Electroanalgesia
Encyclopedia
Electroanalgesia is a form of analgesia, or pain relief, that uses electricity
to ease pain
. Electrical devices
can be internal or external, at the site of pain (local) or delocalized throughout the whole body
. It works by interfering with the electrical currents of pain signals, inhibiting them from reaching the brain
and inducing a response; different from traditional analgesics, such as opiates which mimic natural endorphins and NSAIDs (non-steroidal anti-inflammatory drugs)which help relieve inflammation and stop pain at the source. Electroanalgesia has a lower addictive potential and poses less health threats to the general public, but can cause serious health problems, even death, in people with other electrical devices such as pacemakers or internal hearing aids, or with heart problems
.
and Socrates
, who noticed numbing effects of standing in pools of water on a beach that contained electric fish
. The Chinese practice of acupuncture
, dating back to 3000 BCE, also utilizes the properties of electroanalgesia by stimulating specific nerves to produce electrical signals which produce pleasurable responses in the brain. Another ancient analgesic method, aging back to 5000 BCE in Sumer
, is to use natural minerals, vitamin
s, and herbs, usually in a mixture with other natural products. Technology invented specifically for electroanalgesia emerged at the beginning of the 1900s.
.
and noradrenaline release. TCES can be used on people with cervical pain, chronic lower back syndrome, or migraines. It cannot be used on people with orthopedic or radiological potentially serious spinal conditions; involvement in litigation, hydrocephalus
, epilepsy
, glaucoma
, malignant hypertension
, pacemaker
or other implanted electronic device; recent cerebral trauma, nervous system
infection, skin lesions at sites of electrode placement; oncological disease; patients undergoing any other treatments for pain; any invasive therapy, e.g. surgery, within the last month. The equipment used is Pulse Mazor Instruments' Pulsatilla 1000, which consists of a headset with three electrode
s, two that go behind the ears and one that goes on the forehead, that release set frequencies of electricity at set intervals.
and/or releases endogenous endorphins. This method has mainly been used for chronic pain patients after all other options have failed due to potential of intracranial complications (e.g., intracranial hemorrhage
, infection, and oculomotor abnormalities). A stimulator and an electrode are guided to the site via ventriculography, computed tomography
or magnetic resonance imaging
. Once in place, the electrode is activated by percutaneous leads. It is effective in treating refractory failed back syndrome, trigeminal and peripheral neuropathy, and deafferentation and somatic pain.
level. PNS is most effective in the treatment of neuropathic pain (e.g., posttraumatic neuropathy, diabetic neuropathy) when the nerve lesion is distal to the site of stimulation.
s or muscle
s to electrically stimulate peripheral nerve fibers in the sclerotomal
, myotomal
, or dermatomal distribution corresponding to the patient's pain symptoms. PENS is related to both electroacupuncture
and transcutaneous electrical nerve stimulation
.
The purported mechanism of action of TENS invokes both spinal supraspinal theories.
; it is intended to emulate the H waveform found in nerve signals
, thus permitting the machine to use less power while attaining greater and deeper penetration of its low-frequency current. The waves used in HWT are distinct from the H-waves that are part of electromyography
. It has been used in the treatment of pain related to diabetic neuropathy
, muscle sprain
s, temporomandibular joint disorder
s, type I complex regional pain syndrome
as well as the healing of wounds such as diabetic ulcers. This electroanalgesic modality was originally recommended as an alternative to TENS for dental
analgesia. In a 1999 randomized controlled trial
involving a mechanical pain model, the analgesic effects of HWT were found to be short-lasting and identical to those provided by TENS therapy. HWT has not been shown effective in reducing pain in cases other than diabetic neuropathy, nor has it been shown effective in reducing edema or swelling, and it has specifically not been shown effective in treating chronic pain
due to ischemia
.
