Electromedicine UOT ue aU Ue ACL Re UT San Rome Reno Peer N Ue) By Daniel L. Kirsch, PhD, DAAPM, FAIS. je last three decades have seen a vise in the use of mi | crocurrent electrical therapy (MET). Itis used primarily by physicians, dentists, veterinarians, oceupational ther pists, psychologists, chiropractors, and acupuncturists for the management of acute, chronic, and post-operative pain. The use of MET is. often accompanied by the promotion or accel- ‘ration of healing. Table 1 provides a sample listing of the in- ications and contraindlcations for MET! 1 should be emphasized that with previous forms of elec- ‘wotherapy (eg. transcutaneous electrical nerve stimulators and other technologies based on using electric force as a counter-ir- ritant), price often was the deciding factor when making pur- chase decisions among the many units offered. In choosing 3 microcurrent device, the most critical aspect is the waveform. Specific waveform attributes are essential to achieving good re sults. One must deters imate tesearch associ- ‘ed with a given technology before purchasing or prescribing. Some of the Asian manufacturers, for example, have simply re- ‘duced the current from their TENS devices and started to sell them as “microcurrent” devices. The Food and Drag Adminiss tration is not helpfl inthis instance as the FDA will readily ac cept devices being sold for pain indications as TENS. Accord- ingly, itis caveat emptor and each practitioner must do their ‘own due diligence on the best technology and protocol “The class of deviees known as microcurrent have current les- els less than one milliampere. However, that is only one aspect fof the waveform. Just as not all 5 mg pills are alike, neither are 0.5 Ha MET devices. Heffernan compared a commercially a able MET device using a variable maximum frequency of 0, Hz (0 to 2 second pulses) in a complex 10 second bipolar wave- ‘control device built by the researcher delivering a simple repetitive 0.5 Hz bipolar waveform. Using the same elec- trode locations (bilaterally on the wrists) and the same amou of current (00 microamperes), he found that the MET device was able to significantly reduce pain and produce beneficial smoothing on clectroencephalographic analysis in patients with chronic degenerative joint disease that were unresponsive to medication, The 0.5 itz control device did not produce a sig current, lo Baie nificant reduction in pain and only produced an undesirable si ‘nusoidal pattern on the EEG. Fortunately, MET devices are often subsensory so that they lend themselves tothe gold standard of double-blind studies in ‘4 manner similar to pharmaceutical research, ‘There is no ex cause for a medical device company—entrusted with patient care (on the order of a licensed practitioner — not to sponsor or e courage research with its proprietary technology. ‘Mechanisms Amdi’s Law is often cited in discussions of MET. It states that ‘weak stimuli excite physiological activity, moderate stimu fx vyors it, strong stimuli retards it, and very strong stirnuli arrests it? Chang found that 500 microamperes caused adenosine Uuiphosphate (ATP) to increase by 500% while raising the cur= rent over 5 milliamperes caused ATP to drop below baseline norms. Further, at 100-500 microamperes, amino acid transport rose 30-40% above controls." An eflective MET waveform will use reson: activate central pain modulatory mechan the body manufacture peptides ands to surface re- ceptors on other remote cells, communicating throughout the bbody via the extracellular fuid and the circulatory system.* Nor- denstrm has proposed model of biologically-closed electric circuits analogous to closed circuits in electronic technology.” Lis premise is that mechanical blood circulation is dlosely inte- _gruted anatonnically and physiologically with a controlling bio: ‘electrical system, Endogenous biological circuits ae affected by normal electrical activities of he body and pathological changes. Nordenstrém views bioelectricity as the primary catalyst of the healing process and has shown that augmenting it with MET ‘can produce profound therapeutic effects, ‘MET treatment with an effective waveform may act similar to ligands in activating receptors to send their messages into cells, and produce effeets similar toa wide range of chemical messen- gets. The protocols presented herein effect the peripheral pain site