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EN109-1498740-40 IFU
minutes will need to be delivered as a minimally effective dose. It takes some time for the opioid
levels to build up with this type of TENS/PENS and hence the onset of pain relief may be slower than
with the traditional mode. Once sufficient opioid has been released however, it will keep on working
after cessation of the stimulation. Many patients find that stimulation at this low frequency at intervals
throughout the day is an effective strategy. T
he ‘carry over’ effect may last for several hours, though
the duration of this carry over will vary between patients.
3)
Burst Mode TENS/PENS
As described in Fig. 4, the device is set to deliver traditional TENS/PENS, but the Burst mode is
switched in, therefore interrupting the stimulation outflow at rate of 2 - 3 bursts / second. The
stimulation intensity will need to be relatively high, though not as high as the brief intense TENS/PENS
–
more like the Lo TENS/PENS. It is proposed that the application of Burst mode TENS/PENS can
effectively stimulate both the
Pain Gate
and the
Opioid
mechanisms simultaneously.
4)
Modulated TENS/PENS
In modulation mode, the device delivers a less regular pattern of TENS/PENS stimulation in an
attempt to reduce or minimise the accommodation effects of regular, patterned stimulation.
Modulated patterns fluctuate between upper and lower limits over a fixed period of time.
The device can offer different methods of varying the stimulation pattern. The
pulse
frequency
, the
output intensity (amplitude)
and the
pulse duration
, or a combination of these methods can be
varied. The reseach evidence to date does not favour one variation method over another. This is
potentially most useful for patients who use TENS/PENS for hours a day, if for no other reason than
accommodation occurs at a slower rate and therefore less intensity adjustment may be required.
