10/29/2010

Pain Management and Bioelectric Therapy









Pain Management and Bioelectric Therapy

Bioelectric therapy is a safe, drug-free treatment option for people in pain. It is used to treat some chronic pain and acute pain conditions. It relieves pain by blocking pain messages to the brain. When you are injured, pain receptors send a message to the central nervous system (the brain and spinal cord). The message is registered as pain by certain cells in the body. Using bioelectric currents, bioelectric therapy relieves pain by interrupting pain signals before they reach the brain. Bioelectric therapy also prompts the body to produce endorphins which help to relieve pain.

What Conditions Are Treated With Bioelectric Therapy?

Bioelectric therapy can be used to treat chronic and acute pain conditions including:
Bioelectric therapy isn't right for everyone. It is not recommended for people who:
  • Have a pacemaker.
  • Are pregnant.
  • Have thrombosis (blood clots in the arms or legs).
  • Have a bacterial infection.

How Effective Is Bioelectric Therapy?

Bioelectric therapy is effective in providing temporary pain control, but it should only be a part of a total pain management program. When used along with conventional pain-relieving medications, bioelectric treatment may reduce the dose of some pain medications by up to 50%.

What Happens During Bioelectric Therapy?

During bioelectric therapy, several small, flat rubber adhesive discs (called electrodes) are applied to your skin at prescribed areas to be treated. Sometimes rubber suction cups (called vaso pneumatic devices) may be applied to your skin. The electrodes are hooked up to a computer that programs the precise treatment dosage required. High frequency alternating electrical currents (around 4,000 cycles per second) are then applied to the electrodes. The currents move through the skin quickly with little discomfort. During treatment, your response to the electrical stimulation is measured.
When electricity is applied, a mild vibrating, tingling sensation is common. This sensation should not be uncomfortable; you should feel a relaxing, soothing pain relief. As the currents are applied, you will provide verbal feedback to the clinician. If the sensation becomes too strong, please tell the clinician right away so the treatment can be adjusted. You should be comfortable and enjoy the treatment, which lasts about 20 minutes.

What Are the Side Effects of Bioelectric Therapy?

In rare cases, skin irritation and redness can occur under the electrodes during bioelectric therapy.

How Often Should I Get Bioelectric Therapy?

The number of bioelectric therapy sessions required depends on each person's condition and response to treatment. One bioelectric therapy session does not usually result in pain relief. Therapy usually begins with about five sessions in one week, followed by three treatments per week. A normal course of treatment includes 16 to 20 treatments.

How Do I Prepare for Bioelectric Therapy?

If you are taking insulin or blood-thinning medications, your doctor may give you specific instructions to follow before getting bioelectric therapy.
You may be asked to fast before the procedure, and you may need to make arrangements for someone to drive you home after treatment.
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The Polio Crusade

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Erradicación de La poliomielitis

Polio Tricisilla Adaptada

March Of Dimes Polio History

Dr. Bruno

video

movie

movie2

A 41-year-old man developed an acute illness at the age of 9 months during which, following a viral illness with headache, he developed severe weakness and wasting of the limbs of the left side. After several months he began to recover, such that he was able to walk at the age of 2 years and later was able to run, although he was never very good at sports. He had stable function until the age of 18 when he began to notice greater than usual difficulty lifting heavy objects. By the age of 25 he was noticing progressive difficulty walking due to weakness of both legs, and he noticed that the right calf had become larger. The symptoms became more noticeable over the course of the next 10 years and ultimately both upper as well as both lower limbs had become noticeably weaker.

On examination there was wasting of the muscles of upper and lower limbs on the left, and massively hypertrophied gastrocnemius, soleus and tensor fascia late on the right. The calf circumference on the right exceeded that on the left by 10 cm (figure1). The right shoulder girdle, triceps, thenar eminence and small muscles of the hand were wasted and there was winging of both scapulae. The right quadriceps was also wasted. The wasted muscles were also weak but the hypertrophied right ankle plantar flexors had normal power. The tendon reflexes were absent in the lower limbs and present in the upper limbs, although the right triceps was reduced. The remainder of the examination was normal.

Figure 1

The patient's legs, showing massive enlargement of the right calf and wasting on the left

Questions

1
What is that nature of the acute illness in infancy?
2
What is the nature of the subsequent deterioration?
3
What investigations should be performed?
4
What is the differential diagnosis of the cause of the progressive calf hypertrophy?

Answers

QUESTION 1

An acute paralytic illness which follows symptoms of a viral infection with or without signs of meningitis is typical of poliomyelitis. Usually caused by one of the three polio viruses, it may also occur following vaccination and following infections with other enteroviruses.1 Other disorders which would cause a similar syndrome but with upper motor neurone signs would include acute vascular lesions, meningoencephalitis and acute disseminated encephalomyelitis.

QUESTION 2

A progressive functional deterioration many years after paralytic poliomyelitis is well known, although its pathogenesis is not fully understood.2 It is a diagnosis of exclusion; a careful search for alternative causes, for example, orthopaedic deformities such as osteoarthritis or worsening scoliosis, superimposed neurological disorders such as entrapment neuropathies or coincidental muscle disease or neuropathy, and general medical causes such as respiratory complications and endocrinopathies.3

QUESTION 3

Investigations revealed normal blood count and erythrocyte sedimentation rate and normal biochemistry apart from a raised creatine kinase at 330 IU/l (normal range 60–120 IU/l), which is commonly seen in cases of ongoing denervation. Electromyography showed evidence of denervation in the right APB and FDI with polyphasic motor units and complex repetitive discharges, no spontaneous activity in the left calf and large polyphasic units in the right calf consistent with chronic partial denervation. Motor and sensory conduction velocities were normal. A lumbar myelogram was normal. Magnetic resonance imaging (MRI) scan of the calves is shown in figure2.

Figure 2

Axial T1 weighted MRI scan (TR 588 ms, TE 15 ms) of the calves, showing gross muscle atrophy and replacement by adipose tissue on the left, and hypertrophy of the muscles on the right, with only minor adipose tissue deposition

QUESTION 4

The differential diagnosis of the progressive calf hypertrophy is given in the box.

Causes of calf muscle hypertrophy

Chronic partial denervation

  • radiculopathy

  • peripheral neuropathy

  • hereditary motor and sensory neuropathy

  • spinal muscular atrophy

  • following paralytic poliomyelitis

    Neuromyotonia and myokymia

  • Isaac's syndrome

  • generalised myokymia

  • neurotonia

  • continuous muscle fibre activity due to: chronic inflammatory demyelinating polyradiculopathy, Guillain Barre syndrome, myasthenia gravis, thymoma, thyrotoxicosis, thyroiditis

    Muscular dystrophies

    Myositis

    Infiltration

  • tumours

  • amyloidosis

  • cysticercosis

    Link here