cefar Direct TENS User manual

Transcutaneous Electrical Nerve Stimulator
for Pain Treatment
USER GUIDE
Direct TENS™

2
Direct TENS™
CONTENTS
Quick Start Guide ............................................................................................................................................................3
General Information........................................................................................................................................................5
Key to the Symbols ..........................................................................................................................................................6
1. Points to Note Before Use ..................................................................................................................................7
2. How Does the Direct TENS™ Device Function?....................................................................................... 11
2.1. TENS Therapy Principle .......................................................................................................................................12
2.2. Description of the Programs and the Corresponding Indications...................................................13
3. Preparation............................................................................................................................................................... 16
3.1. Inserting Batteries................................................................................................................................................. 16
3.2. Applying Electrodes, Connecting Leadwires............................................................................................. 16
3.3. Selection, Care and Placement of the Electrodes....................................................................................17
4. Treatment ..................................................................................................................................................................21
4.1. Starting Therapy .....................................................................................................................................................21
4.2. Ending Therapy ......................................................................................................................................................22
5. Special Direct TENS™ Functions.....................................................................................................................23
5.1. Therapy Timer.........................................................................................................................................................23
5.2. Factory Defaults Settings...................................................................................................................................23
6. What To Do, If........................................................................................................................................................ 24
7. Care, Storage, Battery Replacement, Disposal ........................................................................................25
8. Ordering Information, Specifications.......................................................................................................... 26
9. Electromagnetic Compatibility (EMC) Tables ..........................................................................................27

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Direct TENS™
1. Insert batteries
2. Attach belt clip and close battery compartment
3. Connect the electrodes to the leadwire
4. Apply the electrodes.
The electrode placement depends on the indication, see also chapter 2.2 / page 13
5. Connect the electrode leadwire to the device
+
+
-
-
QUICK START GUIDE

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Direct TENS™
6. Switch the therapy unit on
7. Select a program (only possible when intensity = 0)
The program depends on the indication to treat, see also chapter 2.2 / page 13
OR
8. Set intensity for selected channel
9. After approx. 10 seconds the keys are automatically locked to prevent the treatment parameters
from being changed inadvertently. To unlock the keys, press either key (channel 1 or 2).
10. To terminate the treatment simply turn o the device with the ON/OFF key. When the therapy timer
is activated, the stimulator switches automatically o at the end of the programmed interval.
Note: The Belt Clip can be attached or removed as required. You can find the procedure to attach/remove the
belt clip on page 16, chapter 3.1.
QUICK START GUIDE

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Direct TENS™
• The product Direct TENS™ bears the CE marking CE-0473 (Notified Body: AMTAC Certification Services
Limited) showing that it complies with the Council Directive 93/42/EEC as amended concerning medical
devices and fulfils the essential requirements of Annex I of this directive. It has an internal power source
and is classified as IIa equipment (MDD).
• The device has a type BF applied part.
• The device fulfils the requirements of the standard EN 60601-1 “Medical electrical equipment, Part 1: General
requirements for safety” as well as the immunity requirements of the standard EN 60601-1-2 “Electromagnetic
compatibility - medical electrical equipment”.
• This manual is an integral part of the device and should be kept near the device at all times. Close
observance of the information given in this manual is a prerequisite for using the device as intended and
for correct operation to ensure user’s safety. Please note that information pertinent to several
chapters is given only once. Therefore, carefully read the manual once in its entirety.
• Using the device for purposes other than those described in this manual is not permitted.
• The safety information given in this manual is classified as follows:
• No part of this manual may be reproduced without written permission from DJO.
• Key to symbols used on the equipment
Warning
Indicates a hazard. If not avoided, the haz-
ard can result in death or serious injury.
Caution
Indicates a potential hazard. If not avoided,
the hazard may result in minor injury and/or
product/property damage.
GENERAL INFORMATION

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Direct TENS™
REF Reference number, part number
Follow instruction for uses
Type BF applied parts
Council Directive 2012/19/EU concerning Waste Electrical and Electronic Equipment (WEEE)
requires not to dispose of WEEE as municipal waste. Contact your local distributor for
information of the unit and accessories
Keep the device dry
70C
(158F)
-40C
(-40F)
Minimum and maximum temperature indications to respect
This equipment complies with all requirements of the Medical Device Directive
(93/42/EEC)
Manufacturer name and address, manufacturing year
Power/Pause
KEY TO THE SYMBOLS

