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11 Articles in Volume 10, Issue #9
Activated Glia: Targets for the Treatment of Neuropathic Pain
Acute Herpes Zoster Neuritis and Postherpetic Neuralgia
Acute Treatment of Cluster Headache
Chronic Overuse Sports Injuries in the Adolescent/Pediatric Population
Clinical Recognition of Central Abnormal Neuroplasticity
H-Wave® Stimulation: A Novel Approach In Electromedicine
Homeopathy Enters Contemporary Pain Practice
Immune-modulating Effects of Therapeutic Laser
Pain and Addiction: Words, Meanings, and Actions in the Age of the DSM-5
Partial Plantar Fasciectomy With Autologous Platelet Concentrate
Tethered Spinal Cord Syndrome: Pathophysiology and Radiologic Diagnosis

H-Wave® Stimulation: A Novel Approach In Electromedicine

H-Wave technology is built on the work of those pioneers of electro-biology who paved the way and helped shape this technology. The early years of electrotherapy focused on stimulation patterns whose physiologic objectives where to target primary nerve populations—motor nerves (DC current), sensory nerves (TENS), mixed nerve stimulation (IFC), nerve muscle or alpha motor units (EMS), or cellular targets (MENS) and/or neurovascular targets (PENS). This latter category, percutaneous electrical nerve stimulation is usually associated with electro-acupuncture. Before we explore the unique characteristics and benefits of H-Wave technology, it is instructive to review the historical and therapeutic applications of electricity.

Historical Perspective

Benjamin Franklin is perhaps best known as one of the members who helped draw up the declaration of independence and the US Constitution. In 1752, he also proved that lightening and the spark from amber were one and the same. The story of how he tied an iron spike to a silken kite and flew it in a thunderstorm while holding the end of the kite string by an iron key is legendary. When lightening struck, a tiny spark jumped from the key to his wrist proving his theory of electric currents. Many years prior to Franklin, ancient Greek physicians such as Scribonius Largus used what they recognized as being therapeutic electrical properties from the torpedo fish or torpedo ray and used this fish to treat symptoms of headache and gout. The torpedo fish had a reputation of being able to numb fisherman without seemingly touching them in any way. Hence, the electrical properties of this species became well known even in early times. We now know that these electric rays can generate up to 30 Amps and 200 volts of electricity which, when delivered in salt water (which is a better conduction than fresh water), is the equivalent to dropping a hairdryer into a bathtub.

In the year 1600, English physician William Gilbert coined the term electricity from the Greek term “electron” for amber. The Greeks had already identified, many years prior, certain materials that, when rubbed together, would attract light objects. In 1786, Luigi Galvani found that when touched by a metal knife, the leg of a frog twitched strongly. His conclusion was that electricity was contained in the leg muscle of the frog. Alessandro Volta later explained that the key to Galvani’s observation lay in two dissimilar metals—the steel knife and tin plate on which the frog was lying—being the main factors driving this phenomenon. He showed that when water (moisture) came between two different metals, electricity was created. He then went on to invent the electric battery. It wasn’t until Michael Faraday came along in 1831 that electromagnetism was discovered when he realized that a magnet moved inside a coil of copper wire generated a tiny electric current through the wire. In essence, he discovered the first method of generating electricity using motion in a magnetic field and what we now understand to be induction. Prior to that moment in 1785, Charles Coulomb demonstrated that like forces repel and, later in history, both Christian Oersted and Andre Marie Ampere discovered that an electric current produces a magnetic field. It was Michael Faraday’s experiments that later led to Faraday’s laws of electrolysis which expounded on how metals such as sodium and potassium could be precipitated from their compounds by an electric current. Faraday’s induction principle was the basis for today’s dynamo or generator which produces electricity via mechanical means and is the opposite of a motor, which converts electrical into mechanical energy.

Therapeutic Electricity

The use of electricity for therapeutic purposes paralleled the various electricity-related discoveries in general, with an increase in electricity knowledge leading to more medical applications for physiological purposes. Russian emigrΘ George Lakhovsky studied the effects of both electricity and radio waves on living organisms. He wrote the book The Secret of Life and published it in 1935 but, for the most part, it was ignored by conventional medicine. In 1987, Robert Becker wrote his landmark book, The Body Electric, and based many of his arguments on Lakhovsky’s previous work. It is clear that there have been entire libraries of work in the field of electromedicine that, over the years, have been dubbed as quackery and generally criticized by conventional medical proponents. There have been claims of hard-to-believe cures being discovered by pioneers of this technology such as the work performed by Royal Raymond Rife who, by 1932, claimed he had isolated the cancer virus and learned to destroy it in lab cultures and later in animals. His central premise was that all living cells and biochemical compounds have a unique oscillation—a frequency pattern or electro-magnetic signature. Even diseases have their own pattern and Rife categorized these patterns for many disease types. He postulated that he could restore balance in a dysfunctional cell and disrupt balance in a diseased cell thereby destroying a cancer cell using specifically-modified oscillation frequencies. The analogy is that just as a wine glass is shattered only by a particular frequency, a certain cell type can be targeted by similar harmonic principles. These unorthodox ideas did not resonate well with the AMA, in particular, and as a result, the work of Rife was forced underground where it remained for many years.

