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10 Articles in Volume 9, Issue #8
Adjunctive Psychiatric Pain Management Treatment
Deep Cervical Muscle Dysfunction and Head/Neck/Face Pain–Part 2
Hackett-Hemwall Dextrose Prolotherapy for Unresolved Elbow Pain
Intradermal BTX-A Reduces Frequency and Severity of Pain for MMD
Keeping Prescribers on Board if Certification Becomes Part of REMS
Magneto-Laser Therapy of Pulpitis and Vertebra Column Osteochondrosis
Pain and Self-regulation
Pain Care of Severely Neurally-Compromised Patients
Simultaneous Use of Opioid and Electromagnetic Treatments
The Experience of Pain

Simultaneous Use of Opioid and Electromagnetic Treatments

Concurrent therapeutic electromagnetic applications complement opioid treatment and promote enhanced pain control.

Opioid drugs are the backbone of serious pain treatment rendered by a physician. Before consulting a physician, however, persons in pain will usually attempt many other avenues. Pain patients now have great access to countless, over-the-counter remedies for common acute and chronic pain problems. Their source for self-treatment may not only be a pharmacy, but may be a catalogue, internet, or direct marketing company. Also, before a patient calls a physician, he or she will likely attempt non-prescription measures by consulting a chiropractor, acupuncturist, personal trainer, psychologist, podiatrist or other non-MD therapist. Due to the patient’s great access to over-the-counter pain measures for mild forms of pain, the patient who seeks physician care for chronic pain is likely to be a moderate to severe case. The physician will usually initiate chronic pain treatment with non-opioid prescription drugs which may include anti-inflammatory agents, anti-convulsants, muscle relaxants, antidepressants and triptans, among others. If these usual and standard, non-opioid drugs fail to satisfactorily control pain, opioids become the mainstay of treatment. Estimates now put the US national figure at about 10 million persons who use opioids on a regular basis.

Long ago, astute physicians learned to mix opioids and non-opioid drugs and therapeutic measures in pursuit of enhanced pain control. Most contemporary physicians, however, do not incorporate any electromagnetic measures in their opioid pain treatment regimen. This paper summarizes some historical and basic science relative to the development and therapeutic use of electromagnetic measures.1-3 There are old, as well as new, sophisticated electromagnetic treatments that complement and enhance opioid treatment.

What Are Electromagnetic Modalities?

Simply, they are any measure or technique that alters or mobilizes electrical currents or electromagnetic energy in the body.

Biology of the Pain Site

Basic biologic knowledge is critical to the understanding of the simultaneous use of opioid and electromagnetic measures. While it is clearly known that pain results from nerve fiber damage or dysfunction, it is not fully appreciated that a damaged or dysfunctional nerve fiber cannot transmit its normal current of electricity. Consequently, the normal flow of electricity is interrupted and electric charges are sequestered around the damaged site. Furthermore, a nerve fiber is never damaged in isolation. Its blood supply and lymphatic drainage is also damaged, so blood and lymph products are also sequestered in the pain site (see Figure 1). Fundamentally, a pain site is a sequestration of blood, lymph, and electricity—essentially, a wound.

Figure 1. The inflammatory pain site contains sequestered heme and lymph products, electric charges, and newly-formed opioid receptors.

Since a pain site contains blood, lymph, and electric charges, heat and inflammation results. Depending on its depth below the skin’s surface, heat may, or may not, be palpable. Critical to understanding the pain site is that solid research has demonstrated that opioid receptors are produced when and where inflammatory tissue develops.4-6 These receptors are obviously produced to attract natural, endogenous endorphins from the circulating blood. The role of endorphins attaching to opioid receptors in inflammatory tissues is not totally understood.6 They may not only help relieve pain but may also have some healing function.4,5 Opioid receptors in inflammatory tissue also help explain the value of exogenously administered opioids. Not only do opioids work in the central nervous system, they also act in the periphery.6 The combination of opioids plus electromagnetic measures minimizes the effects of sequestered electricity. Opioids and electromagnetic measures, therefore, decrease inflammation, enhance wound healing, and provide a powerful combination in pain treatment.

