Electrotherapy in Pain Management
Electrotherapy or electric medicine, which uses electricity for treating pain, repairing tissues, improving circulation, strengthening the muscles, or promoting bone growth that leads to improvement in overall physical functioning, includes a variety of treatments.
This is a form of neuromodulation that comprises of non-invasive or minimally invasive techniques such as electroacupuncture (EA), percutaneous electrical nerve stimulation (PENS), transcutaneous electrical nerve stimulation (TENS), as well as the more invasive alternative (SCS) and peripheral nerve stimulation (PNS).
Electrotherapy is typically used in conjunction with other treatments. A non-invasive form, electrotherapy such as TENS might be used along with physical therapy. The current stimulates the sensory nerves and helps prevent the pain signals reaching the brain. The device also helps increase the body’s production of its own endorphins and enkephalins.
A stronger deeper penetrating process called Inferential Current Therapy (IFC) puts a higher frequency current along the nerve strands, stimulating the tissues around the part of the body that is injured to promote in healing. IFC is reported to cause less discomfort than other electrical stimulation methods because at higher frequencies the current can pass deeper into the tissues with less resistance. IFC is used to treat circulatory disorders, improve range of movement, reduce range of motion, and reduce edema and muscle spasms.
In case of TENS therapy being not successful, PENS can be considered. In PENS, implanted needle electrodes deliver current closer to the nerves or muscle beneath the skin. The treatment is recommended for diabetic peripheral neuropathy.
There is another electrotherapy treatment called Pulsated electromagnetic field therapy (PEMF) which may be useful after spinal fusion surgery. It promotes bone growth, enhances the strength of fusion, and also eases pain. There is evidence via research that PEMF benefits failed back surgery syndrome and knee pain due to osteoarthritis.
Spinal cord stimulation (SCS) is a good alternative for individuals whose neck and back pain is not relieved by surgery or other treatments. Delivering a mild electrical stimulation to the nerves along the spinal column. SCS currently accounts for 90% of all neuromodulation treatments. SCS is one of the most effective tools for treatment of neuropathic pain. By delivering tiny amounts of electrical energy directly onto the spine, the stimulator interrupts inappropriate pain information being transmitted to the brain.
Peripheral nerve field is a similar type of technique where the devices controlling the electrical pulses are placed under the skin in the area near to the involved nerve. The SCS technique has been used for decades and recommended for conditions such as failed back surgery, cervical and lumbar radiculitis, peripheral neuropathy and complex regional pain syndrome—which are all increasing in number. Before a permanent device is implanted there is a trial procedure that allows the patient to determine whether SCS devise will be effective.
The SCS was first approved in 1989. Since that time the devices have been developed to make it smaller, effective and also more comfortable. Systems using high frequency pulses rather than traditionally used low frequencies may be more effective in reducing pain. Applying SCS to the dorsal root ganglion has been effective for groin, foot pain and complex regional pain syndrome. Over the years technological advance and developments in SCS have optimized the product for better use and for more medical conditions.
The Future in Electrotherapy
Recent advancement in electrotherapy includes stimulation for the vagus nerve to prevent seizures and treat severe depression. Neurostimulation can treat chronic pain, the technology may provide other therapies as well. For example, neural signaling in part controls inflammation, suggesting that neurostimulation may help in treating inflammatory disorders like Crohn’s disease and rheumatoid arthritis.
Currently, clinical research is in progress to map the nervous system’s role in disease, as well as in studying the role of electrotherapy and stimulation in treating rheumatoid arthritis, chronic medical conditions including Type 2 diabetes, autoimmune and endocrine disorders
- Mehta N. “Spinal cord stimulation for chronic neck and back pain. ” Spine – Health Sept. 2016.
- Li J, Song Y “Transcutaneous electrical nerve stimulation for postoperative pain control after total knee arthroplasty.” Medicine (Baltimore) 2017:96(3):e8036.
Sanjay Trivedi, M.D. received training in general surgery from Seton Hall University in New Jersey, and studied physical medicine and rehabilitation at Kingsbrook Jewish Medical Center and David Minkin Rehabilitation Institute in Brooklyn, New York. Dr. Trivedi’s expertise is in the fields of acute and chronic spinal pain management, acute and chronic pharmaceutical pain management, musculoskeletal and joint pain management, and personal injury rehabilitation and care.