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Pain ManagementWithout the effect of DRUGS

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of DRUGS

NexWave

Presentation Overview

Basics of Electrotherapy

Different Types of Modalities

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Theories of Pain Control

Electrotherapy – Indications for use

Zynex NexWave Product Training

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Electrical impulses are sent through electrodes placed on the skin

Electrodes are placed over nerve centers near or over the area of pain

The impulses block pain by stimulating the nerve fibers and/or activating the release of endorphins

Types of Electrotherapy Modalities

Transcutaneous Electrical Nerve Stimulation (TENS)Typically delivered between 1 Hz and 250 HzIndicated for chronic and acute pain relief

Interferential Current (IFC)

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Interferential Current (IFC)Typically delivered between 4,000 Hz and 5,000 HzIndicated for chronic and acute pain relief, edema reduction, increase circulation

Neuromuscular Electrical Nerve Stimulation (NMES)

Typically delivered between 25 Hz and 80 HzIndicated for muscle disuse atrophy, muscle re-education, muscle spasm reduction, increase ROM

TENS Current

TENS current is typically delivered between 1 Hz and 250

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delivered between 1 Hz and 250 Hz.

With TENS and NMES Stimulation, sensation is felt directly under the electrodes

Interferential Current

IFC uses a fixed carrier frequency of 4,000 Hz per second and also a second adjustable frequency of 4,001-4,250 Hz per second.

4000 Hz 4010 Hz

4,010 Hz minus 4000 Hz = 10 Hz

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When the fixed and adjustable frequencies combine (heterodyne), they produce the desired signal frequency (Interference frequency or beat frequency).

IFC is concentrated at the point of intersection between the electrodes. This concentration occurs deep in the tissues as well as at the surface of the skin

4000 Hz 4010 Hz

4,000 Hz 4,010 Hz

10 Hz

Neuromuscular Electrical Stimulation (NMES)

NMES is usually delivered between 25Hz and 80Hz

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Stimulation is delivered at a much higher intensity (mA) than IFC or TENS

Electrodes are placed over muscle motor points to facilitate a muscle contraction instead of at a sensor or muscle twitch like IFC or TENS

TENS Versus Interferential Current (IFC)

TENS Versus IFC

IFC is believed to penetrate to deeper tissues than TENS because

the current is concentrated at the point of intersection between the

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the current is concentrated at the point of intersection between the

electrodes.

This concentration occurs deep in the tissues as well as at the

surface of the skin, reaching to greater depths and over a larger volume of tissue than TENS

Capacitive skin resistance decreases as pulse frequency increases.

For example, at a frequency of 4,000 Hz capacitive skin resistance is eighty times lower than with a frequency of 50 Hz (in TENS range)

How Electrotherapy

Controls Pain

Gate Control – Mild continuous high

There are two theories of pain control:

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Gate Control – Mild continuous high

frequency electrical stimulation (>20PPS) blocks the pain signal traveling to the brain

Endorphin Release – Strong but

comfortable low frequency electrical stimulation at a muscle twitch (<=10PPS) causes the body to release its own pain relieving substances called endorphins

The Gate Control Theory

• Pain stimuli travels along the small diameter, slow conducting nerve fibers to the spinal cord where they are transmitted to the brain (A-delta, C fibers)

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the brain (A-delta, C fibers)

• The pain stimuli carried by the small diameter fibers can be inhibited by stimulating the large diameter, fast conducting, sensory nerve fibers (A-beta fibers).

• The application of TENS to the A-beta fibers “closes a gate” in the spinal column which prevents the pain stimuli from reaching the brain

On-set of pain relief is immediate, but pain returns shortly after treatment

The Endorphin Release Theory

The Endorphin Release theory is based on the presence of natural

opiates in the body.

These opiates, which act as the body’s natural pain suppressor, are

produced in the pituitary gland as beta endorphins and in the spinal

cord as enkephalins.

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cord as enkephalins.

Stimulation of the sensory nerves promotes the release of these

opiates.

These endorphins then bind to specific receptor sites in the central

and peripheral nervous system where they block the perception of

pain.

Electrical stimulation applied at or below 10 Hz at a muscle

twitch has shown to produce endorphins. On-set of pain relief

is slower (20 minutes), but pain relief can last for hours after

treatment

Product Training Overview

NexWave

-Interferential Mode

-NMES Mode

-Marketing Materials

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-Marketing Materials

-Clinical documentation

Specific Treatments

NexWave – Product training

Features & Benefits

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Indications for Use

Product Operation & Programming

NexWave – Patient Locations

Rehabilitation Clinics

Physiotherapists & Doctors

Pain Management

Post Surgery or Injury

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Post Surgery or Injury

Sports Medicine

Sports Clinics & Sports Teams

Work Job Site Doctors

Worker pain relief while on the job

NexWave – Indications for Use

Transcutaneous Electrical Nerve Stimulation (TENS)Management and symptomatic relief of chronic intractable pain, post-traumatic and post-surgical pain

Interferential Current (IFC)Management and symptomatic relief of chronic intractable

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Management and symptomatic relief of chronic intractable pain, post-traumatic and post-surgical pain

Neuromuscular Electrical Stimulation (NMES)Relaxation of muscle spasms

Prevention and retardation of disuse atrophy

Increase of local blood circulation

Muscle rehabilitation and re-education

Maintaining and increasing range of motion

NexWave – Clinical Benefits

Product Features & Benefits

3 Modalities in 1 Device

TENS, IFC, and NMES

Microprocessor controlled

Integrity of waveform is maintained under extreme conditions

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Allows for a small design for portability

