ESTIM for Pain
Pain can be treated using ESTIM that is targeted at the sub-sensory, sensory, motor, or noxious level.
-
sub-sensory, or microcurrent level, is set to an intensity that is below the threshiold for nerve depoleratiation and therefore cannot be felt by the patient. This method has no known efficacy and the mechanism of pain control is not well established.
-
Sensory level (AKA conventional AKA high rate TENS) is the most commonly used treatment method for pain control. It controls pain via the gait control theory of directly blocking the transmission or activation of central ihibition by large diameter fiber stimulation. This puts the nerve on a "busy signal" and prevents the painful response from going through. This have a very short term effect where pain will return when the ESTIM is turned off.
-
Parameters:
-
High rate: 50-150 Hz (pps)
-
Low duration: <100 usec
-
Low intensity: determined by patient
-
Current type: Asymmetric biphasic, IFC
-
-
-
Motor level (AKA low rate TENS AKA acupuncture-like TENS) kicks in our endorphines, making it an opiate mediated pain control. Pain is controlled secondarily by the gate control theory. This will provide a longer lasting pain relief, however it is not seen as frequently in clinics.
-
Parameters:
-
Low rate: 2-10 pps
-
Pulse duration: 100-600 usec
-
Intensity: to a visible, tolerated contraction
-
Current type: Biphasic, Russian
-
-
-
Noxious level stimulation is primarily opiate mediated for pain control with a secondary mechanism of gating. This is commonly used for chornic pain cases, such as Achillis tendinitis or epicondylitis, where other sensory/motor stim has failed. This will provide the longest lasting pain relief.
-
Parameters
-
Carrier frequency: 2500 Hz
-
Frequency: 50 bursts/second
-
On/Off time: continuous
-
Amplitude: max tolerated
-
Treatment time: 10-15 minutes
-
-
Contraindications
-
Synchronous, demand-type cardiac pacemakers
-
Over the carotid sinus
-
Venous or arterial thrombosis or thrombophlebitis
-
Pelvis, abdomin, trunk, and low back during pregnancy
Precautions
-
Cardiac disease
-
Impaired mentation
-
Impaired sensation
-
Malignant tumors
-
Skin irritation or open wounds
Electrode Placement
-
If using TENS, russian, biphasic or any parameter that utilizes 2 pads, those pads should be placed to either side of the pain so that the center of the pain can be found halfway between the pads
-
If using IFC for pain control, then the four pads should be set up so that if you drew lines between them, the resulting "X" shape would have it's cross directly over the site of the pain
-
The closer the pads are too each other, the more superficial the reflex arc of the current will be
-
The further the pads are from each other, the deeper the reflec arc of the current will be