to decrease the discomfort of stimulating deeper tissues
(e.g., muscle) when using transcutaneously applied electrical current. A combination of different stimulation frequencies are used (i.e., one fixed at 4 kHz and another within a variable range) to generate frequencies between 4 and 250 Hz which are alleged to more effectively penetrate the soft tissues while producing less discomfort at the skin surface. With ICT, its postulated mechanism of analgesic action is through direct stimulation of muscle fibers rather than peripheral nerves, allegedly improving muscle blood flow and promoting the healing process. Although ICT is used widely in the physiotherapy and rehabilitative
medicine settings, there is a dearth of rigorously controlled studies to justify its effectiveness in the management of either acute or chronic pain syndromes.
rod produces a burst of 10 electrical pulses (five positive and five negative), each lasting 2–3 ms
. Each electrical burst lasts for 50 to 250 ms (depending on the motor speed set) and generates a current of approximately 25 mA. The application of PECT to the skin for 2 min produces a tolerable "pricking" pain sensation associated with a neurogenic inflammatory response lasting 3–4 h. The extent and duration of this inhibitory process is directly related to the intensity of the applied stimulus and is alleged to be associated with the release of endogenous endorphins.
s and hearing aid
s, because the electrical signals of the multiple devices can interfere with each other and fail. People with heart
problems, such as irregular heartbeat, are also at risk because the devices can throw off the normal electrical signal of the heart.
Electricity
Electricity is a general term encompassing a variety of phenomena resulting from the presence and flow of electric charge. These include many easily recognizable phenomena, such as lightning, static electricity, and the flow of electrical current in an electrical wire...
to ease pain
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
. Electrical devices
Electronic component
An electronic component is a basic electronic element and may be available in a discrete form having two or more electrical terminals . These are intended to be connected together, usually by soldering to a printed circuit board, in order to create an electronic circuit with a particular function...
can be internal or external, at the site of pain (local) or delocalized throughout the whole body
Human body
The human body is the entire structure of a human organism, and consists of a head, neck, torso, two arms and two legs.By the time the human reaches adulthood, the body consists of close to 100 trillion cells, the basic unit of life...
. It works by interfering with the electrical currents of pain signals, inhibiting them from reaching the brain
Brain
The brain is the center of the nervous system in all vertebrate and most invertebrate animals—only a few primitive invertebrates such as sponges, jellyfish, sea squirts and starfishes do not have one. It is located in the head, usually close to primary sensory apparatus such as vision, hearing,...
and inducing a response; different from traditional analgesics, such as opiates which mimic natural endorphins and NSAIDs (non-steroidal anti-inflammatory drugs)which help relieve inflammation and stop pain at the source. Electroanalgesia has a lower addictive potential and poses less health threats to the general public, but can cause serious health problems, even death, in people with other electrical devices such as pacemakers or internal hearing aids, or with heart problems
Heart disease
Heart disease, cardiac disease or cardiopathy is an umbrella term for a variety of diseases affecting the heart. , it is the leading cause of death in the United States, England, Canada and Wales, accounting for 25.4% of the total deaths in the United States.-Types:-Coronary heart disease:Coronary...
.
History
The first cases of electroanalgesia were documented by Greek scholars, PlutarchPlutarch
Plutarch then named, on his becoming a Roman citizen, Lucius Mestrius Plutarchus , c. 46 – 120 AD, was a Greek historian, biographer, essayist, and Middle Platonist known primarily for his Parallel Lives and Moralia...
and Socrates
Socrates
Socrates was a classical Greek Athenian philosopher. Credited as one of the founders of Western philosophy, he is an enigmatic figure known chiefly through the accounts of later classical writers, especially the writings of his students Plato and Xenophon, and the plays of his contemporary ...
, who noticed numbing effects of standing in pools of water on a beach that contained electric fish
Electric fish
An electric fish is a fish that can generate electric fields. It is said to be electrogenic; a fish that has the ability to detect electric fields is said to be electroreceptive. Most electrogenic fish are also electroreceptive. Electric fish species can be found both in the sea and in freshwater...
. The Chinese practice of acupuncture
Acupuncture
Acupuncture is a type of alternative medicine that treats patients by insertion and manipulation of solid, generally thin needles in the body....
