Two Types of PENS

1. Low frequency/High intensity

2. High frequency/low intensity

Low Frequency/High Intensity PENS

1. Hertz?

2. Effect in Spinal Cord (NT and overall effect)?

3. Effect in Midbrain?

4. Effect in Pituitary/Hypothalamus?

5. Effect by Naloxone?

6. Onset and duration?

7. Effects--additive or isolated?

1. 2-15 Hz

2. Spinal cord release of enkephalin and dynorphin --> presynaptic inhibition of Cell 1

3. Midbrain release of Enk to stimulate Raphe to release 5-HT and NE --> postsynaptic inhibition

4. Huge beta-endorphin and ACTH release (anti-inflammatory)

5. Yes --> blocked by naloxone

6. Slow onset but long duration

7. Cumulative effects

High Frequency/Low Intensity PENS

1. Hertz?

2. Effect in Spinal Cord (NT and overall effect)?

3. Effect in Midbrain?

4. Effect in Pituitary/Hypothalamus?

5. Effect by Naloxone?

6. Onset and duration?

7. Effects--additive or isolated?

1. 30-200 Hz

2. GABA

3. GABA

4. NONE

5. NO --> no opioid receptor involvement!

6. Fast onset, short duration

7. Isolated, non-cumulative effects

Pain in arm

1. Needles on spine, head --> what do they do?

2. Needles on the arm  --> what do they do?

1. Activate midbrain +/- Hypothalamus

2. Maximize segmental circuits

Kelvin-Thomas Effect

1. Gradient established?

2. How does it work?

1. Temperature gradient

2. Warm at tip of needle, cold at handle; sucks e- out to remove heat and decrease erythema

Benedick's Effect

1. Gradient established?

2. How does it work?

1. Electical potential gradient

2. Suck e- out