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Twelve studies comparing electrotherapy with "placebo" electrotherapy are reviewed. Ten studies have shown that electrotherapy is significantly more effective in the treatment of depressive illness than "placebo". These results are in keeping with the clinical view that electrotherapy is a valuable therapeutic technique which at times may be life-saving.
All of the established methods of electrotherapy are based on-at least-one of the following three scientifically and clinically confirmed working principles: electro-analgesia, muscle stimulation and tissue heating. The well defined indications for the different electrotherapeutical currents are inferred from these three principles, which are briefly described-together with their principal indications-in this contribution. At present some "complementary" forms of electrotherapy are being increasingly advocated. They are not clinically confirmed and, moreover, they lack a rationally founded working principle. These methods, so called "electromythology", are based on hypothetical and often clearly erroneous assumptions. Their therapeutic objective seems to be an unspecific stimulation of the cell metabolism, and their diagnostic goal is equally unspecific and universal. Frequently, these applications surmise an universal healing power inherent in the electric current as such. Because "electromythology" currently invades veterinary medicine, this contribution should help the reader to distinguish between realistic and excessive expectations.
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Anti-tumor effectiveness of tumor necrosis factor (TNF)-alpha applied peritumorally was assessed in combination with local electrotherapy on subcutaneous SA-1 tumors in mice. TNF and electrotherapy each induced significant tumor growth delay. In combined treatment using TNF and electrotherapy, a synergistic anti-tumor effect was observed, regardless of whether TNF was injected before or after electrotherapy. An extra anti-tumor effect was achieved when TNF in the same total dose (2 x 10(5) U) was split into a priming dose (0.5 x 10(5) U) 1 h before electrotherapy and the other (1.5 x 10(5) U) 24 h thereafter. As the result of this therapeutic combination survival rate of the animals was 40%. No animal survived more than 50 days in groups subjected to TNF or electrotherapy treatment alone. Combined treatment with TNF and electrotherapy induced massive tumor destruction, confirmed by histological examination 2 days after the treatment. The results indicate that TNF and electrotherapy interact and that they can be effective in control of local tumor growth.
Anti-tumour effects of direct current electrotherapy are attributed to different mechanisms depending on the electrode configuration and on the parameters of electric current. The effects mostly arise from the electrochemical products of electrolysis. Direct toxicity of these products to tumour tissue is, however, not a plausible explanation for the observed tumour growth retardation in the case when the electrodes are placed into healthy tissue surrounding the tumour and not into the tumour itself. The hypothesis that the anti-tumour effectiveness of electrotherapy could result from disturbed blood flow in tumours was tested by the measurement of changes in blood perfusion and oxygenation in tumours with three different methods (in vivo tissue staining with Patent Blue Violet dye, polarographic oximetry, near-infrared spectroscopy). The effects induced by electrotherapy were evaluated in two experimental tumour models: Sa-1 fibrosarcoma in A/J mice and LPB fibrosarcoma in C57B1/6 mice. We found that perfusion and oxygenation were significantly decreased after electrotherapy. Good agreement between the results of different methods was observed. The effect of electrotherapy on local perfusion of tumours is probably the prevalent mechanism of anti-tumour action for the particular type of electrotherapy used in the study. The importance of this effect should be considered for the optimization of electrotherapy protocols in experimental and clinical trials. The non-invasive technique of near-infrared spectroscopy proved to be a reliable method for detecting perfusion and oxygenation changes in small solid tumours.
