I am a pain nurse from the Netherlands and i saw your video’s from MedFaxxinc. And the only thing I can say is that they are very helpful for me. This because I just started with TENS-treatment after I followed a course.
I show the patient the movies on the internet if they want to see or hear more about TENS, and the only thing I can say is that the patients are very glad to see your video’s on your webpage.

But I have also another question: do you have a book were you put all the treatments in and also the positions of the electrodes? If so, can you give me the title and the place where I can buy it?

With regards,

T. S.
The Netherlands

Hi T,

Thanks for the very nice comments.   So kind of you.

The answer to your question is “No don’t have a book”, but let me expand on that.

There really is no such thing as a “correct” electrode placement guide.  There is such a thing as an incorrect electrode placement guide such as:

1.  Do not put electrodes on bony prominences ( logic- bone is not conductor of electricity, but resistor, so little gained if bone close to surface and little moist tissue between electrode and bone)

2.  Do not use small electrodes for large pain areas ( current concentration hurts before relief gained)

3.  Do not put tens machines electrodes on head ( refer to 1 above)

Here is what is logical though and this varies from Rx to Rx and patient to patient and time of day to time  of day which is why can’t generalize:

1.  For tens basically want flow of current through area pain being felt ( logic:  pain moves and after treatment then another area may now hurt enough to warrant electrode change so change to target area ( use rifle scope analogy of zeroing in on pain with criss cross ( that’s your electrodes and the flow of current)

2.  What type machine using?  Tens, Hi volt, Russian, Interferential etc. as the current density of those machines changes electrode placement.  ( For Russian/Katz at 2,500 pps you need electrodes placed longitudally (sp) to go with muscle endplates, not transversally)

3.  Unlike acupuncture where one interferes with electrical flow using small pins in specific areas with an electode you are proactive and dispersing electricity  over a general area, not a specific area so need for specificity not as great.   Also acupuncture points, even though specific are specific to each person’s body vis a bis “cun” which is a standard measurement but standard only to the patient’s body, not anyone else.

Giving you some of a “non answer” but there are lots of charts, books etc. but they actually prevent you or your patients from learning what is really going on rather than asking for a “cook book” of pictures on electrode placement.

Hope this makes some sense and if not please let me know.

Thanks.

Bobj

Hi Kin,

Carryover is not related to a numbing sensation per se, or at least to my knowledge it is not. You can create what is called “paresthesia” with high frequency estim. Much of how our body responds to electrical stimulus is not known. When you put positive and negative charges in the body you create a cascade effect of numerous electrical changes which are defined as literally changing the chemical structure of cells, nerves, inter and intra cellular spaces. With interferential one can cause more changes, very rapidly in the body. With pain the changes tend to be beneficial and one has immediate pain relief results. That relief is very much predicated upon the chemical changes one did during the period of stimulation. That relief remains as long as there is similar chemistry in the area or the change has affected how the brain reacted to the changes. The brain can change chemistry within our body and does constantly. Interferential on an “as needed” basis appears to be teaching the brain to either send in different chemical responses or not allow certain previous chemical reactions to occur. It’s not always what is done, but often what is not done.

Tens basically does not “heal” anything although it can be used to heal bones that are not growing together or soft tissue injuries such as bed sores, sports medicine injuries etc. IF ( interferential) has the ability, if used as a preventive, to actually cause permanent changes and falls in the category of a “healing current”.

1. It is untrue that muscle stim can not be applied to the neck. “muscle stim” is not what either tens or interferential is really designed to do. We can pump a muscle, cause a contraction, but most muscle stim units are used for rehab. following injury and have a whole set of parameters not found in most estim units. The term is very much abused and misleading, but that is the norm. Don’t accept the term unless someone can expressly tell you the difference. We have a video about muscle stim on our web site you should watch. Type in the search the term and follow the results you get.

2. Pads applied in different areas, depending on condition at time of using the unit.

3. Your aunt probably needs to change her diet and if unwilling to do so then forget about it. E stim is used to increase blood flow, pump muscles to increase blood flow and is generally very good at doing it as long as there are no occlusions to the blood going into an area such as plaque, constricted vessels etc.

We need a prescription to dispense in the U.S. the Infrex or actually a tens unit. Infrex has a tens mode in it though.

bobj

From: kin
Sent: Tuesday, January 17, 2012 1:01 AM
To: Bob Johnson
Subject: Re: TENS or INFREX

Hi Bob,

I really appreciate your responses.

