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13 Articles in Volume 11, Issue #3
Advances in Cranial Electrotherapy Stimulation
Chronic Migraine: An Interactive Case History, Part 3
Cost-effectiveness Of Treatments for Low Back Pain
Electrical Me
Lessons From The Father of Electromedicine — Dr. Luigi Galvani
Medications for Chronic Pain—Nonopioid Analgesics
Pulsed Radio Frequency Energy As an Effective Pain Treatment
The Role of Body Posture In Musculoskeletal Pain Syndromes
The Role of Body Posture In Musculoskeletal Pain Syndromes
Therapeutic Laser for the Treatment of Chronic Low Back Pain
Tolerance to Opioids
Understanding Electromagnetic Treatments
Update: Clinical Challenges in the Diagnosis And Management of Fibromyalgia

Understanding Electromagnetic Treatments

In addition to immediate pain relief, the administration of electricity or its derivatives may assist tissue healing and regeneration by cell stimulation, removal of edema and inflammatory mediators, and angiogenesis.

Many facts are known about body electricity and magnetism. Most of these facts, however, have little established practicality relative to pain treatment. We know enough, however, to provide a scientific rationale for the various electromagnetic measures being used today.1-4 This paper attempts to set out what we do and do not know so that practitioners can use the electromagnetic measures that best fit their brand and style of practice, pocketbook, and patient profile.

Definition of EMT

There are many measures that attempt to remove, mobilize, or alter electric charges or currents in the body for therapeutic purposes. Chances are, you already use a number of measures in your practice without realizing that their therapeutic effectiveness is based on removing, mobilizing, or altering electric charges or currents in the body.

Basic electromagnetic measures have been used for centuries and are of 2 types: those that remove or mobilize body electricity and those that administer an electronic current or a derivative of a current (see Table 1). The former includes such simple measures as mineral soaking in hot water, copper bracelets, hot water, and needle insertion. The latter embraces the use of electric currents or a derivative of a current in the form of a sound or an acoustic wave or an electromagnetic energy wave. Administered electric currents or their derivatives have 2 attributes: (1) immediate pain relief and (2) regeneration of tissues.

Often Misunderstood

First, the term “electromagnetic” may be intimidating to some practitioners. Few medical personnel have had extensive training in physics or engineering. Second, commercial marketing of electromagnetic devices has, in my opinion, limited a great deal of interest on the part of pain practitioners. What is lost among the insulting and fraudulent claims of some marketers, however, is the fact that some extraordinary new and impressive electromagnetic devices have come onto the commercial market.

In addition, we now have a good understanding, within some scientific limits, of why magnets, acupuncture, electric currents, acoustic waves, and electromagnetic energy waves have much to offer patients with pain. This understanding is fundamentally simple and can and must be learned by those of us with little formal engineering or physics background. More important, any number of electromagnetic measures can be easily incorporated into patient education and treatment plans. Be very clear, however, that electromagnetic measures are complementary and not a substitute for the time-tested treatments of pharmacotherapy, nutrition, exercise, and surgery.

TABLE 1. TWO TYPES OF ELECTROMAGNETIC MEASURES

Opposite Attract

Opposite electrical charges attract each other. This is the first basic principle in understanding electromagnetic measures. All body tissue contains electromagnetic energy. All matter, including cells, are composed of atoms, which contain in their nuclei at least 1 proton and 1 neutron. At least 1 electron circles the nucleus of each atom. All living tissue contains biologic electricity and has varying proportions of electrons (negative charges), protons (positive charges), and neutrons. An excess of either positive or negative charges in tissue attracts the other and causes a flow of electrons. Electrons that move or mobilize are electricity.2,3 We do not know why, where, or how body tissues make electricity or change polarity from positive to negative or vice versa.

Metals

Metal elements such as copper, magnesium, and iron are positively charged and attract negative charges (electrons). This simple principle of electron attraction is the basis for many age-old electromagnetic measures. They include the use of copper bracelets or necklaces and needle insertion such as acupuncture or “dry” needling of a trigger point.

