperative pain, osteoarthritis, diabetic neuropathy, chronic pelvic pain, chronic lower back pain, complex regional pain syndrome).1,3,4,5,8,10 Additionally, TENS is used with patients with fibromyalgia6 and spinal cord injury with neuropathic pain.4
Parameters including frequency (pulse rate), intensity (amplitude), and pulse width (pulse duration) may be adjusted on the TENS unit. The therapist determines the parameters and the duration of treatment, depending on the patient’s diagnosis and tolerance of the treatment.
Frequency, or pulse rate, targets different nerve groups depending on the setting. When applied to the peripheral nerves, high frequencies (50 to 150 Hz)6 activate the delta-opioid receptors, blocking the perception of pain in the brain.10 Low frequencies (1 to 10 Hz)6 activate the mu-opioid receptors and cause the brain to release endorphins, which reduces the sensation of pain.10 Lower frequencies may be ineffective in patients with an opioid tolerance.6
Intensity, or amplitude, is critical to the successful use of TENS. The strongest intensity that is comfortable to the patient should be used.1 Studies have shown that there is a positive cumulative effect with the use of TENS; however, repeated use at the same frequency, intensity, and duration may lead to a buildup of a tolerance of TENS, resulting in an analgesic tolerance.6 To counteract analgesic tolerance and to continue achieving positive outcomes, the therapist should change the frequency and intensity as the patient builds up a tolerance.
Pulse width, or pulse duration, can range from 1 to 400 microseconds.6 The higher the pulse width, the more stimulation the patient feels.
TENS treatment is considered either conventional TENS or acupuncture-like TENS.
Ensure that the patient consents to treatment and will be able to provide feedback throughout treatment.
Rationale: The use of gel on each electrode pad may be required, depending on the manufacturer.
Rationale: TENS units come with either two or four pads, depending on the manufacturer.
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