I had read about carryover. Guess I didn’t understand if carryover results due to a “numbed” nerve (or whatever is affecting the nerve so the pain is reduced?), or because of increased blood flow to the muscle(s) – which is more of a healing condition. That was why I asked which device works best to “heal” the condition — as opposed to “numbing” it. It sounds like you are saying that both would work but that the in Infrex would have more healing effect because of the greater pulse rate per second.

Most important questions yet:
1. I was told that muscle stim can’t be applied to the upper neck muscles, is that true?
2. Where would pads be applied if I get a Tens or an Infrex for my condition?

3. I have a friend who was told she may have to get her lower leg amputated (due to poor circulation). Would an Infrex device save her left leg- even if she doesn’t change her diet?

If your answer is yes, then do I need to ask her to find a doctor in  CA. that can prescribe her one (so insurance will pay)? If so, do you know of any Physicians in Ca. I could send her to?

Thanks again,
Kin

— On Mon, 1/16/12, Bob Johnsonwrote:

From: Bob Johnson
Subject: 2nd comment on RE: TENS or INFREX
To: “kin
Date: Monday, January 16, 2012, 7:54 AM
Hi Kin,

At office now so can give you better answer than from my Blackberry.

To clarify previous answer. Tens may help you but a tens unit goes off and on ( frequency/rate/Pulses Per second) at most 150 times per second versus interferential doing same thing 8,001 – 8,150 times per second. The higher frequency allows more electricity to penetrate to muscles, nerves etc. and actually simulate “deeper”. Difference for patient is longer lasting relief when not using the unit. Type in “carryover” on our web site to get more information on this.

Also the comment “my brain doesn’t work as well” regarding the muscle tension, is not surprising. Reason is with “tightness” in muscles in neck/shoulders there is generally a degree of blood vessel constriction which slows the blood flow to the brain, as well as restricting blood from brain which means the blood, after delivering nutrients, O2 etc. is remaining for longer time period in unusable condition. This physiological process often leads to less mental alertness.

By relaxing the muscles the blood flow is improved as well as the alertness.

Hope this helps explain.

bobj

From: kin
Sent: Saturday, January 14, 2012 6:23 PM
To: Bob Johnson
Subject: TENS or INFREX

Dear MedFaxx,

I have chronic pain in my upper neck muscles (around the C1 and C2 area). I notice when the upper neck muscles are really tight, my brain doesn’t work as well. Which device would be best suited for this condition (TENS or INFREX)? My hope is not so much to “dull” the pain, but to resolve the muscle issue and the restricted blood flow that accompanies it (good posture and chiro adjustments over the last 10 years haven’t been enough to help condition).

Thank you,
Kim

She mentions drinking plenty of water, which is a no brainer.

Beyond that she introduces the topic of massage, which many people find helpful.

Getting good nutrition can also helpful. Exercise helps the muscles and blood flow.

Holistic Stress Management & Relaxation, Yoga and Massage Therapy

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Feel your best by checking out some of the cool ideas in this video.

Many people don’t thank that relaxation is not a valuable use of time. However, reserving 15-20 minutes per day to meditate, do yoga or practice some other form of stress control can be very beneficial.

You can’t get rid of stress, but you can learn how to deal with it more effectively.

Start by wearing comfortable clothing.

Use an exercise or yoga mat on the floor for cushion.

Check out the video for complete instructions.

How To Stretch For Back Pain: Lower Body Russian Twist

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Often back pain occurs from doing activities you are not used to, like shoveling snow for example.

Lower Body Russian Twist can also be done with an exercise ball.

Check out this interview with Todd Durkin M.A. C.S.C.S. and Sean Croxton.

The answer will surprise you.

Fascia is all throughout the body and can affect pain in many areas at once.

Pain, Posture, and Fascia

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Fascia can not only hold on to physical pain, but mental, emotional pain as well. So people that have had traumatic events happen to them, may have pain, stored in the fascia.

Check out the video for more info.

Bob,

My 80 year old mother, a life long right leg amputee, had knee replacement surgery about 6 weeks ago. While she is mobile and is celebrating her increasing accomplishments, she is suffering from reoccurring leg cramps in her calf muscle (which she refers to as a “charley horse”). She describes the leg cramps as being very painful (note: she has a very high tolerance for pain, so I believe her). Her doctors have said that they have never heard of post operative leg cramps, and so, have not offered any possible solutions.

As a runner, I start eating bananas when I get cramps, but she is allergic to them… so this is not a possibility.

Questions: Have you ever heard of this situation following knee replacement surgery? Do you have any suggestions?

Thanks (in advance),

John P.