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Direct TENS™
Intended Use
Direct TENS™ (882700) is a transcutaneous
electrical nerve stimulator. Transcutaneous electrical
nerve stimulation (TENS) uses electrical pulses that
are delivered through the skin to the cutaneous
(outer) and aerent (deeper) nerves to alleviate pain.
Contrary to medication and cream used on the skin,
there are no known side eects resulting from TENS
therapy.
Use Direct TENS™ only as described in this manual.
Other uses of the stimulator are not permitted.
Intended User
The user of both the TensMed P82 and S82 can
be a Health Care Professional or a patient. The
device should be used indoors and may be used in a
healthcare facility setting or in a home environment.
Indications
• Direct TENS™ can be used to alleviate dierent
types of acute and chronic pain such as
• Joint pain (e.g. knee, hip arthrosis)
• Chronic pain originating in the spine
• Degenerative diseases of the musculoskeletal
system
• Tension headache
• Radiating pain (e.g. back pain, cervicobrachial
syndrome)
• Amputation stump/phantom limb pain
• Pain from rheumatic diseases
Contraindications
Do not use Direct TENS™ in the following situations:
• If you have an implanted demand pacemaker,
intracardiac defibrillator or other active implants
• Undiagnosed pain until the cause has been
ascertained
• Epilepsy
• During pregnancy (unless approved by your
referring gynaecologist)
Treatment should never be applied near the area of
an implant, such as cochlear, pacemakers, skeletal or
electrical.
Do not apply stimulation in the vicinity of metal.
Remove jewellery, body piercings, buckles or any
other removable metallic product or device in the
area of stimulation.
Do not attempt to place electrodes on any part of
the body not directly visible without assistance.
Do not stimulate at the front or side of the neck to
avoid a drop in blood pressure. Furthermore it is not
permitted to attach electrodes to the head.
This device should not be used for symptomatic local
pain relief unless diagnosis is established or unless a
pain syndrome has been diagnosed.
Biocompatibility
Those parts of the Direct TENS™ that come into
contact with the user when the device is used as
intended, are designed to fulfil the biocompatibility
requirements of the applicable standards.
. POINTS TO NOTE BEFORE USE

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Direct TENS™
Contraindications
• Implanted electronic devices. Do not use the device on patients who have a cardiac pacemaker, implanted
defibrillator, or other implanted electronic device, because this may cause electric shock, burns, electrical
interference, or death.
• TENS for Undiagnosed Pain. Do not use the device as a TENS device on patients whose pain syndromes are
undiagnosed.
Warnings
• Consult with physician. Consult with the patient’s physician before using the device, because the device
may cause lethal rhythm disturbances to the heart in susceptible individuals.
• Skin condition. Apply stimulation only to normal, intact, clean, healthy skin.
• Long term eects. The long-term eects of chronic electrical stimulation are unknown.
• Stimulation location. Stimulation over Neck or Mouth. Do not apply stimulation over the patient’s neck
(especially the carotid sinus) or the patient’s mouth, because this could cause severe muscle spasms
resulting in closure of the airway, diculty in breathing, or adverse eects on heart rhythm or blood
pressure.
• Stimulation across Chest. Do not apply stimulation across the patient’s chest, because the introduction of
electrical current into the chest may cause rhythm disturbances to the patient’s heart, which could be lethal.
• Across the head. Since the eects of stimulation of the brain are unknown, stimulation should not be
applied across the head, and electrodes should not be placed on opposite sides of the head.
• Stimulation over compromised skin. Do not apply stimulation over open wounds or rashes, or over
swollen, red, infected, or inflamed areas or skin eruptions (e.g., phlebitis, thrombophlebitis, varicose veins).
• Stimulation near cancerous lesions. Do not apply stimulation over, or in proximity to, cancerous lesions.
• Stimulation over eyes. Do not apply stimulation directly on the eyes.
• Environment. Electronic monitoring equipment. Do not apply stimulation in the presence of electronic
monitoring equipment (e.g., cardiac monitors, ECG alarms), which may not operate properly when the
electrical stimulation device is in use.
• Bath or Shower. Do not apply stimulation when the patient is in the bath or shower. Do not apply
stimulation in humid atmosphere exceeding 75% of relative humidity.
• Sleeping. Do not apply stimulation while the patient is sleeping.
• Driving or operating machinery. Do not apply stimulation while the patient is driving, operating machinery,
or during any activity in which electrical stimulation or involuntary muscle contraction can put the patient
at risk of injury.
• Electrosurgical equipment or defibrillators. Disconnect the stimulation electrodes before using electrosurgical
equipment or defibrillators. Otherwise skin burns may be caused below the electrodes and the device
might be destroyed.
• Magnetic Resonance Imaging. Do not wear electrode or the device during Magnetic Resonance Imaging
(MRI) scans as this may result in metal overheating and causing skin burns in the area of the electrode.
• Flammable or explosive environment. Do not use the device in areas where there is a risk of fire or
explosion, such as oxygen-rich environments, in the vicinity of flammable anaesthetics, etc.
• Power supply. Never connect stimulation cables to an external power supply as there is a risk of electric
shock.
• Near other equipment. Do not use the device beside or stacked on top of any other equipment. If you must
use it side by side or on top of another system, you should check that the device works properly in the
chosen configuration.
• Miscellaneous. Electrodes for Single Patient. Do not share electrodes with other persons. All users should
have individual set of electrodes to prevent undesirable skin reactions or disease transmission.
PRECAUTIONARY MEASURES