The field of radiotherapy is historically not only about the use of x-rays, but actually began with the inclusion of radionics, or the study of radiant energy. The original definition of radionics was “the science of detecting, measuring and utilizing micro-energetic emanations which radiate from matter.”1 Using this theory, all matter emanates radio waves that, ultimately, can be detected and altered for treatment purposes. In a very simplistic example, a diseased organ will emanate an altered radio wave pattern that can be detected at the skin level. This radiation could then be neutralized by inverting the wave patterns 180 degrees out of phase and returning them to the patient so as to restore a proper (healthy) radiation pattern. This system of like–curing–like was similar and in concordance with homeopathic principles that explained how remedies worked. In effect, we are talking about “wave cancellation” a concept used extensively in acoustics/electronics and known as phase equalization, phase inversion and phase modulation. Radionics is also a form of “percussive diagnosis” wherein, during the Middle Ages, the abdomen was thumped—with or without drums—to identify an area in a disharmonious state. Today, percussion continues to be part of a medical physician’s standard diagnostic procedure in areas such as the thorax and abdomen where areas of consolidation (masses), or fluid accumulation, alters the resonance pattern of surrounding healthy tissue. Most recently, we have begun to appreciate the early work of these pioneers since they, among other applications, laid the foundation for today’s microcurrent bone stimulation devices. This provides further evidence that yesterday’s outrageous and unproven observations are, in many cases, today’s rational medicine.

Electrotherapy in Clinical Settings

We are all familiar with the term electrotherapy since this is a common mode of treatment with conservative (non-surgical) health care practitioners such as physical therapists, chiropractors, osteopaths, and others. What we might not fully appreciate is the breadth of electrotherapy subcategories that exist under this broad and expansive heading. There are many different waveforms used in clinical practice, with each waveform having unique stimulation characteristics and specific to a certain treatment objective. In the early 1900s, high frequency currents were used in treating joint disease. Twenty years later, researchers began to view human cells as entities that possessed resistance, capacitance and inductance and functioned as tuned resonant circuits. Cells appeared capable of responding to a wide range of frequencies but appeared to have an optimal resonant frequency.

Approximately a decade later came the invention of interferential currents (two medium frequency, crisscrossing currents) which were known for their comfort and ability to reduce muscle tightness/spasm. Later still in the 1970s came the TENS unit which acted in accordance with Melzack and Walls theory of spinal gating which proposed that strong afferent stimulation could “jam” spinal circuitry at the spinal cord level thus blocking any further transmission of pain signals to the brain. At the same time, we have some critical basic research being conducted by Robert Salter, MD, at the University of Toronto studying chondral growth stimulation using continuous passive motion. His studies generally emphasize joint motion for optimal chondral healing, as opposed to bed rest which was once the standard of care.

In a neighboring department of zo-ology, researchers Bruce Pomeranz and Richard Cheng were also helping to unravel the mystery of bio-electricity applied to acupuncture points (electro-acupuncture) by experimenting with various frequencies—i.e., low frequency electro-stimulation that induced endorphin release. Concurrent to this research are the pioneering discoveries of Robert Becker, MD—including his work on the effects of electric fields on limb regeneration and tissue healing/alteration (cell de-differentiation using silver ions) using physiological-carrying currents. His work is best described in his books The Body Electric and Cross Currents. Both are required reading for those working in research or the application of electrotherapeutic devices. Becker was less interested in frequencies and more focused on the intensity of the direct currents as being determinants of cell stimulation or inhibition.

H-Wave Technology

Electronic Waveform Lab, Inc., is the manufacturer of the H-Wave device and markets their product to rehabilitation and sports medicine providers across the globe. The literature packet for this product includes an impressive list of publications in peer-reviewed journals supporting the effectiveness of H-Wave application. Blum et al,2 when making reference to this device, state that there needs to be a paradigm shift in understanding how H-Wave device stimulation (HWDS) operates. They make reference to this device’s ability to stimulate red slow twitch fibers. In doing so, it stimulates small smooth muscle fibers within the lymphatic vessels that ultimately lead to fluid shifts and reduced edema. Rodent studies provide much of the support for this hypothesis showing that HWDS helps to clear proteins in these particular in-vivo models.