Answer to consider:

Hi John,

Historically when a person was having surgery they would put a tens unit on them immediately post operatively and at first the assumptions were the stimulation would:

1.        Lessen need for pain meds

2.       In abdominal area would reduce “gas”, therefore less pain.

Over time it became apparent:

1.        For most surgeries not worth the time, hassle, cost to use tens when drugs did the job and patient only used for couple days in most cases

2.       The “less gas” was probably the result of restoring muscle tone by accelerating tissue repair with the electricity.  The muscle had been literally “cut” and the stimulation we know accelerates tissue repair.

In your Mom’s case what may be happening is she is “favoring” her leg, due to the pain from the knee, and has put additional stress on the calf muscle not only due to pain but has probably shifted her posture which adds additional stress.   Now the issue is not to treat the cramps but to prevent the cramps.

One of reasons tens has helped is it literally reduces the “tenseness, tightness” of the muscles involved and there is less “tightening” of the muscles which often results in “spasms”.  One would intervene when it is felt the calf muscles are getting tense and apply the estim then.  The estim will literally make the muscle relax and prevent the buildup of lactic acid which is what happens when muscles are in constant tightness.  The lactic acid from the fatigue builds up and the result is muscle spasticity or spasms/cramps.

Also before doing any tens have her use warm, MOIST heat to her calf couple times per day to prevent.  The moist heat attracts blood which in turn removes the lactic acid that is building up to cause the cramps.

Both of the above methods do not involve drugs and can be done externally so there is or should be no questions on her alertness, drug interactions, dosage etc.   Of course the two above will be even better if used conjunctively.    When your Mom can, be sure to make sure she is inverting her foot to stretch those calf muscles and increase the elasticity as long term that is also a solution.

Happy Thanksgiving.

bobj

IF and IFC stands for Interferential -

…..

I hadn’t even considered using IFC in a bucket of water.  Thanks for the suggestion.  I’ll have to try it.  Would it also follow that an ice pack over the region (like on my low back) would enhance the therapeutic effect if used during the IF session?   That would be very easy to implement on any location, though not quite as cold as a bucket of ice water.   I don’t do well with heat, even though I like the way it feels.  It worsens my fatigue, so I’ll skip that one, even though it sounds really nice.

Speaking  of using the unit with the battery pack, I have noticed that it has a significant power drop when on battery supply.  (I know you mentioned to me earlier that this was the case).  At what level could I expect it to perform at full power (and not simply assume that my batteries were going bad)?  For example on a 4 pole IFC setup with four 3” electrodes in the low back region, I’ve raised the intensity to 99 for 30 minutes at a time.   A few times, I wanted to move locations and plug in elsewhere.  When I went on battery power, I noticed a significant drop in the stimulation.   Or sometimes I just wanted to finish a couple of chores before sitting down to finish my IF treatment.  What is a reasonable expectation on battery?

What about other pain reliever creams, such as Aspercreme, that contain salicilates, but not menthol.   Can I somehow pair those with the IF to get improved relief?  (I have found that my skin burns like fire with menthol….more than it should.)

Thank you for the time you take to thoroughly educate and assist your clients.  I am amazed and impressed.  In fact, that is something that I have already shared with a number of my friends (who are PT’s and OT’s).  More than anything, I am grateful!

Have a wonderful evening,
SS

Answer:

On warm versus cold you do whatever provides you relief.  Try the ice pack(chilling) in conjunction with IF and just see what happens.  We have one patient who is in his 40’s with some form of degenerative disease but he has to work each day.  He gets relief from cold so at work he takes his shoes and socks off, and sits at his desk with his feet on cold tile.   He does his IF couple times a day with feet being cooled down.  He also does not benefit from heat, but does so from cold and that is how he self treats.

On batteries, especially rechargeable versus disposable, a disposable is about 30% stronger than a rechargeable so that is one difference.  You will have more available power with disposable.  In actuality the Infrex Plus was not designed to use IF mode on batteries.  The batteries were more for tens and in situations where just could not use AC adaptor, then as an emergency Rx.  We were thinking of airplanes, cars, public waiting areas, etc.   If the unit ever takes off then we do have a plan to adapt the adaptor for plug in in car lighter ( that assume lighters still  in cars by time we get there!!!).

ON “menthol”, most topical pain products have menthol in them to some degree.  Menthol being some form of mint oil, ie peppermint, spearmint, mentha ,,,,,, .  Example if you remember Flex All.  It is basically the same product but with different amounts of mint oil.  Regular is 8%, chiropractic is 12%, and professional is 16%.  You can use ultrasound with flexall if you put the flexall in the coupling gel and you use the regular at 8% or chiro, but at Professional of 16% the oil content is so high that almost always there will be a skin irritation problem.   If you have problems with mint topically then make sure menthol is not the first ingredient mentioned on the “ingredients”, the farther down the ingredients menthol is then the better for you.