, dating back to 3000 BCE, also utilizes the properties of electroanalgesia by stimulating specific nerves to produce electrical signals which produce pleasurable responses in the brain. Another ancient analgesic method, aging back to 5000 BCE in Sumer
Sumer
Sumer was a civilization and historical region in southern Mesopotamia, modern Iraq during the Chalcolithic and Early Bronze Age....
, is to use natural minerals, vitamin
Vitamin
A vitamin is an organic compound required as a nutrient in tiny amounts by an organism. In other words, an organic chemical compound is called a vitamin when it cannot be synthesized in sufficient quantities by an organism, and must be obtained from the diet. Thus, the term is conditional both on...
s, and herbs, usually in a mixture with other natural products. Technology invented specifically for electroanalgesia emerged at the beginning of the 1900s.
Technology
Advancements in technology within the past fifteen years have created multiple forms of electroanalgesia. Doctors can target specific electrical signals caused by pain and cancel them out using electrical signals, optimally with alternating low and high frequenciesFrequency
Frequency is the number of occurrences of a repeating event per unit time. It is also referred to as temporal frequency.The period is the duration of one cycle in a repeating event, so the period is the reciprocal of the frequency...
.
Transcranial electrostimulation
A theoretical explanation for the mechanism of pain reduction by transcranial electrostimulation, or TCES, suggests that the electrical stimulation activates the anti-nociceptive system in the brain, resulting in β-endorphin, serotoninSerotonin
Serotonin or 5-hydroxytryptamine is a monoamine neurotransmitter. Biochemically derived from tryptophan, serotonin is primarily found in the gastrointestinal tract, platelets, and in the central nervous system of animals including humans...
and noradrenaline release. TCES can be used on people with cervical pain, chronic lower back syndrome, or migraines. It cannot be used on people with orthopedic or radiological potentially serious spinal conditions; involvement in litigation, hydrocephalus
Hydrocephalus
Hydrocephalus , also known as "water in the brain," is a medical condition in which there is an abnormal accumulation of cerebrospinal fluid in the ventricles, or cavities, of the brain. This may cause increased intracranial pressure inside the skull and progressive enlargement of the head,...
, epilepsy
Epilepsy
Epilepsy is a common chronic neurological disorder characterized by seizures. These seizures are transient signs and/or symptoms of abnormal, excessive or hypersynchronous neuronal activity in the brain.About 50 million people worldwide have epilepsy, and nearly two out of every three new cases...
, glaucoma
Glaucoma
Glaucoma is an eye disorder in which the optic nerve suffers damage, permanently damaging vision in the affected eye and progressing to complete blindness if untreated. It is often, but not always, associated with increased pressure of the fluid in the eye...
, malignant hypertension
Malignant hypertension
Malignant hypertension or hypertensive emergency is severe hypertension with acute impairment of an organ system and the possibility of irreversible organ-damage...
, pacemaker
Pacemaker
An artificial pacemaker is a medical device that uses electrical impulses to regulate the beating of the heart.Pacemaker may also refer to:-Medicine:...
or other implanted electronic device; recent cerebral trauma, nervous system
Nervous system
The nervous system is an organ system containing a network of specialized cells called neurons that coordinate the actions of an animal and transmit signals between different parts of its body. In most animals the nervous system consists of two parts, central and peripheral. The central nervous...
infection, skin lesions at sites of electrode placement; oncological disease; patients undergoing any other treatments for pain; any invasive therapy, e.g. surgery, within the last month. The equipment used is Pulse Mazor Instruments' Pulsatilla 1000, which consists of a headset with three electrode
Electrode
An electrode is an electrical conductor used to make contact with a nonmetallic part of a circuit...
s, two that go behind the ears and one that goes on the forehead, that release set frequencies of electricity at set intervals.
