New innovations in pain control- Anne Hartley- CSTS- March 2011

New Innovations In Pain Control

Anne HartleyBPHE, CAT(C), DO (MP)

©Anne Hartley 2011

Capital Sports Therapy Symposium

• Thank you to KineMedics

copyright Anne Hartley 2011

InterX• My experience with the unit



Interactive Neurostimulation• Non-invasive, interactive

neurostimulation for the treatment of acute, subacute and chronic pain

• Musculoskeletal, Neural, Bursal, Pre and Post Surgical Pain


Latest Pain Control Device

• Alternating current, high amplitude

• Pulsed sinusoidal biphasic waveform

• Microamp and milliamp elements in each phase


Skin Impedance• Works with the skin impedance • Concentric electrodes


Skin Impedance• The amplitude, symmetry and damping

of each pulse depends on the skin impedance.

• The pulses will change depending on the skin impedance


Interactive Technology• The unit displays the differences in skin

impedance when applying the current.• The areas of low impedance correlate

with the acupuncture points and myofascial trigger points

• The low impedance areas also directly co-relate to the structure in disfunction






Treatment


Treatment Time• Usually 15 – 20 minutes depending on

the size of the treatment area, degree of pain, type of application (hand unit, pads, acupuncture head)


APPLICATION METHOD1. Determine aims of

treatment2. Determine

structure injured, stage of healing, pain and ROM

3. Position patient4. Describe your

goals and what patient will feel

5. Go through contraindications

6. Test sensation in treatment site

7. Look up segmental supply and acupuncture points


APPLICATION METHOD8. Set desired

parameters9. Turn up the

intensity gradually inform patient of feelings

10. Sensations should be felt in painful area

11.Treat site, local acupuncture points

12. Treat segmentally or dermatonally

13. Retest after treatment



Contraindications• Electrode over malignant tumors• Over the Carotid Sinus• Over mucous membranes• Patients prone to seizures• Over pharyngeal or laryngeal muscles• Patients with demand-type pace makers


CONTRAINDICATIONS• Over the eyes or genital area• If patient is operating machinery• Anterior chest wall• Senility, language barrier, under age• Without permission• In the cerebrovascular or transient

ischemic patient


CONTRAINDICATIONS

Cardiac pacemakerPregnant womenDecreased sensationOpen skin infection,

lesion, suture or cut


Parameters and Set up• Acute injuries (Inflammatory to Proliferation

Stage of Healing) = High frequency or cycling high frequencies (dynamic)

• Subacute injuries (Healing Stage) = Mid frequencies or cycling mid frequencies (dynamic)

• Chronic injuries (Remodelling Stage of Healing) = Lower frequency or cycling low frequencies (dynamic)


InterX Therapy Presets

• Acute (Inflammatory, Proliferation)– 480, 360, 90-360

• Subacute (Healing)– 180, 240, 30 – 120

• Chronic (Remodelling)– 15, 60, 15-60


InterX Application• Turn unit on• Choose Acute, Chronic or Cycling• Choose frequency• Turn up intensity to an amplitude with

comfortable tingling for the patient• The head of the interX must be in full

contact with the skin (no gel needed)


InterX Application1. Scan to find acupuncture points (active

sites) or ion imbalance in the injured site

2. Target specific acupuncture points or lesion site

3. Dynamic is applying the interX during active exercise (Pads usually)


Scan for Active Sites• Active sites on the skin are areas of lower

impedance than the surrounding areas

• On areas of lower impedance, the device will drag or stick on the skin, the stimulation is stronger and the device gets louder

• The device displays an active reading on the screen – the higher the number the lower the impedance


Scan for Active Sites


Scan for Active Sites• Over larger areas, the user can expect

to find 3 -7 active sites which then can be treated with the Target step of the protocol

• Activity Reading (AR) is an objective measurement of the effect that skin impedance has on the waveform

• Higher AR (lower impedance) indicates where treatment should be applied


Activity Reading


Activity Readings


TARGET• Having identified active sites then1. Point stimulation – hold applicator on

active site- A constant changing waveform is delivered to the for 6 sec – 60 sec- When the stim is complete a yellow value

will appear on the screen




Target2. Multidirectional Sliding Technique

After the point stimulation, slide the device in different directions over the active site until the InterX will slide more smoothly