Dr. Robert Becker, the 20th century’s premier electromagnetic scientist and father of the bone stimulator, theorized that acupuncture meridians carried electric currents back and forth from the central nervous system to the periphery.1 Furthermore, these body “wires” have amplifiers or transformers along them to boost the electric current, just like a transmission high wire will have transformers to boost electric currents over several miles. These body amplifiers, he believed, corresponded to the “acupuncture” points in that a needle insertion at these points would interrupt electric flow and produce pain relief. In a series of elegant experiments, he proved his theories to be correct. Positively charged needles inserted at the amplifier point attracted electrons and “shorted out” the circuit, giving anesthesia and pain relief. His studies clearly give us a scientific rationale for the pain-relief action of acupuncture.

Water

Water is an excellent conductor of electricity. Water has a slightly negative charge because oxygen is slightly more negative than is hydrogen, which is slightly positive. Pure water at its normal temperature is not very effective in extracting electricity from the body. When heated, however, water will speed up conduction of electricity in the body. If a salt with a positive charge, such as sodium or magnesium, is added to warm water, it will immediately attract negative electric charges. The combination of warm water and positively charged salts has been the basis of pain relief by mineral bath soaking for centuries. A hot bath with a commercial salt-like magnesium sulfate (Epsom-salt) is inexpensive, effective, relives pain, and is a good adjunct to just about any pain treatment regimen.

Heat

Because electrons are physical matter, they can be moved by any number of measures. Heat, whether administered by a heating pad, lamp, or hot water, will cause electrons to move. Anything that increases blood flow, including an increase in heart rate caused by exercise or heat, will move electricity. Massage or vibration will also move the body’s electricity, just as you can squeeze water out of a washcloth.

Figure 1. Electricity from a damaged nerveFigure 1. Electricity from a damaged nerve along with waste products from damaged blood and lymph vessels pool, forming a pain site. Inflammatory mediators and opioid receptors appear shortly after injury. Cure requires tissues in the pain site to regenerate.

Pooling of Electricity

A fundamental to understanding electromagnetic measures is the pooling of electric charges around damaged nerves. The pioneering works of Drs. Luigi Galvani and Carlos Matteucci in the late 1700s and early 1800s demonstrated that damaged nerves emit electricity.4 If the wound is open to the air, the emitted electricity merely escapes into the atmosphere. If the injury is under the skin, however, the emitted electricity will collect and pool around the damaged nerves as their normal flow or circuit is interrupted. It is axiomatic that if a nerve is damaged, its blood supply and lymph drainage will also be damaged. This tissue damage therefore produces a pooling of electricity, blood products, lymph drainage, and inflammatory mediators.

Basically, a pain site is a wound under the skin that is simply not visible. The pain site will become warm to the touch as inflammation, which is biologic waste heated by electricity, evolves. Interestingly, opioid receptors propagate in an inflammatory pain site, and it is theorized that these receptors are there to attract circulating endorphins to enhance the inflammatory response and relieve pain5,6 (see Figure 1). One of the best exhibits of inflammatory pain sites can be seen as “hot spots” on thermography (see Figure 2).

Figure 2. Inflamed pain sitesFigure 2. Inflamed pain sites that contain pooled electricity and biologic waste from injured nerves and blood and lymph vessels appear as red, “hot” spots on a thermogram. This thermogram shows typical painful osteoarthritis of the hand.

What is not known, however, is whether patients with severe pain due to severe, intractable nerve damage retain electricity throughout their entire bodies. Although there are a lack of case studies in the literature, some patients with severe, intractable pain anecdotally relate that they retain electricity and, in effect, become a capacitor filled with electricity. These patients relate stories of burning out light bulbs, computers, and wristwatches when they touch them. They can’t touch other people without causing a severe shock, and they may complain that they can’t kiss their spouse.