The H-Wave device was designed to simulate a natural muscle contraction and utilizes a low frequency (1-2 Hz) non-tetanizing, non-fatiguing contraction. H-wave appears to preferentially stimulate smaller muscle fibers and not the motor nerves of larger white muscle fibers. Neither A-delta nor C–nerve fibers are recruited thus eliminating the discomfort associated with tetanizing contractions/fatigue. Unlike a TENS unit that acts to overload the spinal gateway to stop pain signals from reaching the thalamic portion of the brain, the H-Wave is thought to deactivate the sodium pump which leads to post-synaptic depression and ultimately offers a longer-lasting period of analgesia for the patient.3 Another very interesting physiological mechanism of H-Wave is postulated to be the production of nitric oxide-dependent angiogenesis which has again been demonstrated in rodent studies.4

Research Studies

The research studies conducted to date on the H-Wave device show significant gains being made in three distinct areas:

  • functional improvement,
  • pain reduction, and
  • medication use reduction.

These are important target areas for practitioners to take note of since they are arguably some of the most important outcomes we can achieve in the treatment of pain. A recent meta-analysis was conducted to systematically review the results of five studies that were specific to H-Wave and examined the effects of this device on non-inflammatory and neuropathic pain.5 With regard to pain reduction, there was a mean weighted effect size of 0.59 reported by the authors, with an effect size variance of 0.00003 and (95% CI: 0.580,0.600). Regarding medication intake reduction, the mean weighted effect size reported was 0.56 with estimated effect size variance of 0.000013 and (95% CI: 0.553, 0.567). Finally, with regard to functional improvement (functionality) there was a mean weighted effect size of 0.70 reported, with estimated effect size variance of 0.00002 and (95% CI: 0.691, 0.709). The investigators concluded that there is a moderate to strong analgesic effect associated with the use of H-Wave and the resulting improved pain profile, functional status, and reduced medication could naturally lead to faster return to work or sport in those specific situations.

Some interesting work out of Wake Forest University, performed by Smith et al,6 examined the role of H-Wave electrical device stimulation (HWDS) on arteriolar vaso-dilation in rat studies. They looked at the acute effects of HWDS on striated cremasteric rat muscle arteriolar diameters. The study design involved using three treatment arms: the first group was stimulated with H-Wave, the second with a sham stimulation, and a third group was stimulated with H-Wave but given an NO (nitric oxide) blocker drug L-NAME. One of the initial hypothesis was that NO would probably be involved if a dilatation effect was present. The results showed that the HWDS group did indeed have an arteriolar vasodilation effect whereas the sham stimulation group did not. Furthermore, the group given an NO blocking agent also did not show any arteriolar vasodilation suggesting that nitrous oxide does indeed play a role in increased tissue perfusion.

There is further evidence that H-Wave therapy can help in the rehabilitation of certain conditions such as post-perative rotator cuff reconstruction pain and dysfunction by increasing the range of motion. Blum et al7 conducted a randomized controlled clinical trial on H-Wave and used an active (sham) treatment as the control. At 45 and 90 days post-op, the HWDS group showed superior gains in both external and internal rotation range of motion (p=0.007) and (p=0.006), respectively. No differences in shoulder strength were found.

Figure 1. H-Wave device being applied to a patient with diabetic neuropathy.

The H-Wave device has been used extensively in diabetic neuropathy (see Figure 1) for the treatment of pain,8 paresthesia,9 and as a powerful adjunct to medication.10-11 Large population studies have confirmed the unique nature of H-Wave electrotherapy stimulation and found this technique to be a valuable adjunct in the treatment of chronic pain. This particular outcome study had a sample size of 6,774. The participants took a pre– and post–H-Wave treatment 10-item survey that examined the effect of H-Wave therapy on their condition—which was either chronic soft tissue or neuropathic-mediated pain. 65% of respondents reported a reduced need for medication, 79% reported improved functionality, and 78% reported a 25% or greater reduction in pain.12

Conclusion
H-Wave has been shown to be an effective modality in the treatment of chronic pain including that of neuropathic origin such as diabetic neuropathy. The unique mechanism(s) of action intrinsic to H-Wave stimulation makes it an attractive choice for patients who do not tolerate hyper-sensory stimulation (TENS) well—such as those having peripheral neuropathies and complex regional syndromes. H-Wave appears to have a beneficial effect when applied in inflammatory conditions by stimulating interstitial fluid shifts. This is an intriguing finding and consistent with how micro-circulatory engorgement impacts the inflammatory cycle as a whole. Clearing fluids and/or re-establishing optimal fluid dynamics could be an important part of tissue recovery and the healing process in general. As well, the finding that H-Wave enhances micro-circulatory status has implications for improved neo-vascularization and tissue perfusion, in general, and in a diabetic population, specifically. Diabetics often suffer from the consequences of poor circulation and compromised tissue oxygenation.

Last updated on: March 7, 2011
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