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TENS, One of Medical Methode for Back Pain

by. Tim Dr. Eko Agus Subagio, Sp. BS - Spine (Tulang Belakang), Dokter Saraf Kecetit
21 April 2016
TENS, One of Medical Methode for Back Pain

Back pain is excruciating. If the contract is, all activities can be stopped. Many people who had long been taking medication but the pain was back. Therefore, patients seek other therapies, one that is still in the research is the treatment by stimulating the nerves to reduce chronic back pain. The recommended method is transcutaneous electrical nerve stimulation (TENS), in which mild electrical pulses transmitted to the nerves to block incoming pain signals.

Elektroanalgesia technique has been known since 2500 BC in Egypt, where they have been using electric fish to treat several types of ailments. In the year 46 BC, a Roman physician named Scribonius Largus elektroanalgesia use this document. Elektroanalgesia increasing in popularity with the development of an electrostatic generator 18 th Century and the decline in the 19th century and early 20th century TENS was developed further in 1965 by Melzack and Wall with the reasons physiological rationale regarding the effect elektroanalgesia. They mnyatakan that the delivery of pain signal transmission can be inhibited by the activity in the peripheral afferent nerve (large diameter) or through activities in pain inhibitory pathways descending from the brain. High frequency electrical stimulation is used to enable percutaneous peripheral afferent nerve stimulation of large diameter and can relieve chronic pain in patients. Shealy, Martiner and Reswick found that stimulation of the dorsal columns that form the central transmission pathways of large-diameter peripheral nerves can also relieve pain.

TENS is a non-invasive technique elektroanalgesia which has been widely used in various practice physiotherapists, nurses and midwives. TENS involves a weak electric current through electrodes placed on the skin surface. Electrodes are placed at some point in their body, then the current flow through the cable with the frequency and intensity are adjusted to obtain optimum effect during and after stimulation.

Analgesia Mechanism TENS

1. Mechanism of action of TENS in relieving pain is thought through:

2. Presynaptic inhibition in the spinal cord dorsal cornua.

3. Controlling pain endogenously through endorphin, and dynorphin enkhepalin.

4. Direct inhibition of abnormally excited nerve fibers.

5. Restoration of afferent input.

Research in the laboratory showed that electrical stimulation by TENS reduces pain through nociceptive barriers at the presynaptic level in the dorsal cornua. Thus inhibiting transmission to the central. Electrical stimulation of the skin activates the nerve fibers bermyelin low threshold. Input from these fibers inhibit afferent nociceptive propagation carried by small C fibers not bermyelin by inhibiting the transmission along the nerve fibers is to the target cell (T cells) contained in the substantia gelatinous dorsal cornua.

The mechanism of analgesia produced by TENS can be explained by the theory of the control gate (Gate Control Theory) by Melzack and Wall. This theory explains that the nerve fibers with a small diameter that bring pain stimulus going through the same door with fibers that have a diameter greater that carry impulses touch (mechanoreceptors), if both the nerve fibers are jointly passed through the same door, then the fibers are greater will inhibit impulse conduction of smaller fibers. Gate is usually closed, constantly blocking nociceptive transmission through the fiber C from peripheral cells to T cells. If the peripheral pain stimuli arise, the information carried by the C fibers reach the T-cells and the gates will open, causing the central transmission to the thalamus and cortex where impulses are interpreted as pain. TENS role in the mechanism of the closed gate to inhibit nociceptive C fibers by giving impulse to the fibers bermyelin activated.

Low-frequency TENS works mainly with opiod endogens produce chemical compounds and the effect can be reduced or lost by administering an opioid receptor antagonist. b endorphins will increase its concentration in the spinal fluid flow and after the use of TENS either low or high frequency. These compounds will inhibit pain signals in the spinal cord. 2 chemical compounds released into the central nervous system in response to TENS is endogens opioids that inhibit pain transmission in the substantia gelatinous in the spinal cord.

Techniques and Tools TENS

TENS use small sized electric appliance to deliver electrical impulses to the skin. A TENS unit consists of an electric signal generator, battery danelektroda. Stimulation parameters commonly used are:

Amplitude: Low intensity, comfortable and above the threshold level. The extent of the pulse (duration): 10 â € "1000 micro seconds. Pulse rate (frequency): 80 â € "100 impulses per second (Hz), 0.5 â €" 10 Hz if the intensity is set high.