On Aspercreme with IF I don’t know.  Just try it and see how works and let us know. Electricity being used for topical meds works if the med is water based, not petroleum based.  Electricity does not drive medicinal ions in oils but will do so in water based, ie. Iontophoresis.  You might get greater absorption and depth of penetration possibly but not sure.   Also if you do try this then for sure if do with ice/chill then the vasoconstriction that will occur in the chilled area will help retain the meds longer which should increase absorption in the localized area.

I’m using my Infrex unit all the time (and the TENS unit simultaneously on acupuncture/acupressure sites at the recommendation of my physical therapist). I LOVE IT! It is really being very helpful to me in pain management. That said, my electrodes are wearing out, and I need to obtain more. My 3” Round are completely gone, so I am not able to use that protocol until I obtain more, so I was wondering if I could get a couple of spare sets of the things I use most in addition to the replacement set so that I don’t run out like this. I don’t know how that works with insurance/ Medicare, so please let me know on that front. If I can’t get several at a time, just let me know the frequency I can request to obtain what I need.

Also, as per my physical therapist, I am wearing the TENS 22 hours per day and then using both units sometimes simultaneously, combining approaches. He was very impressed with the unit, and I think you’ll likely have some additional clients from his referrals.
I am finding that the smaller electrodes are lasting 3-4 days because of the continual wear. And the larger electrodes are lasting about a week at most. That said, the Pre-Tens and the Clean-Cote are helping tremendously. They help both the condition of my skin and the life of the electrodes.

A few quick questions:

1) How much moisture are the multi-day electrodes supposed to tolerate? (showers, washing hands, etc.) I was afraid that a shower would ruin them.
2) I got one electrode in my last box that had a snap connection instead of a pin connection. Is that possible to use with my Infrex unit? I didn’t know how to hook it up.
3) Can I mix and match electrodes according to the site? For example, one of my protocols requires between the forefinger and thumb on the extensor surface (which is narrow and is in constant movement), two are on the forearm, and one is near the elbow joint (again a lot of movement and easy to bump). So, could I try a .75”X1.375” rectangle or even a 1.5”X2” rectangle on the thumb area while using the 2” electrodes on the rest?
4) What is the easiest way to determine which leads are used in the 2 Pole application? I can figure it out by trial and error a couple of times, and I can mark them with a silver sharpie or something, but I was wondering if there was a simple way of telling visually already that I just missed.
5) I love the Clean-Cote, but is there a way to remove that residue easily besides scrubbing vigorously in the shower?

If at all possible, I would like to request the following: (assuming that each package has four electrodes). Where possible, I prefer latex-free products, but if must use a latex product to obtain the smallest sizes I will do so. Also, I have sensitive skin, so where there is a reasonable option, please provide a skin-friendly electrode. For example, the

• 3 packages 3” Round Superior Starburst Model 628SB (latex free, with aloe)
• 3 packages Re-Flex Tantone 2”X2” square (I am hoping that these might stay adhered better to sites that are continually moving, such as my hands and wrist areas. If you think something else is better, please advise. If you have something that is slightly smaller like a 1.75”X1.75”, that would be even better.)
• 1 package Multi-Day 2.25” square gel pin connection (unless you can tell me how to use the snap connection)
• 1 lumbosacral 6”X4” butterfly – (Do I use the 2 pole or 4 pole protocol with that? I have been using the infrex on this region very often, so I thought this would be easier to use since I often have to ask for help in applying the electrodes there.)
• 1 package1 Re-Ply 2” round (tan)
• 1 package .75X1.375” rectangle
• 1 package 1.5”X2” rectangle

If you have questions or think I should consider something different, please don’t hesitate to call me at xxx-xxx-xxxxor or email me at __________

Thank you so much,
S S
DOB 9-9-1971

Answer To SS:

Hi SS,

   Thanks for the very nice email back.   I’m glad things are working well and once we get the insurance going think all will be fine.  I want to try to address several of your questions however many better answers are on our web site. 

   First off is if your physical therapist would like us to consign a couple of Infrex units to the dept. for patient trials we will be glad to do so.  Also if he/she does that please let me know as I want to send you some extra supplies as a “thank you” for helping us.   I’m also assuming you will not mind if I post your email to our blog, but I will not reveal your name or other identifying info.   Your letter has some very good, well thought out questions that many people need to know.   Also if your P.T. has any questions  then please have them call me.