OBJECTIVE: To evaluate the efficacy of combining electrotherapy with amitriptyline for the management of chronic painful peripheral neuropathy in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: Patients (n = 26) with peripheral neuropathy were treated with amitriptyline. After 4 weeks, those patients (n = 23) who failed to respond to amitriptyline or who only had partial relief were randomized between a sham treatment group (control) or an electrotherapy group. Transcutaneous electrotherapy was given for 12 weeks by a portable unit (H-wave machine) that generated a biphasic exponentially decaying waveform (pulse width 4 ms, 25-35 V, > or = 2 Hz). The degree of pain and discomfort was graded on a scale of 0-5. An analog scale was used to record the overall change in symptoms. RESULTS: Amitriptyline produced some degree of symptomatic relief in 15 (60%) of the 26 patients by the 4th week; pain scores decreased from 3.8 +/- 0.1 to 2.9 +/- 0.2 (P < 0.1) and the overall reduction in pain was 26 +/- 5% on an analog scale. In the amitriptyline plus sham treatment group (n = 9), pain scores declined from 2.8 +/- 0.3 to 1.9 +/- 0.5 (P < 0.03) and the overall reduction in pain was 55 +/- 12%, suggesting a procedure-related placebo effect. In the group receiving combined electrotherapy and amitriptyline (n = 14), symptomatic improvement occurred in 12 (85%) patients. Five (36%) of the patients in this group became asymptomatic. Pain scores declined from 3.2 +/- 0.2 to 1.4 +/- 0.4 (P < 0.01) and the overall reduction in pain was 66 +/- 10%. The degree of reduction in pain scores and the incremental relief (above the amitriptyline effect) were significantly greater (P < 0.03) with electrotherapy as compared with sham treatment. The outcomes indicate a substantial beneficial effect of electrotherapy over and above any placebo influence. CONCLUSIONS: Our clinical observations suggest that transcutaneous electrotherapy is effective in reducing the pain associated with peripheral neuropathy. This form of therapy may be a useful adjunctive modality when it is combined with a pharmacological agent, such as amitriptyline, to augment symptomatic relief.
Electrotherapy by low level direct current has been demonstrated to have antitumor effects in different murine tumor models and in clinics. Electrotherapy in "field" configuration, where electrodes are placed subcutaneously outside of the tumor in a way that tumor lies in between the electrodes, was performed in immunodeficient nude and immunocompetent mice. Electrotherapy was much more effective in immunocompetent mice based on the observed tumor growth retardation, thus demonstrating that antitumor effectiveness of electrotherapy greatly depends on host's immune response. Further experiments were conducted by combining electrotherapy with concomitant immunotherapy in order to potentiate the antitumor effect of electrotherapy. Immunotherapy consisted of local delivery of genetically engineered cells selected for IL-2 secretion. This combined treatment was much more effective than any of the treatments alone.
Electrotherapy was investigated for its ability to increase the responsiveness of murine tumors to bleomycin treatment. Mice bearing fibrosarcoma were treated with 250 micrograms bleomycin and then with 0.6 mA direct current (DC) for 60 min. Antitumor effects of single treatments were moderate with bleomycin, but significant with electrotherapy. Combined treatment with bleomycin followed by electrotherapy was more effective than either treatment alone. Tumor growth delay of the animals after combined treatment was greater than the summation of tumor growth delays after single treatments. The results of our study indicate that bleomycin and electrotherapy treatments interact, with electrotherapy potentiating the effectiveness of bleomycin treatment.
Electrotherapy with direct current (DC) was performed on two murine tumor models, fibrosarcoma SA-1 and melanoma B16. Three Pt/Ir cathodes were inserted directly into the subcutaneous tumors and two anodes subcutaneously in the vicinity of the tumor. Significant tumor growth delay was achieved after electrotherapy and was dependent on DC intensity (0.6, 1.0, 1.4 and 1.8 mA). Melanoma B16 tumors were more sensitive to electrotherapy than SA-1 tumors. In order to enhance the antitumor effect of electrotherapy, combined treatment with interleukin-2 (IL-2) was performed. When both therapies were combined significant tumor growth delay and also higher curability rate was achieved. The results imply that electrotherapy can be an effective antitumor therapy and that the effects can be enhanced with additional IL-2 therapy.
Although electrotherapy has a well established role within physiotherapy practice, the current concepts that influence its application vary considerably from those proposed historically. It is argued that there is a place for electrophysical modalities in contemporary practice, and several basic principles are considered together with more specific information regarding two modalities namely, ultrasound and interferential therapy. Electrophysical agents are utilised to bring about physiological effects, and it is these changes which bring about the therapeutic benefit rather than the modality itself. Clinical decision protocols employing the available evidence should enable the most appropriate modality to be employed for a particular patient. Indiscriminate use of electrotherapy is unlikely to yield significant benefit, however used at the right time, it has the potential to achieve beneficial effect. The patient management programme which combines manual therapy, exercise therapy and electrotherapy, based on current evidence, should enable the most efficacious management of a patients' dysfunction. This paper aims to consider some of the current concepts in electrotherapy and to relate this to both general and specific treatments.