Deep brain stimulation
Deep brain stimulation, or DBS, was first evaluated as an electroanalgesic in the late 1950s. Works in chronic pain patients. DBS decreases pain transmission along sensory discriminative pathwaysNeural pathway
A neural pathway, neural tract, or neural face, connects one part of the nervous system with another and usually consists of bundles of elongated, myelin-insulated neurons, known collectively as white matter...
and/or releases endogenous endorphins. This method has mainly been used for chronic pain patients after all other options have failed due to potential of intracranial complications (e.g., intracranial hemorrhage
Intracranial hemorrhage
An intracranial hemorrhage is a hemorrhage, or bleeding, within the skull.-Causes:Intracranial bleeding occurs when a blood vessel within the skull is ruptured or leaks. It can result from physical trauma or nontraumatic causes such as a ruptured aneurysm...
, infection, and oculomotor abnormalities). A stimulator and an electrode are guided to the site via ventriculography, computed tomography
Computed tomography
X-ray computed tomography or Computer tomography , is a medical imaging method employing tomography created by computer processing...
or magnetic resonance imaging
Magnetic resonance imaging
Magnetic resonance imaging , nuclear magnetic resonance imaging , or magnetic resonance tomography is a medical imaging technique used in radiology to visualize detailed internal structures...
. Once in place, the electrode is activated by percutaneous leads. It is effective in treating refractory failed back syndrome, trigeminal and peripheral neuropathy, and deafferentation and somatic pain.
Peripheral nerve stimulation
The use of peripheral nerve stimulation, or PNS, for the relief of chronic pain states was first reported over 30 years ago. Recent studies have demonstrated that electrical stimulation of peripheral nerves leads to inhibitory input to the pain pathways at the spinal cordSpinal cord
The spinal cord is a long, thin, tubular bundle of nervous tissue and support cells that extends from the brain . The brain and spinal cord together make up the central nervous system...
level. PNS is most effective in the treatment of neuropathic pain (e.g., posttraumatic neuropathy, diabetic neuropathy) when the nerve lesion is distal to the site of stimulation.
Percutaneous electrical nerve stimulation
Percutaneous electrical nerve stimulation, or PENS, is used mainly in the treatment of intractable pain associated with chronic low back pain syndrome, cancer, and other disorders. It is a technique involving insertion of an ultra-fine acupuncture needle which probes into the soft tissueSoft tissue
In anatomy, the term soft tissue refers to tissues that connect, support, or surround other structures and organs of the body, not being bone. Soft tissue includes tendons, ligaments, fascia, skin, fibrous tissues, fat, and synovial membranes , and muscles, nerves and blood vessels .It is sometimes...
s or muscle
Muscle
Muscle is a contractile tissue of animals and is derived from the mesodermal layer of embryonic germ cells. Muscle cells contain contractile filaments that move past each other and change the size of the cell. They are classified as skeletal, cardiac, or smooth muscles. Their function is to...
s to electrically stimulate peripheral nerve fibers in the sclerotomal
Sclerotome
A sclerotome is part of a somite, a structure in vertebrate embryonic development. Sclerotomes eventually differentiate into the vertebrae and most of the skull...
, myotomal
Myotome
In vertebrate embryonic development, a myotome is a group of tissues formed from somites that develop into the body wall muscle.Each myotome divides into a dorsal epaxial part and a ventral hypaxial part....
, or dermatomal distribution corresponding to the patient's pain symptoms. PENS is related to both electroacupuncture
Electroacupuncture
Electroacupuncture is a form of acupuncture where a small electric current is passed between pairs of acupuncture needles. Another term is Percutaneous Electrical Nerve Stimulation ....
and transcutaneous electrical nerve stimulation
Transcutaneous electrical nerve stimulation
Transcutaneous electrical nerve stimulation is the use of electric current produced by a device to stimulate the nerves for therapeutic purposes...
.