Key Historical Developments

The long history of the use of opium for pain relief is legend. Opium has been found in Egyptian mummies showing that the great Egyptian society cared enough for their residents to treat their pain. Ancient Greeks and Romans had patients with painful gout or headaches touch electric fish in the hope that an electric jolt would cure them.1,2 The well-known, electrical conductor copper was also used thousands of years ago to treat pain. In some countries, such as Iraq, it was found on hillsides and inhabitants found that it relieved pain when rubbed on painful areas. Although much refined today, the use of opioids and electromagnetic measures to treat pain is a very old concept.

Besides copper and electric fish, there are a number of other electromagnetic measures that have been practiced over the centuries. It’s just that no one recognized their basic attribute or scientific mechanism—that is, to extract or mobilize electrical charges in the body. Included here are some age-old remedies such as ice, magnets, magnesium, acupuncture, and mineral baths. Few physicians are even aware that Epsom Salts, your grandmother’s favorite, is actually magnesium sulfate. These old time remedies work by extracting sequestered electric charges or mobilizing electricity in pain sites.

There are some famous, historical inventions and discoveries that bear directly on understanding the pain site and the combined use of opioids and electromagnetic measures.1-3 In 1791, Luigi Galvani, of galvanometer fame, published his discovery of bioelectricity. He demonstrated that electricity was the medium by which nerve cells passed signals to muscles and, when injured, electrical activity increased in the damaged area. In 1821, Orsted discovered that a magnetic field existed around all sides of a wire carrying an electric current and established a direct relationship between electricity and magnetism (see Figure 2). Faraday and Ampere later showed that this magnetic field acted as a source of an electric field and that these fields, when manipulated, produced the properties of a wave. In 1864, Maxwell developed equations showing an interrelationship between an electric current, electric charge, electric field, and magnetic field. Pain treatment is now a major benefactor of those early discoveries in that treatment utilizes electric current as well as electromagnetic waves—e.g., electric power, radio, ultrasound, micro, infrared, ultraviolet, laser, x-ray, and gamma rays (see Figure 3).

In 1831, Faraday demonstrated that a magnet brought perpendicular to an electric current exerted a tangential force causing an electric current to flow by producing a potential difference between two points. The ability of a magnet to mobilize an electric current helps explain the spreading use of magnets in pain therapy.

In this century, there have been seminal discoveries that set the stage for a treatment approach which combines opioids and electromagnetic measures. Electric currents and electromagnetic waves have clearly been shown to reduce pain when administered by a wide variety of techniques. Not only do various electromagnetic currents or waves reduce pain within seconds, or minutes, after administration, some electromagnetic waves—particularly those in the radiofrequency range—promote collagen formation, capillary budding, and other wound-healing necessities. Opioid receptors have been discovered in peripheral tissues and they multiply in inflammatory tissue.4-6 Opioids applied topically to a pain site will reduce pain apparently due to binding with these opioid receptors. In summary, many historical and scientific developments now set the stage for a combined, opioid-electromagnetic approach to pain problems. A primer on terms and definitions is presented in Table 1.

Figure 2. Electromagnetic waves are generated by an electric current passing through a conductor such as coil of copper wire. Instruments are used to medically administer either a direct electric current or an electromagnetic energy wave known as a microwave (diathermy), radio wave, or ultrasound. Figure 3. Categories of waves in the electromagnetic spectrum

Table 1. Primer on Terms and Definitions

Electricity
General term that encompasses a variety of phenomena resulting from the flow of electric charges.

Electric Charge
Property of some subatomic particles, usually electrons and protons, which produces electromagnetic interactions.

Electric Current
A flow of electrically charged particles and typically measured in amperage.

Electromagnetic Energy
Waves generated by an electric current moving through a metal object such as a wire. The outgoing electromagnetic waves include those labeled radio, ultrasound, micro, infrared, ultraviolet, laser, x-ray, and gamma ray. The unit of electromagnetic energy is the photon.