It is unclear how the body naturally excretes its electricity. A reasonable belief is that the body excretes its electricity at its distal points such as the extremities, earlobes, and nose. It is generally assumed that ground and gravity naturally pull some body electricity downward to escape through the soles of the feet into the ground. Some patients with pain, such as those with severely damaged clumps of nerves as found in the neck, dura, or lumbar-sacral regions, could possibly retain and emit a large amount of electricity. The question, however, is whether the emitted electricity is retained in the entire body or if it only pools around the injured nerves. Also, is it retained, and what are the consequences of retention?

Magnets Mobilize Electricity

The effects of magnets and magnetic energy on the body are still shrouded, to some extent, in mystery. We have known since the scientific work of Faraday in 1831 that a magnet brought perpendicular to an electric current in a wire will depolarize the ends of the wire and cause the electric current to move.2,3 Because pain is, to a great extent, caused by “pooled” or “trapped” electricity, a magnet or magnetic energy wave brought near a pain site causes pooled electricity to mobilize. Magnets also likely attract iron in red blood cells and increase blood flow into a pain site, which promotes mobilization of pooled electricity and inflammatory mediators.

History of Pain Relief

Pain relief by electricity is legend. In ancient Greece, Egypt, and Rome, electric eels were used to treat arthralgias and migraines.7 In 50 AD, Scribonies Largus wrote that “for any sort of foot gout, when the pain comes on, it is good to put a living black torpedo fish under his feet while standing on the beach, not dry but one which the sea washes, until he feels that his whole foot and ankle are numb up to the knees.”

Among the first electrical instruments used for pain treatment was the “Baghdad Battery.” This was a copper plate around an iron rod placed at the core inside a small clay pot. Water inside the pot would generate a low-level current, which could be placed over a painful area. These batteries date to about 225 to 640 AD. An elementary battery known as the Leyden jar was used between the 16th and 18th centuries for pain treatment. The Leyden jar is named after the University of Leyden in Holland. It had a metal coating, usually tin or silver, on both sides of the glass, with an iron rod at its center. When it was filled with water, an electric current was generated.

John Wesley, founder of the Methodist Church, opened free clinics in the mid-18th century around London and treated more than 20 types of illness by electrifying patients with a friction machine, which generated sparks of electricity. He spoke enthusiastically about the benefits of electrical therapy, saying, “Certainly it comes the nearest to universal medicine of any yet known in the world.”

Today’s electric current instruments are truly remarkable advances. They range from handheld units for at-home use to implanted devices that can be patient regulated on a demand basis.

Electric Currents Promote Regeneration and Healing

Temporary pain relief produced by an electric current device is well established, but it is less widely known that electric currents and their derivatives may heal and regenerate tissue. The seminal clinical discovery and application of this phenomenon is the bone stimulator based on the monumental work of the orthopedic scientist Robert Becker, MD (1923-2008).1 This underappreciated researcher did dozens of experiments on nerve regeneration in frogs and salamanders while a professor at the Veteran’s Hospital attached to Syracuse University. Among his many scientific papers, evidence can be found that electricity can influence the regeneration of bone, cartilage, and nerves. Becker’s work is well summarized in his 1985 book The Body Electric: Foundation of Life.1

In his book, Dr. Becker describes an experiment conducted by the Russian scientist A. M. Sinyukhin of Lomonosov State University in Moscow that illustrates how electrical currents produce healing. Sinyukhin cut off one branch from each of a series of tomato plants. At the wound site, he measured the electricity emanating from the wound, which was a stream of electrons (negative charge). A “current of injury” is emitted from all damaged nerves in animals, as first determined by Galvani in the 1790s.4 After a week, a callus formed over the cut surface, and a new branch began to form. In addition, the electric current changed its polarity to positive. As the positive current increased, cells in the area more than doubled their metabolic rate, became more acetic, and produced more vitamin C. Amazingly, and most cogently for pain practitioners, Sinyukhin applied an electric current to some of the plants. The electricity-assisted plants restored their branches up to 3 times faster than the control plants. The currents were small—only 2 to 3 microamperes administered for 5 days. Larger amounts of electricity killed the cells and had no growth-enhancing effect. It is worth noting that there is now a great interest in using microcurrents to treat painful conditions, and there is a growing number of reports showing good results.