Digital Display

Displays Modality

mA output treatment

Timer information

Program for desired waveform

NexWave – Safety & Compliance

Built in Compliance MeterRecords number of treatments and treatment time

Documents patient usage to help with coverage and substantiate compliance

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and substantiate compliance

Unlock/Lock ButtonAfter 20sec the units locks to prevent accidental changes in stimulation & settings

Dual Power: 9V and A/C AdapterWorks on 220/110 and saves battery life

Battery can be installed either direction

NexWave Programing

On/Off and Modality Selection

1. Press on/off Button Once

to Turn Device On

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2. Press labeled Button to

Enter Modality: IFC TENS

NMES

NexWave Programming

Selecting the Mode

5. To select the desired mode,

continue to pressing Mode button

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6. Must unlock before any changes

can be made

NexWave Programing

Intensity & Treatment Time Setting

7. + (up) to Increase Intensity

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8. Press the Timer button and select a

Treatment Time (10 – 90 min.) or

“Continuous” for No Timer

NexWave Programing

Compliance Meter

9. Screen Demonstrates All

information

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10. Device is Now Programmed and

Ready to Start Treatment

NexWave Operation

Electrode Set-up

1. Connect Leadwires to Electrodes

While Electrodes are Still on Plastic

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Tip: It is easier to connect leadwires to the

electrodes before placing the electrodes over

the treatment site

NexWave Operation

Electrode Placement

2. Place the Electrodes Over the Treatment Site.

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Important: When Using IFC, Electrodes Must be Crisscrossed.

IFC

Placement

TENS

Placement

TENS or NMES

Placement

NexWave - Operation

Connect The Leads

3. Connect Lead wires to Device

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Important: Make Sure Lead wires are

Inserted Completely

NexWave - Operation

Start Treatment

4. Press Up Button to Set Desired

Stimulation Level

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Stimulation Level

Important: Stimulation Should be Set to

a Strong, but Comfortable Sensation

NexWave - IFC Modes

Low High Mode:Channel 2 Freq. Sweeps between 4001 Hz and 4128 Hz every 15 sec. Channel 1 remains set at 4000 Hz

Lumbar – Lower Back Pain

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IFC

Placement

Current should cross where most of the stimulation is delivered in the area of the pain. Placement must allowfor surgical site, density of tissue and nerve position.

NexWave - IFC Modes

Low:Channel 2 Freq. Sweeps between 4001 Hz and 4010 Hz every 15 sec. Channel 1 remains set at 4000 Hz

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IFC

Placement

Current should cross where most of the stimulation is delivered in the area of the pain. Placement must allowfor surgical site, density of tissue and nerve position.

NexWave - IFC Modes

Combo:

Combo consists of three 2 minute cycles which repeat over the duration of the treatment:

1st cycle – Low Mode

2nd cycle – High mode where channel 2 sweeps between4064 Hz 4000 Hz. Both channels are cycled on and off

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4064 Hz 4000 Hz. Both channels are cycled on and off At 6 sec. intervals.

3rd Cycle- Muscle Mode: Frequency of channel 2 is fixed at 4064 Hz, and channel 1 is fixed at 4000. Both channels areCycled on and off at 6 sec. intervals.

IFC

Placement

NexWave - TENS Programs

SweepTENS frequency decreases from 125 Hz to 11Hz over 4 seconds. During this period the Pulse Width adjusts 120 to µs to 300 µs. Then frequency is increased from 1 to 10 Hz over 2 sec, the pulse width remains at 300 µs. The increased from 11 Hz to 125

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remains at 300 µs. The increased from 11 Hz to 125 Hz over a 4 sec. span. During this same time the Pulse Width is decreased from 300 µs to 120 µs.

Benefits:Sweep allows for gate block (quick onset of relief) and Endorphins Release (long Carry-over) in one program

NexWave - TENS Programs

LMD – Low ModulatedThe Frequency sweeps from 66.7 to 100 Hz 100 µs and back again over 12 sec. Pulse

Benefits:

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Benefits:

Quick on set of relief

No modulation may result in accommodation

NexWave – TENS Programs

Modulate

The frequency shifts between 66 and 100 Hz at an interval of 6 seconds. The Pulse Width will also shift during the 6 seconds interval. The default Pulse Width is 225µsec. and when the frequency is at it’s minimum, the Pulse Width is at it’s maximum and visa

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minimum, the Pulse Width is at it’s maximum and visa versa.

Benefits:

Quick onset of relief

Modulation helps prevent accommodation

Comfortable massaging sensation

NexWave – NMES Programs

Preset 10 sec. ON -10 sec. OFF

Preset 20 sec. ON -10 sec. OFF

Preset 30 sec. ON -10 sec. OFF

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Preset 30 sec. ON -10 sec. OFF

Benefits

Both channels are On and Off at the same time

Muscles Strengthening

Increase ROM

Muscle re-education

Low Back Neurostimulation System

Conductive Garment Description

Allows Patient to Place Electrodes on Lower Back Without Assistance

Electrodes Stay on Garment When Removed from Body for Easy Reapplication

Product Positioning

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Product Positioning

Pain Management

Physical Therapy

Compatible Devices:

TruWave TENS

NexWave

IF8100 IFC

Distribution Materials

Communication Materials

International Web page

Device Specs

“Getting Started” Pages

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“Getting Started” Pages

Electrotherapy Studies

Power Point Presentations

Physician & Physiotherapist

Supporting Research on Electrotherapy for

Pain Management

Defines TENS mechanism of pain control

Establishes benefits of electrotherapy as an adjunctive

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electrotherapy as an adjunctive pain control option

Gives Support to electrotherapy by referencing research with copy of abstracts on back

Target market is Interventional Pain Management Specialist

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Thank You

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