Table 2. Some Electric Extraction-mobilization Measures

 

  • Copper
  • Magnets
  • Magnesium Sulfate (Epson Salts)
  • Acupuncture
  • Inserted Needles
  • Water Soaking

Two Basic Types of Electromagnetic Modalities

There are two basic types of electromagnetic modalities. One type attempts to extract or mobilize sequestered electricity. The other administers an electric current or electromagnetic wave to mobilize sequestered electricity and enhance healing of the pain site by stimulating wound-healing mechanisms. The latter may also modulate, or alter, the neurocircuitry of the body.7,8

Electrical Extraction/Mobilization Modalities

Most electromagnetic modalities to extract or mobilize sequestered electricity are simple, inexpensive, and readily available to all who seek them (see Table 2). There are few controlled studies, however, that meet the criteria for “evidence-based therapy.” Precise mechanisms of some measures are not completely known but a basic explanation is given here based on historical developments, theoretical rationale, and the author’s clinical experience. Consequently, the general title for these common measures is “extraction/ mobilization.” Certainly, future developments may provide superior explanation.

Metals such as copper, magnesium, and zinc are positively charged. Sequestered electricity in pain sites is usually negatively charged due to excess electrons. Positively charged metals attract electricity to temporarily relieve pain. Magnets, originally called “lodestones” because of metals “loaded” on them, have long been believed to increase blood circulation. While magnets may attract circulating metals, particularly iron, in blood and lymph to increase circulation, magnets are also known to cause an electric current to mobilize.2,3 A magnet placed over a pain site may produce immediate, but temporary pain relief, because it forces electric charges to mobilize. Physicians should be aware of the growing popularity of magnets and copper among chronic pain patients. There are commercially available copper and magnetic bracelets, necklaces, and anklets. You can buy a mattress, back, knee, or neck brace, and shoe sole inserts that contain magnets. Stick-on adhesive bandages that contain a magnet are also available. Magnesium, zinc, and copper are sold as tablets; and zinc and copper can be purchased as topical creams. Even Epson Salts, which is magnesium sulfate, is commercially available and can be purchased and put in bath water or a pan for soaking painful extremities. Water and ice are good conductors of electricity and act to extract sequestered electric charges. If the water contains metals—i.e., mineral baths—all the better.

There are some other electrical extraction techniques that are common, although, perhaps unappreciated as to causation. Physicians who do trigger point injections found out years ago that a needle injected into a pain site relieved pain without the need for a corticoid. Any metal needle inserted into, or around, a pain site will attract sequestered electricity. Acu-puncture needles do the same thing.

“Grounding” is the simple term used to explain that excess electricity, including lightning, goes into the ground.3 Since the human body continuously produces electricity and moves currents throughout the body, it must naturally ground itself to relieve excess buildup of electricity. The body apparently, and primarily, grounds itself through the hands and feet, as they are the most external points in the circuit. Most massage or acupressure sites are probably ground connections. A few years ago, the author heard a physician lecture who claimed that his pain patients who walked barefoot on grass, rugs, or sand did better. Could that be? That now makes sense. The need to ground excess electricity in the body’s circuit provides a logical rationale for the positive use of massage, stretching and physical movement.

Administration of Electric Currents or Electromagnetic Energy

The administration of electromagnetic measures treats pain with two types: (1) electric current, and (2) electromagnetic energy (see Table 3). Physicians need to know that all forms of energy or electricity are related, and comprised of ionic, invisible matter. Electrical energy is transmitted in waves with different potency (see Figure 3). The electromagnetic devices and techniques being commercially offered to physicians and patients have different ionic waves and strengths. Different measures and techniques may have very different clinical affects as they exert different biological actions. Also, patients may vary in their response to the various administered measures.

Electric Currents

Since the 1970s, electrical nerve stimulation (ENS), has been widely used.7 The best known technique is transcutaneous electrical nerve stimulation (TENS). ENS may be externally administered or is implanted to more directly access nerves. Pain relieving effects can be realized within seconds or minutes. There are two unproven theories as to why ENS may relieve pain. One is a blockage of electrical impulses at the spinal cord level based on the gate control theory of Melzack and Wall.8 The second is a release of endogenous endorphins.9 Acupuncture—particularly if needles are used to administer electric current—is theorized to be effective based on these two theoretical mechanisms. Proposed here is a third possible mechanism: that ENS promotes the mobilization of sequestered electric charges.

