A. Under normal physiological circumstances, the brain generates pain sensations by processing incoming noxious information arising from stimuli such as tissue damage. In order for noxious information to reach the brain it must pass through a metaphorical ¡°pain gate¡± located in lower levels of the central nervous system. In physiological terms, the gate is formed by excitatory and inhibitory synapses regulating the flow of neural information through the central nervous system. This 'pain gate' is opened by noxious events in the periphery.
B. The pain gate can be closed by activation of mechanoreceptors through ¡°rubbing the skin¡±. This generates activity in large diameter Aβ afferents, which inhibits the onward transmission of noxious information. This closing of the ¡°pain gate¡± results in less noxious information reaching the brain reducing the sensation of pain. The neuronal circuitry involved is segmental in its organization. The aim of conventional TENS is to activate Aβ fibres using electrical currents. The pain gate can also be closed by the activation of pain-inhibitory pathways become active during psychological activities such as motivation and when small diameter fibres(Aδ) are excited physiologically. The aim of AL-TENS is to excite small diameter peripheral fibres to activate the descending pain-inhibitory pathways.
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