BACKGROUND: Chronic wounds such as leg ulcers, diabetic foot ulcers and pressure sores are common in both acute and community healthcare settings. The prevention and treatment of these wounds involves many strategies: pressure-relieving beds, mattresses and cushions are universally used as measures for the prevention and treatment of pressure sores; compression therapy in a variety of forms is widely used for venous leg ulcer prevention and treatment; and a whole range of therapies involving laser, ultrasound and electricity is also applied to chronic wounds. This report covers the final three reviews from a series of seven. AIMS: To assess the clinical effectiveness and cost- effectiveness of: (1) pressure-relieving beds, mattresses and cushions for pressure sore prevention and treatment; (2) compression therapy for the prevention and treatment of leg ulcers; (3) low-level laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy for the treatment of chronic wounds. METHODS - DATA SOURCES: Nineteen electronic databases, including MEDLINE, CINAHL, EMBASE and the Cochrane Controlled Trials Register (CENTRAL), were searched. Relevant journals, conference proceedings and bibliographies of retrieved papers were handsearched. An expert panel was also consulted. METHODS - STUDY SELECTION: Randomised controlled trials (RCTs) which evaluated these interventions were eligible for inclusion in this review if they used objective measures of outcome such as wound incidence or healing rates. RESULTS - BEDS, MATTRESSES AND CUSHIONS FOR PRESSURE SORE PREVENTION AND TREATMENT: A total of 45 RCTs were identified, of which 40 compared different mattresses, mattress overlays and beds. Only two trials evaluated cushions, one evaluated the use of sheepskins, and two looked at turning beds/kinetic therapy. RESULTS - COMPRESSION FOR LEG ULCERS: A total of 24 trials reporting 26 comparisons were included (two of prevention and 24 of treatment strategies). RESULTS - LOW-LEVEL LASER THERAPY, THERAPEUTIC ULTRASOUND, ELECTROTHERAPY AND ELECTROMAGNETIC THERAPY: Four RCTs of laser (for venous leg ulcers), 10 of therapeutic ultrasound (for pressure sores and venous leg ulcers), 12 of electrotherapy (for ischaemic and diabetic ulcers, and chronic wounds generally) and five of electromagnetic therapy (for venous leg ulcers and pressure sores) were included. Studies were generally small, and of poor methodological quality. CONCLUSIONS (1) Foam alternatives to the standard hospital foam mattress can reduce the incidence of pressure sores in people at risk, as can pressure-relieving overlays on the operating table. One study suggests that air-fluidised therapy may increase pressure sore healing rates. (2) Compression is more effective in healing venous leg ulcers than is no compression, and multi-layered high compression is more effective than single-layer compression. High-compression hosiery was more effective than moderate compression in preventing ulcer recurrence. (3) There is generally insufficient reliable evidence to draw conclusions about the contribution of laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy to chronic wound healing.
Many new modalities have been developed to treat symptomatic hemorrhoidal disease. In order to determine whether direct current electrotherapy therapy is effective, a prospective, crossover study was done. Sixteen patients referred for treatment of symptomatic hemorrhoids underwent a 16-week treatment protocol. Patients were randomized to receive either medical therapy with a sham therapy, or medical therapy with active direct current electrotherapy at 4-week intervals. All patients were instructed in medical therapy including sitz baths, hydrocortisone suppositories, topical preparations, and a high fiber diet with an educational booklet. Patients who did not respond to initial therapy were crossed over at 8 weeks, receiving alternate therapy twice. Improvement in symptoms, or lack thereof, was not statistically different between the two treatment groups. Comparisons of the internal sphincter pressure, external sphincter pressure, maximum squeeze pressure, and rectal sensitivity to balloon insufflation (volume) were not statistically different before, during, or after any treatment modality (p = 0.46, 0.60, 0.33). The size and grade of hemorrhoids on entry into the study had no bearing on the outcome. In a prospective crossover trial, no difference could be found between standard medical therapy and direct current electrotherapy in the treatment of symptomatic-hemorrhoidal disease.