Percutaneous neuromodulation therapy
PENS used to be a term to describe a neurosurgical procedure involving implantation of temporary stimulating electrodes before an SCS device. The term has recently been changed to percutaneous neuromodulation therapy, or PNT. The term PNT was chosen because it more accurately describes the neurophysiologic basis for PENS-induced analgesia.Transcutaneous electrical nerve stimulation
Transcutaneous electrical nerve stimulation, or TENS, involves the transmission of electrical energy from an external stimulator to the peripheral nervous system via cutaneously placed conductive gel pads. TENS can be subclassified into two variants:- low-intensity (1–2 mA), high-frequency (50–100 Hz) TENS; and
- acupuncture-like high-intensity (15–20 mA), low-frequency (1–5 Hz) or "dense-disperse" TENS.
The purported mechanism of action of TENS invokes both spinal supraspinal theories.
Transcutaneous acupoint electrical stimulation
Transcutaneous acupoint electrical stimulation, or TAES, is a variant of TENS therapy that involves applying cutaneous electrodes at classical Chinese acupoints and stimulating with alternating high- and low-frequency electrical current ("dense-disperse"). Acupoint stimulation is as effective as dermatomal stimulation in producing an analgesic-sparing effect after lower abdominal surgeryH-wave therapy
H-wave therapy (HWT) is a form of electrical stimulation that produces a direct, localized effect on the conduction of underlying peripheral nerves. The electrical stimulation used in HWT differs from other forms of electrical stimulation such as TENS in terms of its waveformWaveform
Waveform means the shape and form of a signal such as a wave moving in a physical medium or an abstract representation.In many cases the medium in which the wave is being propagated does not permit a direct visual image of the form. In these cases, the term 'waveform' refers to the shape of a graph...
; it is intended to emulate the H waveform found in nerve signals
Action potential
In physiology, an action potential is a short-lasting event in which the electrical membrane potential of a cell rapidly rises and falls, following a consistent trajectory. Action potentials occur in several types of animal cells, called excitable cells, which include neurons, muscle cells, and...
, thus permitting the machine to use less power while attaining greater and deeper penetration of its low-frequency current. The waves used in HWT are distinct from the H-waves that are part of electromyography
Electromyography
Electromyography is a technique for evaluating and recording the electrical activity produced by skeletal muscles. EMG is performed using an instrument called an electromyograph, to produce a record called an electromyogram. An electromyograph detects the electrical potential generated by muscle...
. It has been used in the treatment of pain related to diabetic neuropathy
Diabetic neuropathy
Diabetic neuropathies are neuropathic disorders that are associated with diabetes mellitus. These conditions are thought to result from diabetic microvascular injury involving small blood vessels that supply nerves in addition to macrovascular conditions that can culminate in diabetic neuropathy...
, muscle sprain
Sprain
A sprain is an injury in a joint, caused by the ligament being stretched beyond its capacity. A muscular tear caused in the same manner is referred to as a strain. In cases where either ligament or muscle tissue is torn, immobilization and surgical repair may be necessary...
s, temporomandibular joint disorder
Temporomandibular joint disorder
Temporomandibular joint disorder , or TMJ syndrome, is an umbrella term covering acute or chronic inflammation of the temporomandibular joint, which connects the mandible to the skull. The disorder and resultant dysfunction can result in significant pain and impairment...
s, type I complex regional pain syndrome
Complex regional pain syndrome
Complex regional pain syndrome is a chronic progressive disease characterized by severe pain, swelling and changes in the skin. It often affects an arm or a leg and may spread to another part of the body.Though treatment is often unsatisfactory, early multimodal therapy can cause dramatic...
as well as the healing of wounds such as diabetic ulcers. This electroanalgesic modality was originally recommended as an alternative to TENS for dental
Dentistry
Dentistry is the branch of medicine that is involved in the study, diagnosis, prevention, and treatment of diseases, disorders and conditions of the oral cavity, maxillofacial area and the adjacent and associated structures and their impact on the human body. Dentistry is widely considered...
analgesia. In a 1999 randomized controlled trial
Randomized controlled trial
A randomized controlled trial is a type of scientific experiment - a form of clinical trial - most commonly used in testing the safety and efficacy or effectiveness of healthcare services or health technologies A randomized controlled trial (RCT) is a type of scientific experiment - a form of...
