1. Advances in Electrophysical Agents Mark David S. Basco, PTRP Faculty Department of Physical Therapy College of Allied Medical Professions University of the Philippines Manila

2. Objective At the end of the session, you should be able to Explain the physiologic basis supporting the use of electrophysiccal agents Discuss the indications and contra- indications in the use of electrophysical agents.

3. Acupuncture Shockwave Therapy Combination Therapy Russian Current Electrical Stimulation

4. Acupuncture Part of TCM Used for a variety of alternative therapy Based on the concept of balance

5. Acupuncture Meridians and Qi Qi ◦ ‘energy’ Meridians ◦ ‘pathway’

6. Acupuncture Acupuncture Points Share some common characteristics

7. Acupuncture What should the patient feel? -deep ache -feelings of warmth, heaviness, tingling, numbness

8. Acupuncture Physiologic Mechanism Pain Gate Endogenous Opioids Diffuse Noxious Inhibitory Controls (DNIC) Serotonin Bioelectricity

9. Acupuncture Summary of NIH Panel Concensus on the efficacy of Acupuncture (1998) Effective Adult post-op and post-chemo nausea and vomiting Post-op dental pain

10. Acupuncture Chronic Pain Percutaneous electrical stimulation

11. Acupuncture Adverse Events Minimal side effects if conducted with caution and done by trained professionals ◦ Tiredness ◦ Drowsiness ◦ Aggravation of symptoms ◦ Dizziness ◦ Faintness, chest pain

12. Shockwave Therapy

13. A shockwave is defined as a sonic pulse characterized by: High peak-pressure (500 bar) Short duration (10 ms) Fast pressure rise (less than 10 ns) Broad frequency spectrum (16Hz – 20MHz) Narrow effective beam (2-8 mm)

14. Shockwave Therapy Three methods of generation: Electrohydraulic Electromagnetic Piezoelectric

15. Shockwave Therapy Direct effect Indirect effect

16. Shockwave Therapy

17. Dosage Considerable controversy in the literature Energy flux / density (mJ / mm2) ◦ Amount of acoustic energy transmitted through an area 1 mm2.

18. Shockwave Therapy AuthorsLevelmJ / mm2 MainzLow0.08 – 0.27 Medium0.28 – 0.59 High> 0.60 KasselLow ˂ 0.12 High> 0.12

19. Shockwave Therapy Indications Chronic tendinopathies Impaired bone healing Urological conditions Myofascial syndromes

20. Shockwave Therapy Contra-indications Lung tissue Epiphyseal regions Patients who are hemophiliac or who are on anti-coagulant therapy Malignancy Areas with implanted cardiac stents and heart valves Infection

21. Shockwave Therapy

22. Combination Therapy Involves simultaneous application of ultrasound and electrical stimulation Mostly anecdotal evidence

23. Combination Therapy Increased membrane permeability Smaller current used Greater treatment depth Less adverse effects

24. Combination Therapy Diagnostic use ◦ Continuous US ◦ 0.5 W/cm2, 1 MHz ◦ IF = 100 Hz, no sweep, bipolar Treatment ◦ Use individual doses ◦ IFT intensity will be lower

25. Combination Therapy

26. References Wallace, M.S. & Staats, P.S. (2005). Pain medicine and management: Just the facts. California: Mc Graw- Hill. White, P. (2006). A background to acupuncture and its use in chronic painful musculoskeletal conditions, Journal of the Royal Society for the Promotion of Health, 216, 219-227. http://www.electrotherapy.org International Society for Medical Shockwave Treatment website http://www.ismst.com/shockwave.htm http://www.ismst.com/shockwave.htm