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Direct TENS™
• Accessories. Use this device only with the leads, electrodes, and accessories recommended by the
manufacturer. Use of other accessories may adversely aect the performance of the device or may result in
stronger electromagnetic emissions or reduce the electromagnetic immunity of the device.
• No Modification. No modification of the equipment is allowed.
Precautions
• Supervision. Use this device only under the continued supervision of a licensed practitioner. Electrode
placement and stimulation settings should be based on the guidance of the prescribing practitioner.
• Manufacturer. The manufacturer does not take any responsibility for any electrode placements other than
recommended.
• Pregnancy. The safety of electrical stimulation during pregnancy has not been established.
• Skin irritation. Some patients may experience skin irritation or hypersensitivity due to the electrical
stimulation or electrical conductive medium (gel). The irritation may be reduced by using an alternate
conductive medium or alternate electrode placement. Some patients may experience redness under the
electrodes after a session. This redness usually disappears within a few hours. Advise the patient to consult
the clinician if the skin redness does not disappear after a few hours. Do not start another stimulation
session in the same area if the redness is still visible. Don’t scratch the redness area.
• Heart Disease. Patients with suspected or diagnosed heart disease should follow precautions
recommended by their physicians.
• Epilepsy. Patients with suspected or diagnosed epilepsy should follow precautions recommended by their
physicians.
• Internal Bleeding. Use caution when the patient has a tendency to bleed internally, such as following an
injury or fracture.
• After Surgery. Use caution following recent surgical procedures when stimulation may disrupt the patient’s
healing process.
• Over uterus. Do not place electrodes directly over the uterus or connect pairs of electrodes across the
abdomen if you are pregnant. The reason is that, theoretically, the current could aect the foetus’s heart
(although there are no reports of it being harmful).
• Lack of sensation. Use caution if stimulation is applied over areas of skin that lack normal sensation. Don’t
apply stimulation on patient unable to express themselves.
• Stimulation. The stimulator should only be used with skin electrodes intended for nerve and muscle
stimulation. Muscle soreness may occur after stimulation but usually disappears within a week.
• Hot casing or batteries. Under extreme use conditions, some parts of the casing might reach up to 109 °F
(43 °C). Use caution when manipulating the batteries right after device use or when holding the device.
There is no particular health risk associated with this temperature besides your comfort.
• Children. Keep this device out of the reach of children.
• Electrode Size. Do not use electrodes with an active area less than 16 cm2, as there will be a risk of
suering a burn injury. Caution should always be exercised with current densities more than 2mA/cm2.
• Strangulation. Do not wrap leadwires around your neck, and keep them out of the reach of children.
Strangulation may result from entanglement in the leadwires.
• Tripping. Care should be used to avoid tripping on lead wires.
• Damaged Device or Accessories. Never use the device or any of its accessories if it is damaged (case, cables,
etc.) or if the battery compartment is open as there is a risk of electric shock. Carefully inspect the lead
wires and connectors prior to each use.
• Inspect Electrodes. Inspect electrodes before each use. Replace electrodes when they begin to deteriorate
or lose adhesion. Poor contact between the electrodes and the patient’s skin increases the risk of skin
irritation or burns. Electrodes will last longer if used and stored according to instructions on electrode
packaging. Attach the electrodes in such a way that their entire surface is in contact with the skin.
• Foreign bodies. Do not allow any foreign bodies (soil, water, metal, etc.) to penetrate the device and the
battery compartment.

