Chronic Lower Back Pain
Conventional TENS (1st Rx MUST use Conv.)
Action
Step #
Get following materials:
1
Prepar 1. TENS machine
2. Plinth, Towel (drape)
e
Purpose
Communication
3. Pillow (墊Tummy)
4. Pillow (墊頭)
4. Safety pin & Alcohol pad
5. Gel & Adhesive tape
6. Paper towel (for 抹走gel)
- State purpose of
Ask Qs, THEN patient prone, roll up a bit shirt to
treatment
expose Lower back
- Get consent
Inspect treatment area
Observe 1)Open wound, 2)Bleed, 4)Infected
skin dz
Inspect:
2
Ask & DVT: Palpate+swell, pain warmth, red
oberse Thrombophletbitis: Hot & red
rve
Ask
Check contraindication:
- Electrical implants
- Suspected/ known maglignancy
- Tuberculosis
- Pregnancy
Check contraindication:
- Open wound
- Haemorrhage
Consent & Check
contraindication:
- DVT
- Thrombophletbitis
1) Use TENS, to treat your chronic lower back pain
2) you OK with that?
3) Pls roll up your shirt a bit, I will check if your skin is
intact & suitable for TENS.
1) I will check if you have Deep vein thrombosis, could I
have a touch on your leg & thigh?
"Ask you few questions to make sure you are safe to use shockwave diathermy"
1) Do you have any Electrical device impant?
2) Do you have any Suspected maglignancy? Tuberculosis?
3) Are you pregnant?
4) Any heart disease (for chest application only)
5) Any impaired sensation?
Press little toe nail, see if capillary refill (return to Check contraindication:
red) < 2s
- Impaired circulation
I will press on your toe nail, to check your circulation
1- STERILIZE the PIN
"Check your skin senstaion"
2- Open pin WIDER (avoid both ends
** STERILIZE the PIN
touch patient→confusing)手指唔好誤 Check contraindication:
1) During this time, use pin to test
Sharp
觸病人
- mechanical sensation
sensation (試落病人手), this is sharp,
&
3- Test all over places going to
blunt
this is blunt, can you feel the
immerse, 用blunt開始先(大body
(neurological
3 Tests
test
difference?
problems)
part, more pinning)
2) Close your eyes
4- Not answer correctly (injury can
3) Tell me if what you feel
impair sense), test 另㇐邊
Set baseline: VAS, ROM
Remarks/
Materials
For comparison after
treatment
Alcohol wipe
Safety pin
**
STERILIZE
the PIN
*Patient
supine, so
not need
close eyes
1) For pain, from 0-10, 10 is most pain, how pain is it
now? (至少3-4分pain,否則Exs後先TENS)
2) In what move you feel pain? Pelvic tilt?
3) TENS help you reduce pain
1- 病人prone,肚墊pillow, towel drape
2- TENS在抽屜取出電線,移往合適位置插電,取綠
藍線,按顏色插左下方
3-取出合適大小(不用最大,for NMES only)
rubber pads,如用2 channels,取4個
4. 按左上後方turn on, TENS → pulsed biphasic→
A/Symmetrical→ Customise
5. Setting:
Pulse duration: 30-75usec (progress改這)
4
Burst freq: 0
Treatm Freq: 80Hz
ent
Modulated Freq: 120 Hz
Head size (左中): 2" round
Duration: 20min
Amplitude modulation: 40%
1) Are you comfortable in this position?
2) Now i will set the parameter, and make sure the
machine is working
3) Good, now, I will turn it down, applying gel, apply to
your pain area, could you point out your pain area
again?
4) I am going to start TENS, your should feel mild
tingling, if yes, pls tell me (我㇐路慢加到
12w/cm2)
5)OK, shall I add more? is it comfortable
tingling?
6) OK we will start count 20 mins, pls dont sleep
or touch the cable.
5
End
6. 用2指夾住pad (2pad), 將Intensity調至12w/cm2左右, feel the tingling
7. 確認後調回Zero,gel on pad, 用手/pad鋪平, 貼病人pain area
8. 用tape四面封實(全緊貼皮膚),pad隔1指節防short circuit
9. 4個貼4邊,如referral pain, 貼nerve root + distal pain
10. 由0慢慢調,至病人有tingling,慢教至comfortable tingling, 記
下??mA, count 20mins
7) 每隔㇐會問: how's feeling? Is it
comfortably tingling? See if muscle
twitching
10- 按左上返回,心記下parameter
11. Turn off TENS
12. 用紙抹gel, inspect skin confirm alright
1) Please help remove the gel
2)0-10, 0 is no pain, 10 is most pain,
how pain now?
