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19 Articles in Volume 14, Issue #9
10 Must Have Devices for Your Practice
1. Extracorporeal Shockwave Therapy
2. Pulsed Electromagnetic Fields
3. Class IV Laser
4. H-Wave Electrotherapy
5. Interferential Current Therapy
6. Class IIIb Cold Laser-Auriculotherapy
7. Shortwave Diathermy
8. Microcurrents
9. Infrared Phototherapy
10. Transcutaneous Electrical Neuromuscular Stimulation
Pain and Sleep: Understanding the Interrelationship
The Role of Endogenous Morphine and Nitric Oxide in Pain Management
Treating Pain in Patients With Chronic Kidney Disease: A Review of the Literature
Notalgia Paresthetica: An Enigmatic Condition
Preparing Patients Taking Sublingual Buprenorphine to Treat Addiction for Surgery
Editor's Memo: PAINWeek Going Forward Together
Introducing Practical Pain Management’s Newest Editorial Board Members
Ask the Expert: What are the products to prevent NSAID-related peptic ulcers?

4. H-Wave Electrotherapy

In our opinion, the H-Wave machine by Electronic Waveform Lab, Inc., is one of the iconic electrotherapy devices on the market today (Table 1). It has become a staple in our core service provisions and is one of the few devices that all our clinics are encouraged to have on site. I do not sell, assist in selling, advertise, or in any way endorse this or any product for financial or other gains. I have always distanced myself from the products tested to avoid any conflict of interest.

This technology is popular because of its simplicity, ease of use, and patient response. The mechanism of action is rather unique in that H wave stimulation targets the lymphatic system, and flow dynamics in particular. Research supports one of the positive effects to be an enhanced lymphatic flow allowing for improved cellular waste clearance and increased tissue oxygenation. The H wave pathophysiological model represents somewhat of a paradigm shift in the field of electrotherapy.

Strength of Treatment

Most patients who undergo H wave treatment will have an opinion on whether it helps with their problem or not. It is rare to have a non-committal treatment response—the bane of treatment responses. Our practices have had good success at treating a wide range of conditions, including tendinopathies, arthropathy, and myofascial pain, with virtually no adverse effects being reported by patients. Some patients insist on having a home unit, which can sometimes be arranged, depending on the insurance carrier.

Ease of Treatment

The device is very user friendly and does not require an extensive training in-service for providers. The user simply chooses from 2 frequency settings and then adjusts for intensity based on patient comfort. This treatment is unassisted and does not require the provider to administer the treatment, other than simply setting a patient up and turning the machine on.

Patient Adherence

Patient acceptance typically is above average, especially as treatment success builds over time. The H-Wave is a powerful adjunctive treatment, and although I cannot attest to the precision of the postulated mechanism of action (for any device), our empirical observations confirm the positive effects patients experience with lymphedema, acute swelling. and pain.


Good technology doesn’t come cheap. That seems to be the recurring theme among the best of the best electromagnetic technologies. At a price point of just under $4,000 for a clinical unit, the pricing on the H-Wave is more consistent with historical clinical outpatient facility expenditures for electrotherapy devices. The home units, however, are only a few hundred dollars less expensive than the professional grade clinical units. The most common complaint comes not from providers or patients, rather from the payers who have to pay for relatively high-priced home units. Having said this, some will remark that whatever the price, it should be paid if it helps reduce or eliminate pain. The sad reality is that our health care system has limits (finite resources), and health care reform appears to be largely about value. So, pricing does matter at both the individual and institutional level.

Research Base

This proprietary form of electrostimulation has some interesting publications through various academic sources, including independent groups not associated with the product or company. The number of methodologically sound studies exceeds that of many older and more mature devices still in the marketplace today. At the end of the day, however, it will be each clinician’s personal trial with this technology that will determine perceived effectiveness and utility.

Continue Reading: 5. Interferential Current Therapy

Last updated on: June 16, 2015
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