The point that delivered the highest point stim value is the most active site. Repeat the target step on the most active spot with the multidirectional sliding



Target• Treat the spinal segment that serves the

lesion site• Treat the nerve that serves the lesion

site• Treat the dermatome that serves the

lesion site• Treat neighbouring acupuncture points



Dynamic

• The InterX can be used during passive, active, resisted, proprioceptive and sport specific or functional activity

• Use the Flexible Array of pads – Dynamic presets – 5-20 min– Acute 90-360– Healing 90-360– Chronic 30-120– Hypersensitive 15 - 60



Dynamic

Place the device on area area of tightness, pain or restriction for 30 sec while exercising. Can continue for 5 minutes on several points


Research – Post op Hip• Non-invasive interactive neurostimulation

in the post-op recovery of patients with a trochanteric fracture of the femur

Journal Bone and Joint Surgery Vol 89-B, No.11, Nov 2007 (Gorodetskyi et al.)

60 patients divided in 2 groups – one sham and one interX, all other rehab the same

Treatment was for 10 days post surgery


• Http://www.jbjs.org.uk/cgi/content/abstract/89-B/11/1488


Research – Post-op HipOutcome measurements• Visual analog scale for pain• Pain inventory• Ketorolac for post-op pain• Overall assessment by surgeon


Research – Post-op HipResults – stim groupDecrease in the mean VAS pain scale ROM – hip flexion of 88.7 degrees versus

sham who had 63 degreesUse of Ketorolac was much less Pain during walking was lessAt the end of the study, the stim group

reported pain of 1 out of 10 while the sham group had a mean score of 5.3 out of ten


Research – Bimalleolar Ankle Surgically Repaired Fractrures• 60 patients with operative reduction and

internal fixation of the biomalleolar fractures

• 2 groups –one non-invasive interactive neurostimulation device group, sham

• Measured the level of pain, ROM, edema and Ketorolac


Research – Bimalleolar Ankle Surgically Repaired Fractrures• Results:• VAS scores for the stim group were 0 out

of 10 by the end of 10 days, sham was 2.1

• Medication use – stim 112mg mean total, sham was 209mg

• Edema – stim 16.3mm, sham 27.3mm• Mobility - sum of plantar and dorsiflexion

– Stim – 46 degrees, sham – 28 degrees


Neurostimulation in MCL of sheep

• Compared to controls the stimulation reduced the swelling at the surgical site

• The mechanical properties did not improve or decrease from sham (load to failure)

• Histological results show stim group had increase tissue organization over sham


Research – Total Knee Replacement

• 61 subjects – 30 stim and standard rehab, 31 just standard rehab

• Stimulation using the flexible array electrodes

• VAS for pain• Medication• Range of Motion• Edema


TKR


TKR• Medication InterX

ControlPCA (mg) 29.7 32.7Voltarol (100mg) 2.3 3.2Paracetamol (500mg) 7.1 7.2Cocodam 30/500 4 4.5


TKR• ROM


TKR• EdemaNo significant difference in the swelling.

Slightly less in the stim group


Physiological Effects of InterX Scientific Abstract

• Blood was used from 4 healthy adults before and 20 minutes after treatment with InterX

• Treatment was 480 pulse/sec on lateral elbow

• Measured lymphocyte metabolism, gene expression, cytokine production


Physiological Effects of InterX

• Lymphocyte metabolism did not change• Cytokine showed acceleration of wound and

connective tissue healing and inflammation reduction

• Gene expression activity changed– Mitochondrial stimulation– Neuron specific genes activated– LOX4 activated which is related to cartilage

regeneration and repair– LOXL4 activated which is the catalyst for the

formation of collagen and elastin

Accessories


Small Joints, acupuncture points






Case Study - Demonstration• Lets go through a case study of

someone with an injury in the room

New innovations in pain control- Anne Hartley- CSTS- March 2011

Health & Medicine

unit copyright anne

screen copyright anne

phase copyright anne

mp anne hartley

pain control anne hartley

active sites active

skin impedance works

areas of lower impedance