Transcript MENS and IONTOPHORESIS

MENS and IONTOPHORESIS
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)
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 body’s natural
electrical balance allowing metabolic energy for
healing without shocking the system (other
types of e-stim)
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
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
Application Techniques
• Standard electrical stimulation pads
– generator may have bells & Whistles since
MENS is subsensory
• Probe
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
Iontophoresis
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
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
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.
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
Biophysical Effects
• Dependant on Medication
• See following chart
Sample Medications
Meds
Pathology
Dose
Polarity
Acetic Acid
Myositis
80mA/min
+
Dexamethasone Inflammation 41mA/min
& Lidocain & Pain control & 40 mA
-
Lidocain &
Epinphrine
Pain Control
30mA/min
+
Lidocain &
Epinphrine
Pain Control 20 mA/min
+
Dexamethasone Inflammation 41mA/min
-
Electrode Placement
• Delivery Electrode (drug electrode)
– placed over target tissue
• Active electrode (dispersive electrode)
– place 4-6 inches from drug electrode
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
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 patient’s realization
– Don’t need to drive every day 1-2x a week