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Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Transcutaneous Electrical Nerve Stimulation


Text Only Home | Graphic-Rich Site | Overview | Reason for Procedure | How Procedure is Performed | Prognosis | Specialists | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Ability to Work | Maximum Medical Improvement | Medical Codes | References

Medical Codes

ICD-9-CM:
93.39 - Physical Therapy, Other

Related Terms

  • TENS

Overview

Transcutaneous electrical nerve stimulation (TENS) is the use of low-level electric current to stimulate the nerves for therapeutic purposes. TENS is most often used as a method of pain control that involves transmitting electrical impulses to nerve endings through the skin and underlying soft tissues. Low-voltage electrical current is generated in a programmable electric signal generator the size of a cell phone or beeper, powered with a battery pack. The current passes along flexible wires to surface electrodes or patches that have been applied to the skin near the source of pain. Surface electrodes are made of self-adhesive material and are available in variety of shapes and sizes. The current delivered can be modified to different wave frequencies, which, in turn, create different sensations: continuous, interrupted, or pulsating; mild or intense; or a mixture of these patterns. Individuals often describe the sensation as vibrating or tingling.

The generated current is similar to other current in the body, but, in TENS, the current theoretically travels directly to nerve endings and is different enough to block transmission of pain impulses (gate control theory). It is thought to directly inhibit abnormally excited nerves, and to provide presynaptic inhibition in the spinal cord. It is also thought to stimulate the release of the body's own pain control substances: endorphins, enkephalins, and dynorphins.

TENS is noninvasive and drug-free, and is considered safe. Possible side effects are skin sensitivity to the adhesive patches. Currently TENS is considered nonaddictive but there have been some dependence concerns.

A physician's prescription is required to obtain a TENS unit in the US, and patient education on use of the unit is critical to successful utilization for pain relief.

Source: Medical Disability Advisor



Reason for Procedure

TENS is used to control or treat pain. Treatment via TENS has advantages over other modalities because it can deliver constant pain control. The effects of other treatments (such as heat) wear off after treatment has ended (removal of the hot pack). TENS is portable and unobtrusive and may be used throughout the work day.

Indications for TENS include management or relief of pain that is caused by chronic injury or illness. Although initially used to treat chronic pain, TENS is sometimes used in the postoperative period for acute mild to moderate pain, or for acute pain after injury (post-traumatic pain). TENS has been used to treat muscle spasm, musculoskeletal pain such as low back or neck pain, headaches, reflex sympathetic dystrophy, rheumatoid arthritis, phantom limb pain, sympathetically mediated pain, neurogenic pain, visceral pain, and pain incurred during labor and delivery.

Source: Medical Disability Advisor



How Procedure is Performed

The physician, therapist, nurse, or other qualified treating clinician should explain to the individual how the unit works and the associated sensations the individual will experience. The parameters for pulse rate and width are set on the TENS unit. The lead wires are plugged into the self-adhesive electrodes, and the electrodes are placed on predetermined sites on the individual's skin. Electrode placement varies depending on the region of the body and the overall effectiveness, which is often determined on a trial and error basis. Due to the subjective nature of pain, individuals are instructed to try different electrode placement, pulse frequencies, and amplitudes (intensities) to find the best pain relief. Electrodes can be placed above the painful site or above and below the painful site, or one can be placed on the painful area and one on the spine over the corresponding nerve root. Other placement locations can be over trigger points that refer pain to other areas of the body when touched, or over acupuncture sites.

The wires are then plugged into the TENS unit, the unit is turned on, and the amplitude is set to a comfortable setting within the parameters of the TENS mode that is being used. The time that the TENS unit is left on depends on the mode of TENS that is being used.

Conventional mode TENS uses a high-frequency, low-intensity stimulation that usually inhibits pain immediately but may no longer provide analgesia once the unit is turned off. This mode of TENS is normally used all day, either continuously or in intervals of 30 minutes for up to 24 hours.

Pulsed (burst) mode TENS uses low-intensity stimuli delivered in high-frequency bursts. It is normally used for up to 1 hour but shows no significant advantage over conventional mode TENS.

Brief intense mode TENS uses a low-frequency stimulus at a high-intensity setting that simulates an acupuncture-like stimulus. Brief intense mode (hyperstimulation mode) TENS is normally used for 15 minutes because it can be highly effective but uncomfortable for the individual to tolerate. However, this type of TENS mode shows efficacy in some individuals who fail to respond to conventional mode TENS.

Source: Medical Disability Advisor



Prognosis

Individuals who use TENS according to the regimen prescribed by the physical therapist or physician are able to reduce or control the pain they experience from the underlying illness or injury. Studies show that 70% to 80% of individuals experience pain relief initially, although the success rate may decline after more than a few months to 20% to 30% (Kaye).

The use of TENS can improve function and reduce the need for narcotics and other pain controlling drugs, especially following surgery. Studies on the use of TENS following thoracic surgery showed that although TENS did not help with severe postoperative pain, it was effective in controlling mild or moderate postoperative pain. However, recent studies on TENS utilization are inconclusive as to the true efficacy of this treatment for pain control as compared to the placebo effect, especially for individuals with low back pain.

If effective, the use of TENS can allow individuals to participate in physical and occupational therapy, so that a more complete recovery can occur. TENS can ultimately allow individuals to resume participation in their daily activities.

Source: Medical Disability Advisor



Specialists

  • Family Physician
  • Hand Surgeon
  • Internal Medicine Physician
  • Neurologist
  • Orthopedic (Orthopaedic) Surgeon
  • Pain Medicine Physician/Pain Specialist
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Physical Therapist

Source: Medical Disability Advisor



Comorbid Conditions

Source: Medical Disability Advisor



Complications

Complications that may result from TENS are mild and reversible. Low-frequency and burst mode may not be tolerated because these modes can produce localized muscle contractions. Hyperstimulation mode may not be tolerated due to the production of a noxious stimulus. Skin irritation may result from the use of the electrodes and is observed in one-third of individuals, most commonly when the electrodes dry out.

TENS treatment has a risk of interfering with biomedical electronic devices and is contraindicated in individuals with a pacemaker. TENS use also has a risk of interfering with the heart's natural conduction system and should not be used by individuals with a heart condition, who have epilepsy, or who are pregnant because it may induce premature labor. It should not be used on infected skin, around the head, or near the carotid artery on the neck.

Source: Medical Disability Advisor



Factors Influencing Duration

There is no disability associated with the use of the TENS unit itself.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Because TENS can be worn without interfering with other activities, no work restrictions are required to use it.

The ability to work is dependent on the condition for which the TENS treatment is provided. In general the purpose of TENS is to reduce acute or chronic pain. The treatment does not interfere with voluntary function; therefore, the individual's ability to perform tasks is dependent upon the underlying condition and the limitations that result because of that condition.

Risk: Risk for use of TENS is limited.

Capacity: Capacity is often improved with TENS and pain is reduced.

Tolerance: If pain is reduced with TENS, tolerance should increase.

Accommodations: Accommodations may be required during a period of acute severe pain associated with a specific condition. No work restrictions are needed during TENS treatment.

Source: Medical Disability Advisor



Maximum Medical Improvement

0 days.

Source: Medical Disability Advisor



References

Cited

Kaye, Vladimir, and Murray E. Brandstater. "Transcutaneous Electrical Nerve Stimulation." eMedicine. 26 Jun. 2013. Medscape. 20 Jul. 2015 <http://emedicine.medscape.com/article/325107-overview>.

Source: Medical Disability Advisor