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The Iontophore

High potency corticoid hormones that are iontophoretically delivered by modern electromagnetic instruments have great patient acceptance and therapeutic benefit.
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To date, no lasting side-effect of the use of these high potency hormones has been noted. This is likely because the active hormone does not enter the systemic circulation in a high enough concentration to cause even temporary, nuisance side effects such as nausea. A caution is raised, however, that too frequent administration of prednisone or medroxyprogesterone could cause symptoms and signs of hyperadrenalism (e.g., Cushings Syn-drome) such as hypertension, edema, and a buffalo hump. Given this theoretical possibility, high potency corticoid hormone iontophoresis is not recommended for daily use. Also, it should be used sparingly in pregnant women, infants, and severe insulin-dependent diabetics.

All electromagnetic devices can pro-duce unpleasant, temporary side effects of nausea, headache, dizziness, and even increased pain. For this reason, treatment should begin with low intensity and frequency of the instrument and then increased as the patient tolerates it. Treatment should cease in the event side effects occur. It is theorized that electromagnetic side effects occur because the instrument sends an electric current or electromagnetic wave into a pain site that contains sequestered electric charges. The retained electric charges disperse into the surrounding tissue and/or along nerves connected to the pain site (see Figure 1). Patients should be informed before a treatment that these minor, harmless side-effects can occur and that the treatment may be stopped or adjusted at any time.

Results and Outcomes of Treatment

Fundamentally, the results of iontophoresis with high potency corticoid hormones is similar to that seen with intralesional, injected corticoids. Immediately following the treatment, the vast majority of patients report symptomatic pain relief. In addition they also tend to report: (1) less stiffness, (2) more movement, and (3) warmth. Those patients who treat them-selves at home with ultrasound or infrared report the same positive attributes and also report less reliance on oral medications together with improved activities of daily living.

A single office-based treatment will usually provide some symptomatic bene-fits for time periods up to six weeks as illustrated in the case reports below. Iontophoresis with high potency hor-mones is an adjunct to other treatments and should not be viewed as “curative” or as a “singular” treatment.

Case Illustrations

Case 1. A 44-year-old female has severe neuropathic pain of her face and jaw resulting from being trampled by a horse. She was given a single 30-minute pulsed radiofrequency treatment with medroxy-progesterone. Following this treatment she had immediate pain relief and could fully open her mouth and blink her eye. Pain was reduced about 80% and relief lasted about six weeks.

Case 2. A 26-year-old woman had a caesarean section. Post-delivery she had severe upper lumbar back pain and partial paralysis of both legs. She walks bent over and uses a walker at times. Diagnoses of transverse myelitis and arachnoiditis have been given as there is no stenosis, bulging disc, or other surgical spine lesion. Epi-dural corticoid injections and lidocaine patch have not provided any relief. Other than oral opioids for symptomatic relief, her only relief has been with iontophoresis using a pulsating electric current (H-wave) with high potency medroxyprogesterone. After two treatments a week for four weeks she has had less pain and is able to walk standing upright.

Case 3. A 34-year-old female has severe cervical spine disease and has had a cervical spine fusion. Pain has been severe between her clavical and spine. High potency prednisone was applied to the skin over the area and penetration into the pain site was done with a microcurrent under a probe instrument (Alpha-Stim®). This instrument was selected because the anatomic area over the pain site is small and not flat. After her first treatment, she received considerable pain relief and had a better range of motion in her shoulder and arm. Relief lasted four to six weeks.

Attributes of Hormonal Iontophoresis

Corticoids have been the long-standing, hormonal choice for intralesional treatment. The hormone cortisone and other members of the steroidogenic family such as progesterone are potent anti-inflammatory agents. Medroxyprogesterone is a derivative of progesterone that is a pre-cursor of cortisol, androgens, and estrogens. Although less appreciated and less used than cortisone analogues, it has been very effective in our hands.

The administration of these hormones by iontophoresis has several positive attributes. Injections of hormones (i.e., “trigger point”, etc.) are not only painful but, by the very nature of an intralesional injection, the practitioner must hit a pain site which may be very small in size. Whereas topical placement and massage of a hormone may not cause enough diffusion of the hormone into a pain site to be effective, iontophoresis with modern electromagnetic instruments covers a much wider area than can be achieved by an injection. For example, the pulsed radiofrequency instrument (Provant®) has a square skin contact surface plate of about eight inches on a side. The lack of pain from injection and the safety of hormone iontophoresis has great acceptance by patients.

Summary

The iontophoresis techniques of decades past have never been widely accepted due to a lack of effective medications and instruments that can predictably deliver medication to a sub-surface pain site. High potency corticoid hormones that are now iontophoretically delivered by modern electromagnetic instruments have great patient acceptance and therapeutic benefit. Pain practitioners should strongly consider adding high-potency hormone iontophoretic capability to their current treatment modalities.

Last updated on: December 28, 2011
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