Pain facts 6

1. Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip.Diab. DCA, Dip. Software statistics PhD (physio) Mahatma Gandhi medical college and research institute , puducherry – India Pain facts 6

2. Usually we do by

3. Nonpharmacological methods

4. TENS (TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION) acupuncture Others ultrasound heat and cold laser Some methods

5. TENS is the process of applying low-voltage electrical impulses to the skin to affect conduction in the underlying nerves No drugs But use our own neurobiology to relieve pain What is TENS

6. gate control theory

7. Underlying mechanism explaining the efficacy of TENS is based on the gate-control theory. It is felt that stimulating the larger A-β fibers by selective application of electricity may inhibit nociceptive conduction by the smaller A-δ and C fibers. Works by gate control theory

8. Conventional TENS High frequency (40- 150 Hz) low intensity 10-30 mA ----- gate control theory Acupuncture like TENS Low frequency bursts (1-2 Hz) high intensity (20 -50 mA) – endorphin release Types

9. Intense mode – high freq, high amplitude Modulating ( rise is in steps) Conventional and acu – alternate Other modes

10. Three parts Stimulator On/off switch, pulse width, amperage , frequency Leads Electrodes Carbon rubber, self adhesive Application

11. Commercially available TENS unit

12. Position the electrodes In pairs Minimum 1 cm apart even jelly (TENS jelly) ECG more saline , more skin irritation Skin clean and dry Maximum 24 hours – change electrodes Dual sometimes Use of equipment

13. comfortable paresthesia What is shock ?? Demonstrate usually 70 Hz Comfortable No muscle spasm (conventional) TENS trial 1 hour, familiarize, no side effects, acceptance Start for a treatment plan Stimulator

14. Increased amplitude

15. Acute Labour Arthritis Dysmenorhoea Post op pain No side effects of opioids or NSAIDs Indications – acute and chronic

16. Examples

18. Superficial pain and deep pain SHAM TENS – less effective All types of surgeries Peak pain Total narcotics Side effects , lung function TFA – all are favourable Innumerable studies for TENs in post op analgesia

19. PHN ICN Facial pain Tic Angina Itch Peripheral vascular insufficiency Central pain states, psychogenic ?? Other painful conditions

20. Region, stimulator type,patient type – no changes VAS reduction by 50 % in 47 % individuals Onset – 30 minutes in 75 % one hour in 95 % Some may need 9 hours a day Not useful as a single therapy in severe pain Outcomes

21. Skin irritation Possibly one third in patients – more than 7 hours Dry skin and proper electrode gelly with changing the place atleast every 24 hours Complications

22. Allergy Possibly around 1% Gelly, pads, can be changed Skin burn Think of TENS only when there is normal sensation in the area applied Complications

23. Equipment failure Battery exhaustion, wire fracture especially in the junctions Tolerance Stop , Change mode Use other methods Complications

24. 1. don’t -- anterior neck Fear of carotid sinus stimulation , fear of laryngeal spasm 2. don’t stimulate on the pregnant uterus 3. pacemaker patients beware 4. implantable drug delivery and SCS Contraindications

25. TENS – expansion What is it? Types Parts Uses Side effects Contraindications Summary

26. JOACP 2001 Dr. s.parthasarathy

27. It is estimated that acupuncture was first used in China 4000 to 5000 years ago. Preliminary evidence suggests that acupuncture may modulate the hypothalamus–limbic system and subcortical gray structures of the human brain. EA to modulate expression of the c-fos gene in the central nervous system. Acupuncture

28. acupuncture can alleviate dental pain and postoperative nausea EA can decrease the postoperative opioid requirement. used in other types of surgical procedures such as craniotomy, tonsillectomy, thyroidectomy, and labour-related procedures as analgesia As a sole anaesthetic ?? Clinical uses

29. chronic neck pain Headache LBA, OA PA Tennis elbow CRPS Chronic pain – uses

30. labour pain Post op pain Trauma Angina Acute pain – uses

32. IJA 2001 . Dr.s.parthasarathy

33. Needle injuries Infection Bleeding Problems – not much

34. As old as human being Pain, spasm, RSD, thrombophlebitis, FMS, bursitis, hematoma resolution Superficial and deep heating modalities Therapeutic heat

35. Gonads, Malgnancies Haemorrhagic disease Foetus Problems

36. Water heating pads Chemical pads Paraffin baths Hydrotherapy Superficial

37. Ultrasound1 MHz Direct and indirect - ?metal prostheses ,more deep Amputation neuroma Short wave diathermy 25 MHz Electromagnetic radio waves , no metals no jewels , Cu T , superficial poor water Microwave diathermy 1000 MHz High water content , less energy leak and more efficient Edema sweat, cataract ?? Deep modalities - Conversion of physical energy to heat

38. Pain, injury spasm,tendinitis etc No in raynauds, cold intolerance and decreased sensation. Packs, whirlpools, evaporative cool sprays, and chemical ice packs Massaging in acu points – effective Alternating heat and cold - CRPS Therapeutic cold

39. J Midwifery Womens Health. 2003 Sep-Oct;48(5):317-21. Ice massage for the reduction of labor pain. Waters BL, Raisler J. Labour pain

40. Neo dymium , Helion neon laser Various indications with variable results Lasers

41. Presentation to the individual a sensory signal (audio or visual ) that changes in proportion to the biological process. All pain syndromes Thermistor Skin temperature monitors and blood flow Electromyographic device Galvanic skin response Heart rate monitors Biofeedback – adjunct

42. Thank you all