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Direct TENS™
• Batteries. Do not carry batteries in a pocket, purse, or any other place where the terminals could become
short-circuited (e.g. by way of paper clip). Intense heat could be generated and injury may result. Never
open the battery cover during stimulation in order to avoid electrical shock. Remove the batteries from the
device if you do not intend to use it for a prolonged period of time (more than 3 months). Extended storage
of the batteries in the device might lead to batteries and device damage.
• Cable. The cable is best preserved if left attached to the stimulator between sessions. Do not jerk the cable
or connection.
• Heat and Cold products. The use of heat or cold producing devices (e.g. electric heating blankets, heating
pads or ice packs) may impair performance of the electrode or alter the patient’s circulation/sensitivity and
increase the risk of injury to the patient.
• Pulled muscles. Do not apply electrodes over pulled muscles. Using the stimulator on a previously extended
muscle might further pull such muscle. The higher the stimulation intensity, the higher the risk to further
overextends such muscle.
• Additional Precautions for TENS
– TENS is not eective for pain of central origin, including headache.
– TENS is not a substitute for pain medications and other pain management therapies.
– TENS devices have no curative value.
– TENS is a symptomatic treatment and, as such, suppresses the sensation of pain that would otherwise
serve as a protective mechanism.
• Eectiveness of TENS is highly dependent upon patient selection by a practitioner qualified in the
management of pain patients.
Dangers
• Electrodes. Any Electrode with a minimum active area of 16 cm² may be used with this device. Use of an
electrode with an area less than 16 cm² can cause burns when the unit is used at higher intensities. Consult
your clinician prior to using any electrode less than 16 cm².
Adverse Reactions
• Patients may experience skin irritation and burns beneath the stimulation electrodes applied to the skin.
• Patients may experience headache and other painful sensations during or following the application of
electrical stimulation near the eyes and to the head and face.
• Patients should stop using the device and should consult with their physicians if they experience adverse
reactions from the device.
• Precaution: Do not disconnect any stimulation cables during a session while the stimulator is switched on.
Switch the stimulator o first. Always turn o the stimulator before moving or removing any electrodes
during a session.
• Precaution: Do not use electrodes with an active area less than 16 cm2, as there will be a risk of suering a
burn injury. Caution should always be exercised with current densities more than 2mA/cm2.
• Precaution: Do not apply stimulation in the vicinity of metal. Remove jewelry, body piercings, buckles or
any other removable metallic product or device in the area of stimulation. Never use the electrodes contra-
laterally, i.e. do not use two pins connected to the same channel on opposite segments of the body.
• Precaution: Never carry out an initial stimulation session on a person who is standing. The first five minutes
of stimulation must always be performed on a person who is sitting or lying down. In rare instances, people
of a nervous disposition may experience a vasovagal reaction. This reaction is connected with fear of the
muscle stimulation as well as surprise at seeing one of their muscles contract without having intentionally
contracted it themselves. A vasovagal reaction causes heart to slow down and blood pressure to drop,
which can make you feel weak and faint. If this does occur, stop the stimulation and lie down with the legs
raised until the feeling of weakness disappears (5 to 10 minutes).
• Precaution: Sudden temperature changes can cause condensation to build up inside the stimulator. To prevent
this, allow it to reach room temperature before use.

