phonophoresis

PHONOPHORESIS

BY:KARISHMA.GAVLI

INTRODUCTION PHONOPHORESIS:Is defined as the

movement of drugs through skin into the subcutaneous tissues under the influence of ultrasound .

Also called as Sonophoresis or ultrasonophoresis.

PRINCIPLE:Phonophoresis relies on perturbation of

the tissue causing more rapid particle movement and thus encouraging absorption of the drug.

Ultra sound facilitates the passage of some drugs into and through the skin

The effects are due to both absorption of the drug and to the ultrasound

Lower ultrasonic frequencies appear to lead to deeper drug penetration

Pulsing the ultrasound may lead to better drug penetration

The quantity of drug entering the skin is proportional , in general ,to the time and intensity of ultrasound application

PHYSICSMolecules into the target must be broken into

component elements and radicals by natural chemical process and recombined with existing blood stream radicals

Soundwaves may easily penetrate to depths of 4 to 6cm,but no clinical evidence of molecular transfer to depths greater than 1 to 2 mm

However it is highly unlikely that substances of molecular sizes can be forced into the tissues to those depths.

EFFECTS OF PHONOPHORESISThe thermal effects of ultrasonic increase

tissue permeability.The medication follows the path of beam.Continuous ultrasonic at an intensity great

enough to produce thermal effects may induce a pro-inflammatory response.

If the goal is to decrease inflammation , pulsed ultrasonic with low spatial-averaged temporal peak intensity may be the best choice.

PENETRATION OF DRUGS

Once the drug has passed through the epidermis ,it is likely to be dispersed in the circulation to an extent which depends on the vascularity of the tissues concerned and the ease with which molecules of the drugs can enter blood vessels.

Low frequency leads to greater penetration.

Deeper penetration does not necessarily infer greater effectiveness.

Therapeutic effects occur in the dermis and epidermis ,such as cutaneous anaesthetic effect of lignocaine

This has been shown to occur in that 1.5 and 3 MHz ultrasonic appeared to be more effective in achieving absorption of local anaesthetic than 0.75 MHz

Pulsed is more effective than continuous in transfer of analgesic

DRUGS USED IN PHONOPHORESIS

Anti-inflammatory drug hydrocortisone has been widely used.

Other steroid-type drugs and non-steroidal anti-inflammatory drugs mainly salicylates.

Anti-inflammatory analgesic cream trolamine salicyclate ,the effectiveness of this agent on DOMS (delayed onset muscle soreness)

A lotion containing zinc oxide, tannic acid, urea and menthol has been applied by phonophoresis to treat herpes simplex virus type II in both oral and genital infections with good results.

Antibiotics such as penicillin have been given by phonophoresis for the treatment of skin infection.

Hydrocortisone gel or ointment (1-10%)

It may be used for strong anti-inflammatory action in acute inflammation of soft tissues.

In rare cases skin rashes may be seen which is best treated by antihistaminic drugs.

It helps in treating many skin reactions such as psoriasis, scleroderma and bursitis.

Lidocaine(4-5%) gel (xylocaine)-It is very effective for analgesic and

relief of acute pain with no adverse reaction.

Zinc oxide cream(20%)-Zinc is a healing agent and can be

useful in treating open wounds.

Methyl salicylate(4.8%) ointment or salicylate (10%) ointment (myoflex)-

As a basic anti-inflammatory agent salicyclate may be considered for chronic painful disorders of the musculoskeletal system.

Patient sensitive to aspirin should not be treated with salicylates.

Iodine(4.7%) ointment (iodex)-It is used in softening of scar tissues ,

soft tissue adhesion , calcification of ligaments and tendons and also for adhesive capsulitis of joints.

Patients allergic to sea food should not be treated with iodine.

PRODUCT ACTIVEINGREDIENTS

TRANSMISSION RELATED TO WATER(%)

0.75MHz

1.5MHz 3MHz

STEROIDS:COBADEX CREAM,LOCOID LIPOCREAM

HYDROCORTISONE,DIMETHICONE

HYDROCORTISONE BUTYRATE

55

38

6761

7571

ANTI-INFLAMMATORY DRUGS:INTRALGIN GEL,MOVALET CREAM

BENZOCAINE SALICYLAMIDE,

CORTICOSTEROIDS,HEPARINOID,SALICYCLIC ACID

87

33

11

48

120

69

LOCAL ANAESTHETICS:EMLA CREAM,XYLOCAINE OINTMENT

LIGNOCAINE, PRILOCAINE,

LIGNOCAINE HYDROCHLORIDE

83

2

90

2

95

0

APPLICATIONThe drug to be driven is combined in a

suitable gel or cream which forms the couplant.

It is smeared onto the part using spatula so that it is not applied by patient fingers.

Treatment head is used in a usual manner.Relatively high intensities of 1 and 1.5 W/cm2

have been used.The depth of the target tissue determines the

frequency used.The time of the treatment depends on the

area over which phonophoresis is to be applied.

1 minute treatment for every 10cm2 area is reasonable (although some suggest 5 minute for each 25cm2, i.e. about 1 minute for 30cm2.

After the completion of treatment , the drug should be removed from both the patient’s skin and transducer head.

Since the cream or gel containing the drug is being used as the coolant, it is important that it transmits ultrasonic adequately.

(gels are more efficient coupling agents than creams particularly for high frequency ultrasonic-1.5 & 3MHz)

CONDITIONS TREATED WITH PHONOPHORESIS

Post – injury conditions(dislocation, distortion of joints, inflammation of muscle , tendons etc.)

Pain in rheumatic diseases. Low back pain of

neurological origin( i.e. root pain discopathies, sciatica)

Bursitis and similar inflammatory ailments.

Carpal tunnel syndrome. Foot /toe pain/ Achilles

sprains and strains. Ankle/knee/calf/neck sprains

and strains Wrist /hand /elbow /shoulder

sprains and strains

Hip/thigh sprains and strains. Ligament strains Osteoarthritis Post –exercise recovery(when

the workout goes a bit too far) Plantar fascitis(heel spurs) Rheumatoid arthritis Shoulder capsulitis Supraspinatus /infraspinatus Tarsal tunnel syndrome Tendonitis (acute or chronic) Tennis elbow or golfers elbow Tension headaches Upper and low back strains

CONTRAINDICATIONRapidly dividing tissue

Spread of infection

Vascular problems

Radiotherapy

Implants

Anaesthetic area.

REFERENCES

Low and reedKhatriJoseph khan www. Google .comWikipediaelectrotherapy.org

Thank you