Myelomeningocele is the most common cause of neurogenic bladder dysfunction in children. Urinary incontinence is socially disabling for many of these children and undetected elevations in detrusor pressure can lead to serious upper tract damage. Sensory receptors in the bladder mucosa and submucosa provide afferent information to the central nervous system regulating the micturition reflex. Since 1959 Katona and several other investigators have used intravesical electrotherapy for diagnosis and treatment of the neuropathic bladder. Our objective was to conduct a randomized, sham controlled and blinded clinical study on the efficacy of transurethral intravesical electrotherapy in treating urinary incontinence in the myelodysplastic child. A total of 36 children was enrolled in the study and 31 completed the entire protocol. Of the patients completing the study 13 were randomly selected to serve as an internal sham control having the electrocatheter placed without activating the stimulator. These patients were subsequently treated with a 3-week course of electrotherapy. The remaining 18 patients completing the study were randomly selected to undergo 2, 3-week courses of intravesical bladder stimulation. Urodynamic studies were performed before and after each treatment series. Detailed daily questionnaires were submitted to each participant covering subjective improvement in urinary continence and any development of bladder sensory awareness. Analysis of the urodynamic data and questionnaires failed to reveal any statistically significant increase in bladder capacity, development of detrusor contractions, improvement in detrusor compliance or the acquisition of bladder sensation allowing timely intermittent catheterization preventing urinary incontinence.
A total of 20 children with incontinence due to myelomeningocele and 1 due to occult neuropathic bladder underwent a course of endovesical electrotherapy. There was temporary improvement in 1 and more lasting in another, but this was the result of catheterisation and bladder training rather than the electrotherapy. It is concluded that the electrotherapy has helped none of the patients, and no significant change in their bladder function was detected.
OBJECTIVE: To retrospectively evaluate the ability of high voltage pulsed current (HVPC) to increase microcirculation in critically ischemic wounds (transcutaneous oxygen [TcPO(2)] less than 10 mm Hg) and, as a result, to improve wound healing. DESIGN AND METHODS: Clinical case series with successive adult diabetic subjects (3 men and 3 women) with nonsurgical ischemic malleolar or inframalleolar skin lesions, each subject serving as his or her own control. Wound area and TcPO(2) were measured periodically. Presence of distal arteriosclerosis was assessed on 5 patients by 2-dimensional, time-of-flight magnetic resonance angiography. End point was either complete wound closure or leg amputation. RESULTS: Maximum mean TcPO(2) was 2 +/- 2 mm Hg at the wound edge before the start of electrotherapy. After electrotherapy began, maximum TcPO(2) was 33 +/- 18 mm Hg (N=6; P<.05, Wilcoxon signed rank test). After treatment with HVPC, 4 patients' wounds healed and 2 patients underwent amputation. As expected, healed patients initially deteriorated after the start of treatment, but their wounds began healing when the perilesion TcPO(2) measurement exceeded 20 mm Hg. Thereafter, the wounds closed at a predictable rate. Complete closure occurred for patients who had a relatively low atherosclerotic burden. CONCLUSION: The results of this clinical case series suggest that electrotherapy can improve periwound microcirculation of ischemic inframalleolar skin lesions.
The Dutch Health Council recently published a report on the efficacy of electrotherapy, laser therapy and ultrasound treatment for musculoskeletal disorders. The assessment was based on three systematic reviews, including 169 randomized clinical trials, and focused on a best-evidence synthesis. Virtually no conclusive clinically relevant effects of the three forms of physical therapy were found. Possible exceptions are electrotherapy for osteoarthrosis of the hip or knee, laser therapy for pain treatment and rheumatoid arthritis, and ultrasound treatment for epicondylitis lateralis. But even for these putative indications, further research is clearly needed before implementation in practice is justifiable. It is strongly recommended that the current widespread use of electrotherapy, laser therapy and ultrasound treatment should be reduced, preferably by self-regulation within the profession itself.
As a therapeutic management of neurogenic disorders of micturition is an actual problem, the authors analysed the results of electrotherapy in 58 patients suffering from the aforementioned conditions. Out of them 22 patients sustained conservative and 36 combined treatment with the use of electrical stimulation of the urinary bladder. With regard to the clinical manifestations of micturition distress and the pattern of the bladder dysfunction the patients were allocated to three groups: group 1-34 patients with chronic urine retention; group 11-9 patients with enuresis; group 11-15 patients with the combination of all the symptoms mentioned. With regard to the disease etiology and pathogenesis as well as the functional performance of the lower urinary tract, electrotherapy of the bladder sphincter-detrusor system was performed according to certain parameters developed. Group I patients were exposed to impulsive cross currents with following linear electric stimulation of detrusor; group II patients underwent transrectal electrical stimulation of the sphincter, group III patients were simultaneously subjected to the effect of impulsive cross currents and linear electrical stimulation of the detrusor. In 70.7 per cent of the patients the treatment was a success, in 13.9 it led to an insignificant improvement and in 15.4 per cent it was a failure. Thus, selectively used electrotherapy essentially improves the rehabilitation of the patients suffering from neurogenic distress of micturition.