Iontophoresis is commonly used in physical therapy practice as an alternative to oral or injection methods of drug delivery. Electrostatic repulsion is the driving force behind this modality. Common indications for iontophoresis are pain, inflammation, edema, calcium deposits, and hyperhidrosis. Generally, results should be achieved within 4-5 treatments and there must be at least 24-48 hour separation between each treatment.
Article for Ionophorsis
The study by Melson.,et al. (2011) examined the effectiveness of dexamethasone iontophoresis for temporomandibular joint involvement in juvenile idiopathic arthritis. There were twenty-eight patients used in this study between the ages of two and twenty-one years old. They received dexamethasone iontophoresis for the temporomandibular joint an average of eight sessions. This type of iontophoresis used low-grade electric currents to deliver dexamethasone into the temporomandibular joint. One TMJ measurement (in mm) examined was the maximal interincisal opening (MIO) which is the distance between the upper and lower incisor during full mouth opening with head in neutral. The other measurement (in mm) was the maximum lateral excursion (MLE) which is the horizontal distance measured between the upper and lower central incisors with movement of the mandible to the left or right side. Both measurements used the TheraBite range of motion scale and were measured before and after treatment.
After accessing the patient’s records, 28 of the patients had serial MIO measures and only 16 of the 28 had serial MLE measurements. The median increase in MIO measurement was 4.5 mm and 2.25 mm for the MLE measurement. There were 19 of the 28 patients (68%) that saw an increase in their MIO measurement, and there were 11 of the 16 patients (69%) that saw in increase in their MLE measurement. Also, 15 of the 28 patients reported that they had pain in their TMJ joint when they were chewing or they were at rest, which was resolved in 11 of the patients with the use of dexamethasone iontophoresis. There were 1/3 of the 28 patients that saw no improvements. Overall, the article shows that dexamethasone iontophoresis is effective for treating temporomandibular joint limitations in juvenile arthritis patients.
In the study Physical Therapist Management of an Adult with Osteochondritis Dissecans of the Knee by Michael P Johnson, interventions for OCD were evaluated and followed up nine months after the treatment. The patient was a twenty-four year old female who was diagnosed using MRI. During therapy, she was educated on minimizing loading across the knee, performed strengthening exercises, and received iontophoresis. Iontophoresis was applied to anteromedial condyle of the femur using 4mg/mL solution of DEX-P. After five treatment sessions, the patient reported 0/10 knee pain and only reported slight pain with palpation. At the nine month follow-up, the patient reportedly had 95% of prior knee function and no pain during daily activities or palpation.
In a study by Sreerekha et al, the use of dexamethasone to suppress the histamine-induced wheal was examined. They compared dexamethasone delivered by iontophoresis and without iontophoresis (topical). Twenty volunteers were used. Each volunteer had a dexamethasone soaked gauze piece placed on each forearm, one connected to the iontophoretic machine and one not. Electric current was delivered for 15 minutes with amperage according to patient tolerance. Prick testing was done with histamine solution at the end of 30 minutes, 1 hour, and 2 hours. The wheal diameter on the arm that used iontophoresis was lower and statistically different than the other at the end of 30 minutes. At the end of 1 and 2 hours there was no statistically significant difference in wheal suppression. This study found iontophoresis to be more effective in suppressing the histamine wheal at the end of 30 minutes, but the effect decreases at the end of 1 hour. It was also concluded that dexamethasone administered using iontophoresis is more effective than dexamethasone without iontophoresis.
Article Against Iontophoresis
In a study by Cleland., et al. (2009) the effectiveness of manual therapy and exercise was compared to the effectiveness of electrophysical agents and exercise for the management of plantar heel pain. There were 54 subjects in this study between the ages of 18 and 60 that had a primary complaint of plantar heel pain. There were six therapists involved in this study that received standardized training by one of the investigators. Each patient was seen a total of 6 times over a period of 4 weeks. The patients were divided into two groups (27 people in each): manual physical therapy and exercise (MTEX) and electrophysical agents and exercise (EPAX). The MTEX group received 5 minutes of aggressive soft tissue mobilizations that were directed at the triceps surae, insertion of plantar fascia, and rearfoot eversion. They also received impairment based physical therapy for hip, knee, ankle, and foot. They also were given a home exercise program that included gastroc and soleus stretches. The EPAX group received ultrasound for five minutes followed by iontophoresis with dexamethasone. They then were given stretches for the gastroc, plantar fascia, and soleus along with intrinsic foot strengthening exercises.