11
Direct TENS™
Via electrodes attached to the skin, Direct TENS™ sends electrical pulses to the nerves. This will block the
pain impulses.
Four electrodes – two for each channel – can be connected to the device. Pain relief is most ecient during
stimulation, but the eect can last after the treatment. Additionally, the TENS treatment increases the blood
circulation. You can use Direct TENS™ at any time for pain relief and muscle relaxation. Each therapy session
should last 30 minutes minimum and can be continued for several hours.
This is where you connect the electrode lead
wires.
This key are used to increase
the current and thus the
intensity of stimulation:
Increase the intensity very
carefully!
This key are used to
decrease the intensity
and to unlock the
locked keys during
operation.
This button is used to switch
the stimulator on and o. If
no stimulation is started for
approximately 5 minutes,
the stimulator automatically
switches o to save batteries.
These keys are used
to select one of the 13
programs.
These are the quick select keys
for choosing an indication-related
program.
. HOW DOES THE DIRECT TENS™DEVICE FUNCTION

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Direct TENS™
2.1. TENS Therapy Principle
Two pain theories play an important role in the application and parameter settings of the Direct TENS™
device:
• The Gate Control Theory by WALL and MELZACK (1965)
• The Endorphine Theory by ERIKSON and SJÖLUND (1979)
According to the Gate Control Theory, weak TENS impulses block the pain impulses travelling to the
brain (sensor stimulation).
ERIKSON and SJÖLUND found that strong TENS impulses increase the release of internal substances (e.g.
endorphins) that also alleviate pain (motor stimulation).
Theory Gate Control Theory Endorphin Theory
Principle Via sensory nerves Via motor nerves
Intensity Low, light tingling High, just bearable
Impulse Width1Short, e.g. 100 µs Long, e.g. 250 µs
Frequency1100 Hz 2-10Hz
Muscle Contraction No Yes
Onset Pain Relief Quickly Slowly (20-60 minutes)
Duration of Pain Relief Short (5-15 minutes) Long (30 minutes-12 hours or longer)
Treatment Duration Permanent 30-60 minutes, 3-5 times/day
1 For easier operation, intensity and pulse width are combined in Direct TENS™.
(low intensity = short pulse width, high intensity = long pulse width)

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Direct TENS™
2.2. Description of the programs and the corresponding indications
Program Stimulation Frequency
(Hz)
General
Indications Advantages
11 impulse every 2 seconds 0.5 Kaada TENS
(similar to
acupuncture)
Ideal for sensitive people
Supports acupuncture
treatment
2Double pulse at 20 Hz
(pulse separation 3 ms)
20 Cervical spine
syndrome
Tense muscles
Muscle relaxation
by double pulses
3High frequency, 1000 Hz 1000 Acute, strong
back pain
(lumbar spine)
Strong analgesia
Brief, very intensive TENS
treatment
4Bi-modal Channel 1 =
100Hz
Channel 2 =
4Hz
Tension headache
Neck / back pain
Radiating pain
Simultaneous treatment
with high and low
frequency
In 2-channel mode,
channel 1 stimulation is
superimposed on the low
frequency stimulation in
channel 2
5Burst with alternating work
and rest phases of 3 and 2
seconds respectively
Work = 100Hz
Rest = 0Hz
Tense muscles
Amputation
stump /phantom
limp pain
Herpes zoster
Reflex
sympathetic
dystrophy (RSD)
Easily tolerable stimulation
for chronic pain conditions
Sensory as well as motor
stimulation
6Similar to program 5, but
channels 1 and 2 alternating
and longer work/rest times,
6 seconds respectively
Work = 100Hz
Rest = 0Hz
See program 5 Similar to program 5,
but channels 1 and 2
alternating
7Intensity decreases 40% in 0.5
second intervals
100 Lumbar back pain
Joint pain
Similar to massage
Eects both on the sensory
and on the motor level
Avoids habituation