directly and access the central nervous system by placing, cleetrodes in position to direct the current through the spine. frequencies that 1s. Cells throughout Practical PRIN MANAGEMENT, October 2006 39Electromedicine Heao aNo Neck PAIN ‘Cervicogenic headache ‘AsoouinaL Pan Back Pan Bladder pain Coceydynia, Bowol stasis Failed back surgery Diverticulosis Intercostal neuralgia Dysmenorrhea Intervetebral disc syndrome Labor Low back pain Postoperative pain Lumbrosacral pain Prostatitis Radicultis Spasm Sprains and strains ‘Thoracodynia ‘Whole back pain Custer headache Svsremie PAIN Dental cisorcers (periodontal ‘Acupuncture points and ohodontc pain) ‘acts Facial palsy Bursitis Migraine Cancer Sinusiis Causalgia Sprains and straine Gholecyeits (chronic) Subocciptal headaches, Decubitaluieers Tinnitus Effusions Temporomancibuar joint disorder Fibrosis Tension headache Hematoma calcification | Toticolis Hemiplegia, Trigeminal neuralgia Herpes zosterlschialgia | Whiplash Lymphedema uttipe sclerosie Myalgia Lowen Exrnemry Pain Myositis “Ankle pain femige Anterior tibial syndrome Ostooartaiis Proce Pain (systemic and idopathic)| Joint mobilization Phantom limb syndrome | Knee pain Post traumatic edema Pasatle retch pain Raynaua's disease Sciatica Rheumatoid arthritis Sprains and strains Scars Spurs Synovitis Tendinitis THager points Thrombophlebiis Upper Exrnenrry Pan Carpal tunnel syndrome Epicondyitis Frozen shoulder Hand pain Peripheral nerve injury Shoulder.arm syndrome Sprains and strains Subdeltoid bursitis Wrist pain Carotid sinus area Demand type pacemakers Pregnancy ‘TaBLE 1. Indications and contraindications for microcurreut electrical MET: A Tutorial While MET devices difles; and the manufacturers’ recommen: dations should always be followed when first learning to use a medical device, a basic protocol can be utilized for quick and consistent results This article is based on the author's 38 years of experience with MET It is not meant as complete discourse fon the subject, but rathera "how-10” tutorial to achieve substan- tial, cumulative effeets in the least amount of time, MET is a very easy and efficacious procedure when performed properly As with any medical intervention, there is a learning curve so don't give up if the first few treatments do nor produce the de: sired outcomes. MET produces significant results (225% pain reliel) for over 90% of patients. MET is both long lasting and cumulative, The goal of'a MET session is to achieve 100% pain relief Although not achievable in every case, and seen less often with the first few treatments series, anything less than full pain relie se sion will inversely impact the longevity of the results obtained and impact the cumulative effect. The protocols pres will usually take 2-5 minutes, but may take up to 15 minutes in patients who have severe or multiple pathologies. top when the med here pai is no longer able to be elucidated, even in a position that previously exacerbated the pain, Of course, one can alays cause pain in extreme positions so itis only reasonable to evaluate the treatment in comparison within the limits of the restricted lim: 60 therapy (MED). itation of motion that the patient originally presented with and never mote than the normal range of motion, Results will vary with the technology utilized, the pathology ofthe patient undergoing treatment, the overall health, hydra tion, and compliance ofthe patient, The patient's history, espe- ally s it pertains to prior medical intervention, may be a delin= ing factor It is not possible o achieve resultswhen limiting treat ‘ment with MET to the chief complaint since the entire body is aan electrical circuit” Previous injur and surgical scars may resistive nature that cause subile electrical blocks Ifa patient is refiactory to tweatment with MET, place electrodes at the end of each scar or cover small sears ‘with an electrode (with the other one being placed opposite the on another scar), for at least 10, need tobe treated de to their high tes, 4 days ima row. A suceessful scar treatment may exacerbate pain as it increases the pain inereases, the pro- are the subject ofthis article will usualy start to work. difficult cases, it could take 3 weeks or more of da significant cumulative elfec, This is es 18 patients with fibromyalgia ‘overall functioning and star tocols th ‘Analyze the Patient Naming a disease and knowit he