A relatively new technique is the use of microelectric currents which have very low amperage. The area of impact may vary from one to two square inches. The electrode pad placed on the skin over the pain site is very small—less than ½ inch in diameter. It administers the current directly into the pain site. Some instruments are using microelectric currents to stimulate alpha brain waves within the skull. This technique is known as cranial electric stimulation (CES). While these cranial, electric techniques may assist psychiatric conditions or otherwise modulate the body’s electricity, there are no accepted theories as to why a peripheral pain site would benefit. Physicians should know, however, that the term “neuromodulation” is now in widespread use and is somewhat based on the belief that an alteration of electrical activity a distance away from the pain site may somehow alter the body’s electric circuitry to relieve pain. It is recommended that this belief be acknowledged but that it requires some evidence that pain can be relieved for considerable time periods using electromagnetic techniques that don’t directly deal with the pain site.

Electric current has been used to deliver medication to pain site by a process called iontophoresis. This technique has had only modest acceptance as the commercial instruments that have been available to deliver medication are very small and cover a skin area that is usually less that 1 to 2 square inches. Also, phonophoresis, the technique that utilizes ultrasound waves, is equal or superior in delivering medication to the pain site.10-12

Diathermy, Infrared, and Ultraviolet Techniques

Diathermy, infrared, and ultraviolet were all initially developed to bring heat to deep tissue.13 All three are waves of the electromagnetic spectrum (see Figure 3). Dia-thermy became the name for shortwave or microwaves. Beginning in the 1950s, there was an attempt to therapeutically use electromagnetic energy rather than a direct electric current. The advantage that this technique brought to medical practice was the ability to direct heat to deep tissues. It found considerable use in sports injuries and some chronic conditions such as hip arthritis.13-15 Research showed that diathermy also caused tissue proliferation and wound healing.14 Diathermy, commercially called “diapulse,” has been removed from the commercial market and is no longer available. A new technique, using the same shortwave frequency (27.12 megahertz) and referred to as radiofrequency, has been brought into the commercial market.16 This upgraded and enhanced electromagnetic treatment is discussed below.

Table 3. Administered Electromagnetic Measures
  • Diathermy
  • Ultraviolet
  • Infrared
  • Ultrasound
  • Pulsed Radiofrequency
  • Electric Current
  • Laser

Ultraviolet and infrared devices were developed to direct heat to deep tissues. They have a shorter electromagnetic wave length than diathermy and are considered light waves. These devices can be hand held and are inexpensive. This author has been unable to identify any reports that infrared or ultraviolet devices have any therapeutic attributes other than deep heat. Nevertheless, heat can be quite therapeutic for some acute and chronic pain sites, and the patient can easily use these devices at home as they are inexpensive, safe, and simple to operate.

Pulsed Radio Frequency

A new effort to utilize electromagnetic energy for pain therapy is a high frequency, pulsed radio wave referred to as “radiofrequency.”3,16 This wave is about the length of one that would play a transistor radio (see Figure 3). It is at the same frequency formerly used in diathermy (27.12 MHz). The wave and frequency used for external pain treatment is not to be confused with the high frequency, heat-producing radiofrequency wave used to ablate tissue during paraspinal interventions.

Pulsed radiofrequency has been extensively used to treat wounds and open sores including the pain and edema surrounding them.16 Use of this technique has demonstrated that high frequency electromagnetic waves cause many tissue elements including collagen, capillaries, and osteoblasts to grow and provide healing.16,17 To date, this modality has been shown to accelerate wound healing, bone growth, and decrease pain and edema around wounds.14-18 This technique is now in early trials for chronic painful conditions such as plantar fasciitis and spine degeneration. As in the case of phonophoresis, early trials indicate that radiofrequency is capable of delivering medication including opioids and corticoids to the pain site.

Ultrasound

Along with diathermy, ultrasound was developed in the 1950s.15 By use of a crystalline-bonded applicator, electromagnetic energy is converted to sound waves that penetrate and heat deep tissues. Ultrasound waves are non-ionizing and have a high frequency above the range of the human ear. It can be administered in pulses or continuously.