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Direct TENS™
Program Stimulation Frequency
(Hz)
General
Indications
Advantages
8Random modulation of
intensity and frequency
(down to 50% of set intensity
and frequency modulation
between 8 dierent
frequencies, 2-150 Hz)
Random
modulation
Chronic pain
resisting therapy
Avoids habituation
Sensory as well as
motor stimulation
9Continuous 2 – 150 Standard TENS Fast pain relief in acute
pain conditions
Fast acceptance of therapy
Dierent programmable
frequencies, e.g.
100 Hz = Standard
2 Hz = Similar to
acupuncture
10 Burst with alternating work
and rest phases of 2 seconds
each
Work =
2 - 150 Hz
Rest = 0 Hz
Long-term
treatment
Classic burst
Pleasant form of
stimulation
Reduces muscle fatigue
Prolongs battery life
11 Mixed frequency Phase 1 =
2 - 150 Hz
Phase 2 = 50%
of work freq
Strong pain Pleasant stimulation also
at higher intensities
Permanent stimulation of
the deep aerent nerve
fibers with modulated
muscle activation
12 Multi modulation 2 – 150 Chronic pain Avoids habituation
Simultaneous sensory and
motor stimulation
Fixed modulation pattern
for intensity and
frequency
13 Simple modulated pulse
(SMP), intensity modulation
diametrically opposite to
frequency modulation
according to a fixed
12-second cycle
2 – 150 Chronic pain Avoids habituation
Simultaneous sensory and
motor stimulation
Intensity and frequency
modulation according
to fixed pattern, but
diametrically opposed, i.e.,
when the intensity
increases, the frequency
decreases and vice versa.

15
Direct TENS™
Frequency Selection for Programs 9 to 13
2 – 60 Hz 60 – 150 Hz
Preferred in the treatment of chronic pain Preferred in the treatment of acute pain
With the standard TENS programs 9 to 13, the frequency can be adapted manually.
Possible settings: 2, 10, 20, 40, 60, 100, 125, 150 Hz
Factory defaults for programs 9 to 12 is 100 Hz and 125 Hz for program 13.
Changing the frequency:
1. Turn on the device and select one of the programs 9 to 13
2. Simultaneously press the program selection keys and release them.
3. Using the intensity keys , choose the set frequency.
4. Press the two program selection keys again or switch the device o to save the settings.

16
Direct TENS™
3.1. Inserting Batteries
• Adjust the belt clip until it points to the right at
a 90° angle. (Figure 3-1)
• Push the battery cover down and lift. (Figure 3-2)
• Insert the batteries as shown in the illustration.
Observe the correct polarity,
see label in battery compartment. (Figure 3-3)
• Reinstall the battery cover and close the compartment.
Notes:
• Use only new AA type batteries.
• You may or may not use the belt clip, as
preferred. Open the battery compartment. If
you wish to remove the clip, pull it out towards
the left. If you wish to attach the clip, push it
into the holder from the left. When you close
the battery compartment, the belt clip is
automatically secured onto the device. (Figure 3-4)
• Dispose of the worn out batteries in accordance
with local and national regulations
3.2. Applying Electrodes, Connecting Leadwires
• First connect the electrode leadwires to the
electrodes (Figure 3-5). (The colour of the electrode
connectors is irrelevant.)
• Peel the electrodes o their protective paper.
Keep the protective paper and the bag, because
the electrodes will be reattached to the protective
paper after use and stored in the bag (see also 3.3.2
“Care of the Electrodes”).
• Carefully apply the electrodes on the skin (see also
3.3.3 “Electrode Placement”).
• Connect the electrode leadwire(s) to the Direct
TENS™ device (Figure 3-6).
Figure 3-1
Turning the belt clip
Figure 3-2
Opening the battery compartment
Figure 3-3
Inserting the batteries
Figure 3-4
Removing/attaching the belt clip
Figure 3-5
Connecting the electrode
leadwire to the electrodes
Figure 3-6
Connecting the electrode
leadwire to the device
. PREPARATION

17
Direct TENS™
3.3.1. Electrode Selection
Use large electrodes (e.g. 50 x 90 mm, to be
purchased separately) for large body areas (e.g. back,
leg) and for general conditions of pain.
Use small electrodes (e.g. 50 x 50 mm) for small
body areas (e.g. face, hand) and for deep, local pain.
3.3.2. Care of the Electrodes
When properly handled and maintained, the supplied
electrodes can be used 20 times or more.
Important for a long service life:
• Clean the skin application sites with mild soap
water before attaching the electrodes. After
cleaning,
thoroughly rinse with water and dry the skin
carefully.
• Dry electrodes with poor adhesion can be
reconditioned as follows: apply a small quantity of
water to the adhesive surface with your finger tip.
• If you face bad contact with the skin or repeated
open lead detection, change the electrodes.
• Remove electrodes by pulling on their edges.
Do not pull on the leadwire.
• After use, reattach the electrodes to their
protective paper. Store the electrodes in their bags.
• Store the electrodes in a refrigerator, if possible.
Do not store them in warm rooms.
• We recommend shaving skin sites where
electrodes will be applied, if very hairy. Shaving
irritates the skin. Therefore wait 24 hours after
shaving before you attach the electrodes. Then
you may start therapy.
• Do not leave the electrodes attached to your
skin for a prolonged period of time. Remove the
electrodes after each use. Apply the electrodes on
dierent sites to avoid skin irritations. For the same
reason clean the skin thoroughly after treatment. If
you observe skin irritations, consult your physician
and suspend therapy until clarification.
3.3. Selection, Care and Placement of the Electrodes