How Does Electricity Relieve Pain?

If one administers an electric current or one of its derivatives to a pain site, pain relief may occur within seconds or minutes.8-13 The reason for this is not entirely known. The prevailing thinking propagated by Melzak and Wall in 1965 is that administered electric currents block the gates that control afferent and efferent impulses in the spinal cord, thus preventing pain impulses from reaching the brain. Others have postulated that endogenous endorphins are released, giving pain relief.9

These two mechanisms may be operative, but they are very likely not the sole answers. Administered electricity simply has too many biologic effects independent of the spinal cord. Galvani showed that frog legs, when separated from their spinal cord, would still contract when an electric current or metals touched the legs4. Electricity administered though acupuncture needles placed in the body’s meridians relieve pain, and the meridians are not connected to the spinal cord.1,9

It is this writer’s conviction that an electric current and its derivatives disperse pooled electricity and/or change the polarity of pooled electricity to reduce pain. Painful, pooled electricity can be either dispersed into the surrounding tissue or channeled into intact nerves. The dispersion theory is enhanced by the clinical observation that pain may be relieved for hours or days after a single administration of electricity, but the pain will recur. The pain returns when electricity emitted from the damaged nerves again recollects and pools. In summary, we must labor with an incomplete understanding of the precise mechanisms by which an electric current or one of its derivatives produces short-term pain relief.

Figure 3: The Electromagnetic Spectrum

Derivatives of Electric Currents

An electric current that passes through a wire will produce electromagnetic energy around the wire. The unit of measurement is the photon.2,3 All of us have seen and heard the displacement of air caused by the emission of these energy waves when we look up at a high transmission wire carrying an electric current of high amperage. The fields emitted around the wire are about 50% electric and 50% magnetic in nature. The energy waves generated by an electric current are collectively known as the “electromagnetic spectrum” (Figure 3). The smallest waves are invisible and consist of ionizing gamma and x-rays.

Of the waves in the electromagnetic spectrum, laser, infrared, and radio are currently used in pain treatment. Radio waves are very long—about the size of a building—and laser waves are about the size of a protozoan. The different wavelengths and frequencies of these energy waves are believed to give each wave varied clinical usages and potentials, but this hope has not yet materialized enough to permit specific clinical recommendations. The electromagnetic devices that administer the energy waves are of a low, safe frequency and are to be clearly contrasted with the high-frequency lasers and radiofrequency devices used solely for tissue ablation.

In addition to electromagnetic energy waves, scientists found a way to make an acoustic or sound wave from an electric current. Ultrasound, the first innovation, has been a mainstay of electomedicine for more than 5 decades.12,13 It has found great use in acute injuries to soft tissue structure such as muscle and fascia. It can also diffuse medications through the skin (eg, phonophoresis).

Inexpensive ultrasound devices are now available for at-home use by patients. More potent acoustic wave devices have been developed that effectively disintegrate kidney stones—lithothripsy. A related technology now available for pain treatment is called extracorporeal shockwave therapy (ESWT). ESWT is a high-pressure acoustic wave derived by passing an electric current through a crystal. Clinical investigations have found that some recalcitrant problems such as plantar fascitis and chronic epicondylitis respond to this new derivative of an electric current.14,15

Regeneration of Tissue

An exciting area of current research has been the use of electrical currents to regenerate tissue—and even “cure” a pain site.16-19 Just as Sinyukhin regenerated his tomato plants and Becker his salamanders, clinicians everywhere are progressively observing regeneration of tissue with these devices. Acute injuries and wounds such as the common low back problem or diabetic ulcers heal much more quickly with these devices.16-19 The regenerative effects on tissue are well documented and are summarized in Table 2. They include growth of cells, angiogenesis, reduction of edema, and clearing of inflammatory mediators.