Ultrasound has advantages over diathermy.15 It is less costly than diathermy, is portable, and has short treatment times ranging from 3 to 8 minutes. It has been reported to be effective in treating many types of inflammatory conditions including tendinitis, bursitis, tenosynovitis, muscle spasms, epicondylitis and arthritis. It promotes some reabsorption of blood and lymph products sequestered in the pain site.15 One of its greatest attributes is that it very effectively delivers pharmaceuticals, including corticoids, lidocaine, and opioids,10-12 to the pain site—providing it is not too deep below the skin surface. As mentioned previously, this process is called phonophoresis.

Low Level Laser

Laser instruments for pain treatment have recently arrived on the commercial market. On the electromagnetic spec-trum, lasers fall below visible light and are close to infrared waves. In fact, some commercial laser products contain an infrared component. The U.S. Food and Drug Administration has approved laser products for “temporary relief of minor muscle and joint pain.” Lasers are commonly marketed as “phototherapy” since they are a light wave. Indeed, the unit of energy is the photon. Numerous studies indicate that lasers, just as ultrasound and radiofrequency, have multiple biologic affects on the pain site and that includes proliferation of tissue.18 It may also, like electric currents and other electromagnetic waves, provide almost immediate, but temporary, pain relief. Immediate pain relief (i.e., within five minutes) suggests that sequestered electric charges are mobilized to leave the pain site.

Selection of Electromagnetic Modality

It is unknown whether an electric current or electromagnetic wave has either short or long term advantages over the other. In fact, at this time, there is no compelling reason to select one electromagnetic modality over another. The author’s own clinical experience indicates that different patients respond differently to the various modalities—just as they do with pharmacologic agents. What is clear, however, is that practically every patient will respond positively to one of the administered electromagnetic measures. Furthermore, patients already taking opioids for chronic pain greatly welcome and appreciate the opportunity to experience the wound-healing capabilities of the various electromagnetic measures. It may well be that “cure” is possible for some patients previously thought to be intractable.

Barriers to Clinical Implementation

There have been, and currently exist, significant barriers to the clinical use of electromagnetic modalities. An obvious barrier has been a lack of knowledge concerning the benefits and merits of electromagnetic measures. Commercial marketing companies have sold their various products as if they are “unique” and not related to any other measures that extract or mobilize sequestered electricity or administer electromagnetic current or energy waves. These sales practices have distorted the fact that these measures are a “class” and not a “one size fits all.” Training to properly use the various instruments has been confusing—if even available.

Time and cost to administer the various electromagnetic instruments in the clinical setting are formidable. Most of the electric current and electromagnetic energy devices are so expensive as to be prohibitive in all but a few medical settings. Third party reimbursement is a rarity because of cost as well as the fact that only a few physicians can even explain the therapeutic merits, differences, and effectiveness of the various electromagnetic devices.

One barrier need not exist. All physicians can and should educate patients on the merits of such inexpensive and simple electrical extraction and mobilization measures such as copper, magnets, min-eral baths, and grounding.

Summary

Apparently little is really new! The use of opioids and electromagnetic measures to control pain actually date backward to antiquity. A long series of historical discoveries and inventions bring us to a point in modern time when opioids and electromagnetic measures can be effectively and simultaneously applied. In chronic pain, simultaneous treatment will have to be daily and ongoing—at least for a considerable time-period—because the body has an electric circuit that constantly and continuously produces moving, electric currents. Electric charges, blood and lymph products sequester in pain sites and produce inflammation. Electromagnetic measures include those that extract or mobilize electric charges from the pain site and those that administer an electric current or electromagnetic wave to the pain site. Electromagnetic waves and electric currents that enter the pain site vary in their effects depending upon their specific nature. They have multiple attributes including electromobilization and cellular growth. Some modalities are also capable of delivering medication including opioids and corticoids to the pain site and is especially useful given that opioid receptors are produced in inflammatory pain sites. Although the understanding of the interplay between opioid receptors and electromagnetic measures is elementary, it is time that physicians and patients capitalize on the obvious benefits that a simultaneous approach can bring.

In a future issue, the author will share his experience in reducing the dosage of opioids necessary to achieve stability by simultaneously administering a complementary therapy such as electromedicine along with opioid therapy.

Last updated on: November 13, 2012
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