18
Direct TENS™
3.3.3. Electrode Placement
If your physician showed you the best application
points, we recommend that you use them.
Otherwise figures 3-7 to 3-11 show possible electrode
configurations.
Figures 3-12 to 3-21 show electrode configurations
for dierent indications. However, check that the
configuration is appropriate and adapt, if necessary.
Depending on the site and cause of the pain,
electrodes may be placed on acupuncture points
or in specific dermatomic areas.
In other situations we recommend applying the
electrodes around the center of the pain at a
distance of 3 to 5 cm (where you feel the pain).
Notes:
• Concerning the choice of indication-specific
programs, please refer to the Notes in section 2.2.
• Before applying the electrodes, observe the care
instructions in section 3.3.2.
• If appropriate, you can also use only two electrodes
(one channel).
Figure 3-7 Bilateral placement
(e.g. cervical dysfunction)
Figure 3-8 Diagonal placement
(e.g. shoulder or knee)
Figure 3-9 Parallel placement (e.g.
on scarred tissue) Figure 3-10 Bracket position
Caution
Failed stimulation, skin irritation, malfunction -
• Use only the original electrodes supplied
with the system and replacement
electrodes provided by DJO.
• Attach the electrodes on intact skin only,
avoid skin areas with reduced sensitivity.
• Ensure that good contact is achieved
between electrode and skin. Although
the stimulator switches o when the
electrode-skin contact resistance is too
high, poor electrode techniques may cause
skin irritations under the electrodes.

19
Direct TENS™
Figure 3-13 Electrode application on the
shoulder joint
Indications:
e.g. General pain in the shoulder, bursitis
Figure 3-12 Electrode application on the
shoulder blade
Indications:
e.g. General pain in the shoulder
accompanied by headache
Figure 3-11 Electrode application in pain
conditions involving the shoulder and
shoulder blade
Figure 3-14 Electrode application on the
cervical spine
Indications:
e.g. pain caused by intervertebral disk or
vertebral arch joint problems , cervical
spine syndrome, cervical syndrome,
tension headache, migraine
Recommended electrode placement:
Diagonal
Figure 3-15 Electrode application on the
cervical spine Picture to be replaced
Indications:
e.g. for conditions of pain in the muscles
or soft parts, see also Figure 3-15
Recommended electrode placement:
Parallel

20
Direct TENS™
Figure 3-16 Electrode application on
the knee joint
Indications:
e.g. arthrosis of the knee joint (gonarthrosis),
generalized pain in the knee, TEP
Recommended electrode placement:
Attach electrodes above superficial skin nerves
or acupuncture points around the knee joint.
The electrode configuration may be parallel,
medial, lateral or crosswise above or
below the knee.
Figure 3-17 Electrode application
on the back
Indications:
e.g. lumbar spine syndrome,
lumboischialgia, pseudoradicular back pain
Recommended electrode placement:
paraspinal, proximal and distal to the pain
area. Channels 1 and 2 diagonal
Figure 3-18 Electrode application
on the back
Indications:
Radicular (radiating) pain
Recommended electrode placement:
Channel 1 proximal and distal to the pain
area, channel 2 above the nerve.
Figure 3-19 Electrode application
on the back
Indications:
Radicular (radiating) pain (alternative)
Recommended electrode placement:
Channel 1 proximal and distal to the pain
area, channel 2 above the nerve.
Figure 3-20 Electrode application for
phantom limb pain, version 1
Figure 3-21 Electrode application for
phantom limb pain, version 2