At this time, there is considerable clinical study by practitioners as to which device may provide maximum regeneration and healing of some difficult pain problems. For example, microcurrents (Alpha-Stim) are being used for cranial stimulation, and radiofrequency (Provant) is being used for plantar fascitis.10,19

Use With Other Therapies

All of the electromagnetic measures mentioned here can be used in combination with the standard pharmacotherapy agents, including anti-inflammatory agents, antidepressants, neuropathic drugs, opioids, and topical medications. The simultaneous use of drugs and electromagnetic measures is highly complementary and enhancing.

Some pain treatment drugs directly or indirectly act to control electrical activity. Opioids suppress electrical activity.4 The antidepressants and neuropathic agents attempt to curtail electrical transmission at synapses. Anesthetics and some oral agents aim to retard the transmission of electronic signals by blocking sodium or calcium channels in nerve membranes. Topical treatment agents, including opioids, anti-inflammatory agents, and homeopathic solutions, can be used simultaneously with or even diffused through the skin into a pain site by many of the electromagnetic devices that administer an electric current or an electromagnetic energy wave.

Along with pharmaceutical agents, there is now a growing number of reports that prolotherapy, homeopathy, and hormone treatments also may be curative at some pain sites. Concomitant use of these modalities with electromagnetic measures may also be helpful.

Side Effects

Electromagnetic measures can produce side effects. Even a simple magnet or piece of copper may cause pain in some patients as it mobilizes the body’s electricity. Electric currents and electromagnetic energy waves are actual matter. When administered into pain sites, they may cause rather than relieve pain. This author has particularly observed this in patients with intractable pain who have very old, scarred, and contracted pain sites. All the electromagnetic devices on the commercial market meet FDA safety requirements, so one can have a high degree of confidence in their safety. Be on the lookout, however, for pain generation rather than pain relief. If it occurs, simply stop or modify the treatment, as the side effects are transient.

Future Research

The revelations that severe chronic pain may induce brain atrophy and cause the memory of severe pain to become imbedded in the neurons and/or glial cells of the spinal cord and/or brain are a major challenge facing pain practioners.20-22 Electricity of some form is likely responsible for abnormal central neuroplasticity and brain atrophy that may occur with severe pain. The question of whether pooled electricity or abnormal electronic impulses generated by damaged nerves reach the brain and cause neuroplasticity or atrophy is a most serious one. It is obvious that something—probably a form of bioelectricity—is causing brain tissue loss in patients who develop abnormal neuroplasticity.21,22 Do clinicians need to more aggressively extract electricity from patients with acute injuries? Can some of the electromagnetic therapies described here prevent or correct abnormal central neuroplasticity? These questions beg for answers.

Conclusion

The centuries-old practice of treating pain with electric eels and primitive batteries has progressively evolved into therapeutic measures that have some sound scientific underpinning and growing clinical experience. These measures are simple, safe, and effective, but in this day of high-tech medicine, they are sometimes forgotten as excellent adjunctive measures to any pain treatment regimen.

The precise mechanisms by which electric currents and their derivatives relieve pain is uncertain. Apparently, they involve blocking of the afferent-efferent gates in the spinal cord, activation of endogenous endorphins, dispersion of pooled electricity into surrounding tissue, or change in polarity of pooled electricity. In addition to immediate pain relief, the administration of electricity or its derivatives may assist tissue healing and regeneration by cell stimulation, removal of edema and inflammatory mediators, and angiogenesis.

Pain practitioners should embrace the electromagnetic measures that complement their style of practice, pocketbook, and patient profile. Practitioners are urged to select a few electromagnetic measures and master them, as there are some experiential and technologic skills required for their use. Recent revelations that severe, chronic pain may produce brain atrophy and abnormal central neuroplasticity with embedding of pain memory has caused enhanced interest in electromagnetic measures for preventive and therapeutic purposes.

Last updated on: November 30, 2011
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