involving a mechanical pain model, the analgesic effects of HWT were found to be short-lasting and identical to those provided by TENS therapy. HWT has not been shown effective in reducing pain in cases other than diabetic neuropathy, nor has it been shown effective in reducing edema or swelling, and it has specifically not been shown effective in treating chronic pain
Chronic pain
Chronic pain has several different meanings in medicine. Traditionally, the distinction between acute and chronic pain has relied upon an arbitrary interval of time from onset; the two most commonly used markers being 3 months and 6 months since the initiation of pain, though some theorists and...
due to ischemia
Ischemia
In medicine, ischemia is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. It may also be spelled ischaemia or ischæmia...
.
Interferential current therapy
Interferential current therapy, or ICT, is another variant of TENS that uses the principle of amplitude modulationAmplitude modulation
Amplitude modulation is a technique used in electronic communication, most commonly for transmitting information via a radio carrier wave. AM works by varying the strength of the transmitted signal in relation to the information being sent...
to decrease the discomfort of stimulating deeper tissues
Tissue (biology)
Tissue is a cellular organizational level intermediate between cells and a complete organism. A tissue is an ensemble of cells, not necessarily identical, but from the same origin, that together carry out a specific function. These are called tissues because of their identical functioning...
(e.g., muscle) when using transcutaneously applied electrical current. A combination of different stimulation frequencies are used (i.e., one fixed at 4 kHz and another within a variable range) to generate frequencies between 4 and 250 Hz which are alleged to more effectively penetrate the soft tissues while producing less discomfort at the skin surface. With ICT, its postulated mechanism of analgesic action is through direct stimulation of muscle fibers rather than peripheral nerves, allegedly improving muscle blood flow and promoting the healing process. Although ICT is used widely in the physiotherapy and rehabilitative
Physical therapy
Physical therapy , often abbreviated PT, is a health care profession. Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, diagnosis, treatment/intervention,and rehabilitation...
medicine settings, there is a dearth of rigorously controlled studies to justify its effectiveness in the management of either acute or chronic pain syndromes.
Piezo-electric current therapy
Piezo-electric current therapy, or PECT, is an analgesic technique based on the principle that mechanical deformation of a motorized piezoelectric ceramicCeramic
A ceramic is an inorganic, nonmetallic solid prepared by the action of heat and subsequent cooling. Ceramic materials may have a crystalline or partly crystalline structure, or may be amorphous...
rod produces a burst of 10 electrical pulses (five positive and five negative), each lasting 2–3 ms
Millisecond
A millisecond is a thousandth of a second.10 milliseconds are called a centisecond....
. Each electrical burst lasts for 50 to 250 ms (depending on the motor speed set) and generates a current of approximately 25 mA. The application of PECT to the skin for 2 min produces a tolerable "pricking" pain sensation associated with a neurogenic inflammatory response lasting 3–4 h. The extent and duration of this inhibitory process is directly related to the intensity of the applied stimulus and is alleged to be associated with the release of endogenous endorphins.
Controversies
Electroanalgesia poses serious health problems in those patients who need other electrical equipment in their bodies, such as pacemakerPacemaker
An artificial pacemaker is a medical device that uses electrical impulses to regulate the beating of the heart.Pacemaker may also refer to:-Medicine:...
s and hearing aid
Hearing aid
A hearing aid is an electroacoustic device which typically fits in or behind the wearer's ear, and is designed to amplify and modulate sound for the wearer. Earlier devices, known as "ear trumpets" or "ear horns", were passive funnel-like amplification cones designed to gather sound energy and...
s, because the electrical signals of the multiple devices can interfere with each other and fail. People with heart
Heart
The heart is a myogenic muscular organ found in all animals with a circulatory system , that is responsible for pumping blood throughout the blood vessels by repeated, rhythmic contractions...
problems, such as irregular heartbeat, are also at risk because the devices can throw off the normal electrical signal of the heart.