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Electrode Placement Guidelines

The placement of TENS electrodes is not an exact science. Often different placements will relieve pain of like diagnosis. Perhaps the greatest difference between proper placement and less than desirable placement is not whether the patient gets pain relief but instead, how soon the patient gets relief.

It is impossible in this brief manual to describe every diagnosis. Many electrode sites are identical regardless of the underlying cause. A patient who has a cervical strain would use the same placement as a patient with cervical arthritis.

There are different approaches to electrode placement. In this section we will discuss two guidelines for electrode placement. First, the “Electrode Placement Guidelines”, Staodyn Form 4405 and its use will be discussed. Then a series of “Placement By Diagnosis” will be presented.

The combination of these references along with other available material should insure simple yet effective electrode placement.

Electrode Placement Guide Lines:

The chart below, is a proven and effective method of electrode placement. The guidelines for use are as follows:

1. The orange numbers are potential electrode placement sites. These are generally trigger points or acupoints. They are listed along the sides of the body forms by etiology or diagnosis, identifying them for location on the body.

2. The blue numbers designate a specific dermatome. A dermatome is the skin area of sensory nerve distribution. There is a nerve distribution area for each spinal level and is so designated by number. Example: Pain in the L-4 dermatome (skin area) follows the sensory nerves to the L-4 nerve roots (spinal level). There it enters the spinal cord and is transmitted to the brain. Dermatome electrode placement is generally on the nerve root along the side of the spine at the appropriate spinal level. Nerve roots are bilateral and do not cross midline.

3. The recommended usage of this chart includes the following steps:

1. Through communication, determine the involved area of pain.
2. Using the electrode placement guide, locate the red numbers that are possible placement sites. Palpate these sites for a sensitive or tender response. A sensitive response to palpation designates that point as a possible electrode site.
3. Attempt to locate at least three of these sensitive sites.
4. The electrodes are then applied to two, three, or four sensitive points and any remaining electrodes are placed on the appropriate nerve roots along the side of the spine. All patients are generally started with four electrodes to improve the probability of success.
   

4. A visceral pain section is also provided listing the approximate nerve root level for electrode placement. Deep organ pain can best be managed by placing the electrodes along the side of the spine on the involved nerve root.

Initial Placement Patterns

• For radiating pain: place the electrodes (not directly on) but near the spine, on either side.
• For specific joint or distal arm pain: Place the electrodes nearer the area of pain, according to the chart
• For deep pain of myotome or sclerotome origin: place the electrodes several spinal segments more proximal than the segmental innervations shown

Interferential Technique

Use the interferential placement of four electrodes to:

• Bombard localized are of paine (e.g., hip or knee)
• Achieve greater pain relief if use of two electrodes has proved unsatisfactory (see Low Back Pain on chart)

Interferential technique is shown on the charts by this symbol:

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Introduction to T.E.N.S. Do you really understand how TENS works? Download our "Introduction to T.E.N.S." brochure. It's a great resourse that provides detailed information about TENS, waveforms, electrode placement and more. It is essential for the patient just getting started.