patien jes is often su ' weight and per 110 prescribe phar ET, one needs to go beyond the ehiel co hhaps medication alle rmaceuticals. With Practical PAIN MANAGEMENT, October 2006Electromedicine plaint(s) 6 understand all comorbi ‘medical history, and prior interventions. This is essential because the electrical cir- ‘ciety of the entire body must be consid- ‘ered. All current, and sometimes seem ingly resolved pathologies, may need to be treated along with the chief com- plain(s)ifonly for 10 t© 30 seconds each in order to obtain optimum results, ‘A theumatoid arthtitis patient, for ex ample, will only respond well to MET if all involved joints are treated. This can be accomplished quickly using these proto- cols, Treatment can then be concentrated ‘on the chief complaint. Curiously, igree of chronicity does not seem to be a significant factor in MET outcomes. History and Brief Exam A comprehensive history is helpful o de- termine co-morbidities, past pathologies and trauma that might need to be treat- ced along with the chief complaint. stan- dard brief pain evaluation is essential (0 determine when the pain first presented, its frequency, curation, intensity, limita: tions-of-motion, positions which exacer bate the pain, and any precipitating fac- tors, This should include details ofall sur- gical scars, eraumatic injuries, and an Analysis ofthe patient's current condition prior 10 initiating MET. Determine the patient's present pain level and positions that exacerbate the pain. Ask patients to rate their present pain on a scale of O (no pain) to 10, with 10 being the worst the pain to be treated has been perceived, Because the results of MET can be seen. afier only a minute or to of treatment in most people, these indicators are neves- sary reference parameters to determine cllectiveness during a single weatment Adjust the Settings If choices are offered, use the manutae- turer's recommendations forthe frequen- oy setting of a given device. Higher fre- quencies (eg., 100 Hz) might produce faster results but the effets do not ast as Jong asthe effects achieved fiom the use of alow frequency e.g. <1.0 2) Set the current level atthe highest comfortable Position (eg, 300 to 600 microamperes). Be carefil to only use low resistance electrodes. Standard TENS electrodes havea resistance of about 200 obi, hile some silver electtodes havea resistance of only 20 ohins. Only low resistance elec- tvodes will work eflecively with MET de- Most good MET devices utilize probes These work better than seléadhesive elec trodes. Ibis better tobe on the right weat- tent site with probes for 10 seconds than on the wrong site with seadhesve elec: trodes for 10 hours. When using probes, alfix new electrodes and saturate them ‘sith an appropriate electromedical con: ‘ducting solution, Saline solution may be used if conducting solution is not avail- able. Apply firm pressure to help mini mize skin resistance. A major cause of ited or no results is being too gentle the probes. For extremely hypersensitive people such as fibromyalgia patients, itis neces” sary tostart witha minimalamount of cur- rent. In some rare cases, even low level MET currents may be uncomfortable in some patients, Over a series of treatment ‘might be possible to inerease the cur- rent improve the results. However there is never any reason for patients to be un- ‘comfortable during MET treatment. Ad- ditional treatment time will compensate for the reduction in curtent Basic Treatment Strategy “The most important variable is the po tion of the electrodes. Place them on. ther side of the area being treated to rect the current through the problem area. Keep in mind that the body is S-li- ‘mensional. Therefore, there will be many possible electrode positions. Some will work much better than others. The eor= rect electrode location is the one that works! However, the one that works may be transient, working well one day, but i effective another. As the problem begins to resolve, the electrode locations may te ‘quite frequent adjustments ‘A common mistake made by elinieians Familiar wi ional TENS is placing Figure 1. An exemple of the 2 Minute Probe Treatment Protocol for right knee pain, The ends of the lines vepmesent approximate locations for ‘probe placements, and the nuombers represent the omer in which the probes are placed to treat the area 62 Practical PAIN MANAGEMENT, October 2006