At the time of wearing the patient is asked to try different frequency and intensity to get the best pain control for the individuals concerned. The position of electrodes mounted on the sore area (also in other areas such as acupuncture, trigger point, the nerves of the skin) to get a better comparison of results.

There are three options with TENS therapy methods are:

1. Conventional TENS

Conventional TENS uses high frequency (40-150 Hz) and low intensity, setting the current between 10-30 mA, short duration (up to 50 microseconds). The onset of analgesia in this method was modest. Pain is lost when the instrument is turned on and usually come back again when the instrument is turned off. Every day patients placing electrodes throughout the day, the stimulus is given at intervals of 30 minutes. In individuals who respond favorably, we will get analgesic effect until some time after the use of the tool is stopped.

2. Acupuncture Like TENS (AL-TENS)

In this method is used with low frequency stimulus begins with 1-10 Hz, high intensity, but still tolerable patients. This method is more effective than conventional TENS, but there are some patients who feel less comfortable. This method is usually used for patients who have not responded to conventional TENS.

3. Intense TENS

Using stimulus with high intensity and high frequency. Spark flows released 1-2 Hz, with each spark frequency of 100 Hz. There is no particular advantage of this method compared to conventional TENS.

TENS is used to selectively activate Aβ afferent nerves that causes inhibition of nociceptive transmission in the spinal cord. Stated that the mechanism of action and analgesic profile AL-TENS and intense TENS-TENS is different from conventional methods are more useful than conventional TENS, because conventional TENS offers little advantage. There are several studies reported that there is evidence which is not so strong that supports the use of TENS in the management of postoperative pain and labor pain. However, this finding has been questioned because it contradicts all with clinical experience and would not be appropriate to deny use of TENS in acute pain until there is evidence or reasons that explain the difference between clinical experience with clinical research on further exploration. Systematic review showed more positive results regarding the use of TENS in chronic pain. So that better research is needed to determine the difference in effectiveness between various types of TENS, and to compare the cost-effectiveness (cost-effectiveness) TENS with conventional analgesic interventions and other eletrokterapi

Indications and Contraindications TENS

TENS has been used for the type and condition of pain varied as low back pain (LBP), myofascial and arthritis pain, pain that is mediated by the sympathetic nervous, urinary incontinence, perssalinan pain, neurogenic pain, visceral pain and pain post operasi.Sakit back is so painful , If the contract is, all activities can be stopped. Many people who had long been taking medication but the pain was back. Therefore, patients seek other therapies, one that is still in the research is the treatment by stimulating the nerves to reduce chronic back pain. The recommended method is transcutaneous electrical nerve stimulation (TENS), in which mild electrical pulses transmitted to the nerves to block incoming pain signals.

Elektroanalgesia technique has been known since 2500 BC in Egypt, where they have been using electric fish to treat several types of ailments. In the year 46 BC, a Roman physician named Scribonius Largus elektroanalgesia use this document. Elektroanalgesia increasing in popularity with the development of an electrostatic generator 18 th Century and the decline in the 19th century and early 20th century TENS was developed further in 1965 by Melzack and Wall with the reasons physiological rationale regarding the effect elektroanalgesia. They mnyatakan that the delivery of pain signal transmission can be inhibited by the activity in the peripheral afferent nerve (large diameter) or through activities in pain inhibitory pathways descending from the brain. High frequency electrical stimulation is used to enable percutaneous peripheral afferent nerve stimulation of large diameter and can relieve chronic pain in patients. Shealy, Martiner and Reswick found that stimulation of the dorsal columns that form the central transmission pathways of large-diameter peripheral nerves can also relieve pain.

TENS is a non-invasive technique elektroanalgesia which has been widely used in various practice physiotherapists, nurses and midwives. TENS involves a weak electric current through electrodes placed on the skin surface. Electrodes are placed at some point in their body, then the current flow through the cable with the frequency and intensity are adjusted to obtain optimum effect during and after stimulation.

TENS has been used for the type and condition of pain varied as low back pain (LBP), myofascial and arthritis pain, pain that is mediated by the sympathetic nervous, urinary incontinence, perssalinan pain, neurogenic pain, visceral pain and postoperative pain.

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