1. MENS and IONTOPHORESIS

2. MENS No universally accepted definition or protocol & has yet to be substantiated This form of modality is at the sub-sensory or very low sensory level –current less than 1000 A (approx 1/1000 amp of TENS)

3. Biophysical Effects Theory: –Currents below 500 A increases the level of ATP (high Amp decreases ATP levels) –Increase in ATP encourages amino acid transport and increased protein synthesis –MENS reestablishes the bodys natural electrical balance allowing metabolic energy for healing without shocking the system (other types of e-stim)

4. MENS Duration –30 min to 2 hours up to 4x a day Precautions –Dehydrated patients –on Scar tissue (too much impedance) Contraindications –Pain of unknown origin –Osteomyelitis Indications –Acute & Chronic Pain –Acute & Chronic Inflammation –Edema reduction –sprains & Strains –Contusion –TMJ dysfunction –Neuropathies –Superficial wound healing –Carpal Tunnel Syndrome

5. Electrode Placement Electrodes should be placed in a like that transects the target tissues –Remember that electrical current travels in path of least resistance, thus it is not always a straight line. TARGET

6. Application Techniques Standard electrical stimulation pads –generator may have bells & Whistles since MENS is subsensory Probe

7. Bone Stimulating Current: –MENS Has been advocated in the healing of bone, using implanted electrodes and delivering a DC current with the negative pole at the fracture site. Further use of MENS has allowed increased rate of fracture healing using surface electrodes in a non-invasive technique. Theories on the physiology behind the healing focus on the electrical charge present in the normal tissue as compared to the electrical charge found with the injured tissue. MENS is said to allow an induction of an electrical charge to return to he tissues to a better healing environment

8. Iontophoresis

9. Iontophoresis: The transfer of ions across the skin (transdermal)by use of continuous direct current –Iontophoresis is based on the principle that an electrically charged electrode will repel a similarly charged ion (first reported by LeDuc in 1903). –Delivers a low-volt High-amp DC current –Local lood flow is increased for 1 hour post tx

10. Iontophoresis Duration of Tx: –Based on intensity desired usually every other day for 3 weeks Indications –Acute or Chronic Inflam –Arthritis –Myositis –Myofacial Pain Syndromes –Invasive method for delivering drugs Contraindications –Hypersensitivity to electrical currents –Contraindications to meds. –Pain of unknown origin Precautions –Prescription –Dosage –Do not reuse electrode –Burns if intensity to great

11. Iontophoresis –Effects of treatment depends on the ion(s) delivered musculoskeletal inflammatory conditions (tendonitis, bursitis) have been successfully treated: Using desamethosone sodium phosphate (decadron) and Xylocaine Reduction of edema has been achieved by driving hyaluronidase Transitory (5min) local anesthesia has been produced by delivering lidocaine to the tissues. The anesthesia was better than that achieved by topical application but less effective than infiltration of the area with lidocaine.

12. Medication Dosage Medication dose delivered during tx is measured in mA based on relationship of amperage, tx duration –Current Amp (mA) x Tx Duration - mA/min Iontophoresors are doe-oriented - where user indicated desired tx does and generator calculated duration and intensity

13. Biophysical Effects Dependant on Medication See following chart

14. Sample Medications

15. Electrode Placement Delivery Electrode (drug electrode) –placed over target tissue Active electrode (dispersive electrode) –place 4-6 inches from drug electrode

16. Side Effects: Tissue burning –An alkaline reaction occurs under the cathode (negative electrode) which is much more caustic to the skin than the acidic reaction occurring at the anode. The cathode may be increased in size to attempt to decrease this caustic reaction

17. Side Effects: Tissue burning –Continuous unidirectional current (as needed for iontophoresis) tends to cause tissue irritation because skin will not tolerate current density greater than 1mA/sq.cm. Thin tissue areas, areas of skin abrasion and areas of scarring are certain areas to avoid. This potential for burn is exacerbated by the fact that there is an anesthetic effect of DC under the electrode. Thus tissue irritation may develop without the patients realization –Dont need to drive every day 1-2x a week