Box 121 Comparison of the two methods of TENS

Conventional TENS

High frequency, low intensity, gate control theory mechanism

Low intensity activates large muscle (type I) and large skin (A-beta) nerves for gate effect

Segmental effects based on gate theory: large-diameter fibres inhibit pain from small fibres

High intensity of most TENS devices causes burning from skin but no Deqi from muscle

Pads are placed near the site of pain as large-diameter fibres are widely distributed

High frequency (50-200 Hz) produces best presynaptic inhibition at low intensity (for gate) but produces spasm at high intensity

Pulse trains maximise comfort of low-intensity, high-frequency stimulation

Analgesia has rapid onset and short duration, requiring continuous treatment all day long

Tolerance develops from continuous therapy

From Pomeranz & Stux (1995)

Acupuncture-like TENS

Low frequency, high intensity, Deqi mechanism High-intensity pulses produce (type III) Deqi via small muscle nerves to release endorphins Non-segmental and segmental effects: small fibres act on three sites: spine, brainstem and pituitary High intensity of some TENS devices activates small muscle (type III) nerves producing Deqi Pads placed on acupuncture points as these are over small-diameter afferent nerves (type III) in muscle Low frequency (1-4 Hz) produces no muscle spasm at high intensity and hence allows strong stimulation needed for Deqi Pulse trains cause muscle spasms at high intensity and do not permit adequate intensities for Deqi Analgesia has slow onset and long duration; needs only 30 minutes of therapy for prolonged effects No tolerance from short, 30-minute treatments

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