Electrotherapy and Pain

This article is about pain - and the waveforms included in the Stimulette Edition 5 S2x for working with various kinds of pain. Electrical stimulation is extensively used for the symptomatic control of pain. Although the idea had been proposed for many years (decades even) the rationale boost was provided by the so called “gate control theory” of pain proposed in the mid 1960s by Meizack and Wall. Even today the mechanisms of pain generation and perception are being revised and updated so we won’t review that here. We will point to the scope and variety of waveforms available.

We can point to a number of types of pain - Acute, Nociceptive, Chronic, Neuropathic

• Acute pain - closely associated with tissue damage. “Nociceptive pain” is usually acute and develops in response to a specific situation. It tends to go away as the affected body part heals. For example, nociceptive pain due to a broken ankle gets better as the ankle heals. The body contains specialised nerve cells called nociceptors that detect noxious stimuli or things that could damage the body, such as extreme heat or cold, pressure, pinching, and chemicals. These warning signals are then passed along the nervous system to the brain, resulting in nociceptive pain.

• Chronic pain - defined by it’s persistence for at least 3 months after healing is presumed to have occured. Neuropathic pain is a term used to describe the pain that develops when the nervous system is damaged or not working properly due to disease or injury. It is different from nociceptive pain because it does not develop in response to any specific stimulus. In fact, individuals can suffer from neuropathic pain even when the aching or injured body part is not actually there. This condition is called phantom limb pain, which may occur in people after they have had an amputation. It is relevnt to diabetic foot disease and some forms of nerve trauma. Neuropathic pain is also referred to as nerve pain and is usually chronic.

The Edition 5 electrotherapy product supports a number of waveform types for application across the spectrum of pain manifestations. Particular waveforms may be favoured in different parts of the world and yet virtually unknown in others. The particular waveform groups included are:

• GALV - Three “galvanisation” waveforms for Acute, Chronic, nociceptive pain, Neuropathic Pain. Primarily used for Iontophoresis.

• IG - Two Impulse Galvanisation waveforms or Acute, Chronic nociceptive pain, Neuropathic Pain. IG30 is also effective at enhancing blood flow in an area. IG30 also for neuropathic pain

• UR - Ultra-Reizcurrent waveform. The UR waveform is applicable to Acute and Chronic nociceptive and neuropathic pain.

• DIAD - Four diadynamic waveforms - Diadynamic waveforms for pain relief for Acute, Chronic nociceptive pain, Neuropathic Pain. Also used for Iontopheresis

• TENS - Transcutaneous Electrical Nerve Stimulation for Chronic pain. Also for Acute, Chronic nociceptive pain and Neuropathic Pain. TENS-HFT for Acute pain and TENS LFT and TENS-BuT for Chronic pain

• HV - HV100 (High Voltage) particularly for Acute pain although applicable also to neuropathic pain

• MFR - Medium frequency waveforms can be used with acute and chronicpain. MF100 is used for acute pain

The obvious question then is which ones to use in a particular case?

A distinction is made in the list above between the various types of pain as a starting point. In addition we generally recommend using Biphasic waveforms as being generally more useful with individuals who are sensitive to stimulation and they can be used when metal work such as orthopaedic instruments are present int eh treatment area - the GALV waveforms used for iontophoresis especially require experience and input from a prescriber and should be avoided for home use.

Some waveforms are particularly favoured in some countries - ie DIAD France, UR Central Europe - but virtually unknown elsewhere. Although there is a broad body of evidence for partiuclar waveforms - especially the TENS waveforms, there is a lack of formal research information on how the various waveform options compare in terms of effectiveness and how parameters should be chosen.

The fact is, some experimentation will almost certainly be needed to choose a waveform and associated parameters that work. The good news is that such experimentation involves little risk if approached with care. Bear in mind that eectrotherapy is best considered as an adjunct to other forms of therapy.

Probably the best place to start is with the TENS waveforms utilising the Biphasic forms
With Acute pain - TENS-HFT
With Chronic pain - TENS-LFT or TENS-BuT

If you would like to know more about the specific details of these protocols let us know.