  Now to some of your questions:

“ If I can’t get several at a time, just let me know the frequency I can request to obtain what I need. “ ( electrodes) – This to Linda but when possible, after insurance determined, then anytime we can send one shipment with more electrodes etc. then do so.  We can ship once with a year’s supply, but bill them out as allowable each month.  That way Sherri gets more electrodes because we only have one shipping charge rather than 12- 24 with minimal cost of $10 each when you put in handling.

“I am finding that the smaller electrodes are lasting 3-4 days because of the continual wear. “  Do not use any reusuable electrodes for “extended time periods” if you can prevent.  To increase the life of the electrodes it’s best to rotate them and the life is extended.  Example is if you are wearing electrodes 16 hours a day, it’s better to wear one set for 8 hours, then put on other electrodes for 8 hours.  That alone should minimally double the life span of the electrodes. As is seen on one of our electrode videos, store the unused pair in the refrigerator, wipe surface gently with toothbrush, and may occasionally need to dampen with water before putting back on.

1)    How much moisture are the multi-day electrodes supposed to tolerate? (showers, washing hands, etc.)  I was afraid that a shower would ruin them. ( Shower will not ruin as that is a main reason for having that type electrode)

This multiday electrode is generally not a very good electrode and especially so when doing interferential therapy on the Infrex.  Reason  for IF treatment is the surface area for stimulation is very small and therefore the stimulus is concentrated in very small area – not good with interferential.

Other issue with this electrode is not skin friendly at all, occluding skin for long periods so breakdown more likely.  You doing right thing with the skin prep and clean cote so keep that up. 

Gravity is constantly pulling gel etc. down on that electrode as you wear it.  You stand up or sit up and gravity starts trying to get the gel out which means might have “leakage” on bottom edge breaking through the adhesive that is holding electrode on and dry out.  If dries out you will start feeling a “pin stick” because the current is concentrated in only areas where conductive gel/medium is.  This electrode is fine if you are happy and can be very good for small areas like hocu, space between thumb and forefinger in web space.

2)    I got one electrode in my last box that had a snap connection instead of a pin connection.  Is that possible to use with my Infrex unit?  I didn’t know how to hook it up. No was a mistake – Sorry.

3)    Can I mix and match electrodes according to the site?  For example, one of my protocols requires between the forefinger and thumb on the extensor surface (which is narrow and is in constant movement), two are on the forearm, and one is near the elbow joint (again a lot of movement and easy to bump).  So, could I try a .75”X1.375” rectangle or even a 1.5”X2” rectangle on the thumb area while using the 2” electrodes on the rest? 

Yes and that is really a good strategy.  Your therapist seems very knowledgeable and is unique in helping you with more knowledge than most have.  This is very good to cut and shape electrodes for the specic areas.  As an example if you are having pain in the “lower back” in large area then generally use larger electrodes, but if on small joint like wrist then use smaller electrodes.  Mixing and matching is perfect way to go.

Another useful tip is you can always use an “ace” wrap/bandage and secure electrodes like on your forearm by simply binding with the Ace and securing that way if helps.

4)    What is the easiest way to determine which leads are used in the 2 Pole application?  I can figure it out by trial and error a couple of times, and I can mark them with a silver sharpie or something, but I was wondering if there was a simple  way of telling visually already that I just missed. 

Might want to take magic marker as you’ve done  and mark the two cables if that makes it easier.  Now important point is when you have electrodes on and working, yet one electrode area felt more than the other, don’t’ change the electrode location but simply pull out cables at electrode and switch.  One electrode always has more of the positive/negative charge than the other and one always dominants.  If electrode you are feeling most is not one where most pain is, then switch cable and now the electrode over most painful area should be felt more and should help more.  Not sure what going on but most of our cables for Infrex are color coded to start with.  I do know that we do have some that were not color coded but you’ve overcome that with your markings which was smart.

5)    I love the Clean-Cote, but is there  a way to remove that residue easily besides scrubbing vigorously in the shower?   Acetone ( finger nail polish remover ingredient)  which can get at drugstore or we have some removal pads you can wipe with.

I had a tens unit sitting in my desk drawer for months, I had it prescribed for my hip, but it was unsuccessful. Over the last 4-5 months, my knee has developed a terrible and constant pain. i decided to throw the tens on to see if it would help. I’m still going to see a doctor but, I just wanted to thank you for the late night lesson, and instant pain relief without worrying about messing with more narcotics. Thank you, very much.
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