Electromagnetic Devices: A New Partner in Pain Management
Physicians are used to thinking in terms of generational treatments. For example, the discovery of penicillin led to the development of the first generation of antibiotics, which were later replaced by second- and third-generation antibiotics, such as the cephalosporins. The same generational developments occurred with antihypertensive and antidepressant agents.
Medical devices that administer electricity, or an agent derived from electricity, have also evolved. Simple electric currents or static electrical charges were the first generation of these devices.1,2 About 2,000 years ago in ancient Rome, a physician by the name of Scribonius Largus used an electrical torpedo fish, or electric eel, to administer electricity. If a person had a foot, ankle, or knee problem such as gout, plantar fasciitis, or arthritis the good doctor would have you stand on the electric eel until your leg became numb from heel to knee. This was the first transcutaneous electrical nerve stimulation unit!
Progress from the early days of electromedicine has been profound. Over the centuries, a variety of batteries and static friction devices have delivered electric charges to patients in pain. Today, we have implanted electrical stimulators, bone stimulators, and inexpensive take-home devices that give thousands of patients extra pain relief each day.3-9 Electric currents may be pulsed and have varied amplitudes and frequencies.7,8 One new, especially innovative electrical device is the microcurrent. This low amplitude device sends a current the patient can’t even feel into small joints, myofascial trigger points, and even the central nervous system.8
The second generation of electromedical devices are those that use ultrasound, which is derived from an electric current.3,4 It is actually a form of radar. During World War II, British and American scientists teamed up to find a technique to detect German planes flying over the English Channel on their way to bomb London. After the war, some bright medical scientists rightfully figured that radar could have some medical uses. The rest is history. By 1955, ultrasound was used for both diagnosis and treatment of painful conditions. John F. Kennedy reportedly had ultrasound used on his painful back in the late 1950s. Today, ultrasound has many diagnostic and therapeutic uses including the break up of stones and painful calcific deposits in muscles and nerves.10
The electric current and ultrasound devices used in pain medicine today have a most welcome partner—the electromagnetic devices.1,3 This third generation of devices are causing eyes to roll and minds to open as pain practitioners start to use and understand the therapeutic benefits of devices that simultaneously deliver electrical and magnetic energy to tissue.
Third Generation of Devices
The story of this new generation began with the scientific finding that an electric current in a wire has an energy field around it that is 50% electronic and 50% magnetic.1,4 Further scientific realization determined that the energy field around a wire conducting electricity is emitted in waves of different lengths ranging from subatomic (ie, ɣ ray) to the length of a building (ie, radio waves) (Table 1). These waves now make up the collective phrase, “electromagnetic spectrum.” At this time, the energy waves called laser, light, infrared, and radio have been manufactured in devices for pain treatment.11-17 There are several key points about these devices that are pertinent to the pain practitioner. All the waves are 50% electronic and 50% magnetic. If the frequency of the wave being administered is high, the wave is called “hot.” These waves are administered for tissue ablation. The two that fall in this category are “laser” and “radio.” “Hot” radio waves are very effective for many back and neck pain problems.18 If the frequency is low, it is called “cold.” We now have cold lasers and radio waves.11,12,17 Cold laser treatment has been shown to ameliorate many pain problems.11-15 The cold radio wave is only available at this time in military and veterans hospitals. It has shown great therapeutic ability to resolve some difficult pain problems since it delivers its wave through an 8-inch square plate that covers a large pain site.17
The electromagnetic energy waves used for pain treatment produce immediate pain relief by activation of peripheral endorphins, reduction of edema and inflammation, dissemination of sequestered electrical charges, and production of local anesthesia.1,7,12,17 Most impressive is that the combination of electronic and magnetic energy fields causes the genes in soft tissue to activate.12,14,16,17 Over several days of treatment, gene activation leads to proliferative growth of fibroblasts, angioblasts, and Schwann cells among other soft tissue healing cells. This is an exciting phenomenon that usually adds up to some tissue healing and permanent pain reduction. Sometimes a cure is even possible. Lastly, some of the new electromagnetic devices, particularly infrared and radio, cause medications including lidocaine, corticoids, and anti-inflammatory agents to diffuse through the skin. This is the new and improved “iontophoresis.”19
In the past 3 years, Practical Pain Management has published almost 2 dozen articles on electric currents, ultrasound, and the new electromagnetic devices.1-19 Think of it: science has now captured the miracle of electricity, sound, and electromagnetic energy for the benefit of pain patients. We will continue to publish exciting developments with these devices, as we believe every pain practice should acquire and master their uses. As with pharmaceuticals, these devices have different uses and indications. Practitioners are now finding innovative and effective ways to use these devices that best suit their patients and practice situations. It’s time to add some electromagnetic devices to your armamentarium, which may already contain some electric current and ultrasound devices. We owe it to our patients to adopt these forms of treatment, as they offer some permanent healing therapy as opposed to sympathetic care.