1.Ask outcome measure
Prepare to
Exs
6
Conv. TENS to bilateral PSIS; Pronel ying with pillow under tummy; medium electrode (1 channel); 60usec PD; 80-120Hz
Document (to
(如冇modulated freq=80Hz), 40% Amplitude modulation, 45-40mA; 20min; Contraindicaitons checked, skin sensation
reproduce
intact, warning given; Post Tx: No adverse effect, Tx outcome: no decrease in pain
exact Rx)
Chronic Lower Back Pain
Acupuncture TENS (sunsequent Rx)
Action
Step #
Get following materials:
1
Prepar 1. TENS machine
2. Wooden plinth, Towel (drape)
e
Purpose
Communication
3. Pillow (墊knee)
4. Pillow (place elbow)
4. Safety pin & Alcohol pad
5. Gel & Adhesive tape
6. Paper towel (for 抹走gel)
Ask Qs, patient sit, knee slight flex on chair,
expose knee
- State purpose of
treatment
- Get consent
Inspect treatment area
Observe 1)Open wound, 2)Bleed, 4)Infected
skin dz
Check contraindication:
- Open wound
- Haemorrhage
2
Ask & Inspect:
oberse DVT: Palpate+swell, pain warmth, red
rve Thrombophletbitis: Hot & red
Ask
Check contraindication:
- Electrical implants
- Suspected/ known maglignancy
- Tuberculosis
- Pregnancy
Consent & Check
contraindication:
- DVT
- Thrombophletbitis
1) Use TENS, to treat your chronic knee pain
2) you OK with that?
3) Pls roll up your trousers a bit, I will check if your skin
is intact & suitable for TENS.
1) I will check if you have Deep vein thrombosis, could I
have a touch on your leg & thigh?
"Ask you few questions to make sure you are safe to use shockwave diathermy"
1) Do you have any Electrical device impant?
2) Do you have any Suspected maglignancy? Tuberculosis?
3) Are you pregnant?
4) Any heart disease (for chest application only)
5) Any impaired sensation?
Press little toe nail, see if capillary refill (return to Check contraindication:
red) < 2s
- Impaired circulation
I will press on your toe nail, to check your circulation
1- STERILIZE the PIN
"Check your skin senstaion"
2- Open pin WIDER (avoid both ends
** STERILIZE the PIN
touch patient→confusing)手指唔好誤 Check contraindication:
1) During this time, use pin to test
Sharp
觸病人
- mechanical sensation
sensation (試落病人手), this is sharp,
&
3- Test all over places going to
this is blunt, can you feel the
3 Tests blunt
immerse, 用blunt開始先(大body
(neurological
test
difference?
problems)
part, more pinning)
2) Close your eyes
4- Not answer correctly (injury can
3) Tell me if what you feel
impair sense), test 另㇐邊
Set baseline: VAS, ROM
1- 病人prone,肚墊pillow, towel drape
2- TENS在抽屜取出電線,移往合適位置插電,取綠
藍線,按顏色插左下方
3-取出合適大小(不用最大,for NMES
only)rubber pads,如用2 channels,取4個
4. 按左上後方turn on, TENS → pulsed biphasic→
A/Symmetrical→ Customise
5. Setting:
Pulse duration: 150-250usec (progress改這)
4
Burst freq: 0
Treatm
Freq: 10Hz
ent
Modulated Freq: 0/ 10 Hz
Head size (左中): 2" round
Duration: 20min
Amplitude modulation: /
Remarks/
Materials
For comparison after
treatment
Alcohol wipe
Safety pin
**
STERILIZE
the PIN
*Patient
supine, so
not need
close eyes
1) For pain, from 0-10, 10 is most pain, how pain is it
now? (至少3-4分pain,否則Exs後先TENS)
2) In what move you feel pain? Pelvic tilt?
3) TENS help you reduce pain
1) Are you comfortable in this position?
2) Now i will set the parameter, and make sure the
machine is working
3) Good, now, I will turn it down, applying gel, apply to
your pain area, could you point out your pain area
again?
4) I am going to start TENS, your should feel mild
tingling, if yes, pls tell me (我㇐路慢加到
12w/cm2)
5)OK, shall I add more? is it comfortable
tingling?
6) OK we will start count 20 mins, pls dont sleep
or touch the cable.
5
End
6. 用2指夾住pad (2pad), 將Intensity調至12w/cm2左右, feel the tingling
7. 確認後調回Zero,gel on pad, 用手/pad鋪平, 貼病人pain area
8. 用tape四面封實(全緊貼皮膚),pad隔1指節防short circuit
9. 4個貼4邊,如referral pain, 貼nerve root + distal pain
10. 由0慢慢調,至病人有tingling,慢教至comfortable tingling, 記
下??mA, count 20mins
7) 每隔㇐會問: how's feeling? Is it
comfortably tingling? See if muscle
twitching
10- 按左上返回, 心記下parameter!!!!
11. Turn off TENS
12. 用紙抹gel, inspect skin confirm alright
1) Please help remove the gel
2)0-10, 0 is no pain, 10 is most pain,
how pain now?
1.Ask outcome measure
Prepare to
Exs
6
AL. TENS to Lt knee; Sitting with Lt leg elevated, pillow under knee; medium electrodes for 2 channels; 150usec PD; 10Hz
Document (to
(如冇modulated freq=10Hz), 0 Amplitude modulation, ? mA; 20min; Contraindicaitons checked, skin sensation intact,
reproduce
warning given; Post Tx: No adverse effect, Tx outcome: no decrease in pain
exact Rx)