The results were measured using the LEFS (lower extremity functional scale), the FAAM (the foot and ankle ability measure), and the NPRS (the numeric pain rating scale). The patients were examined at baseline, 4 weeks, and 6 months. For the LEFS and FAAM tests the MTEX group had better measures than the EPAX group at both the 4 week and 6 month follow up appointments. Also The MTEX groups had a much larger NPRS improvement than the EPAX group at the 4 week follow up appointment, but by 6 weeks there as not a significant difference between the groups. The results show that MTEX is a better choice than EPAX for the management of plantar heel pain. This means that ultrasound and dexamethasone iontophoresis with exercise are not the most effective choice when compared to manual therapy and exercise.
Amirjani et al conducted a study evaluating the effectiveness of dexamethasone iontophoresis as a noninvasive method of treating carpal tunnel syndrome. Subjects in the treatment group received 0.4% dexamethasone sodium phosphate dissolved in distilled water, whereas the placebo group received distilled water. The delivery electrode was placed directly over the carpal tunnel, and each patient received 6 treatments (on alternate days over a 2-week period) of a dose of 80 mA/min at a rate of 2 mA/min. Baseline measures were repeated at monthly intervals after treatment for a total of 6 months. Most of the outcome measures were not shown to have any significant change after treatment. This study found that although iontophoresis of 0.4% dexamethasone is well-tolerated by patients, it was not effective in the treatment of moderate carpal tunnel syndrome.
In a study A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia by Bisset L, Paungmali A, Vicenzino B, and Beller E, the effectiveness of treatment for lateral epicondylagia was evaluated. Twenty eight randomized controlled trials met the minimum criteria for meta-analysis. Iontophoresis was evaluated using a control group receiving saline and the experimental group receiving a corticosteroid solution. After one to three months of treatment, significant results were not found in the experimental group.
Chelsea K., Kelci M., Shannon L.
References
Mina, R., Melson, P., Powell, S., Rao, M., Hinze, C., Passo, M., et al. (2011). Effectiveness of Dexamethasone Iontophoresis for Temporomandibular Joint Involvement in Juvenile Idiopathic Arthritis. Arthritis Care & Research, 63(11), 1511-1516. doi:10.1002/acr.20600
Cleland, J., Abbot, J., Kidd, M., Stockwell, S., Cheney, S., Gerrard, D., et all. (2009) Manual Physical Therapy and Exercise Versus Electrophysical Agents and Exercise in the Management of Plantar Heel Pain: A Multicenter Randomized Clinical Trial. Physical Therapy, 39(8), 573-585. doi:10.2519/jospt.2009.3036
Amirjani, N., Ashworth, N. L., Watt, M. J., Gordon, T., & Chan, K. M. (2009). Corticosteroid iontophoresis to treat carpal tunnel syndrome: a double-blind randomized controlled trial. Muscle & nerve, 39(5), 627-33. doi:10.1002/mus.21300
Sreerekha, Rai R, Shanmuga SV, Karthick, Prabhu S, Srinivas CR, Mathew AC. Study of histamine wheal suppression by dexamethasone with and without iontophoresis. Indian J Dermatol Venereol Leprol 2006;72:283-5
Johnson, Michael P. "Physical Therapist Management of an Adult With Osteochondritis Dissecans of the Knee." Journal of the American Physical Therapy Association 85.7 (2005): 665-75. Physical Therapy. Web. 05 Mar. 2012. <http://ptjournal.apta.org/content/85/7/665.long>.
Bisset, L., Paungmali, A., Vicenzino, B., & Beller, E. (2005). A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. British Journal of Sports Medicine, 39(7), 411-422. doi: 10.1136/bjsm.2004.016170
Logan Hubbard-Iontophoresis
ReplyDeleteA Randomized Study Comparing Corticosteroid Injection to Corticosteroid Iontophoresis for Lateral Epicondylitis
This study was a prospective randomized study that aimed to study the effects of iontophoresis with dexamethasone vs. the effects of corticosteroid injection. Patients were eligible for this study if they were between the ages of 18-70 with a diagnosis of lateral epicondylitis. Patients were excluded if they were pregnant, had a history of fibromyalgia or elbow surgery, had duration of symptoms greater than 2 years, used steroid medication within the previous 6 months, had bilateral symptoms, bony abnormalities around the elbow or resisted elbow function. The primary outcomes studied were grip strength, pain and function scores. The secondary outcome studied was return to work status. 82 patients were randomized into three groups: 10 mg dexamethasone through iontophoresis, 10 mg dexamethasone injection and 10 mg triamcinolone injection. All patients received the same hand therapy treatment for 8 weeks consisting of rest, ROM and strengthening. Patients were evaluated at initial evaluation, after completion of physical therapy and 6 months after physical therapy.
After the completion of therapy, the iontophoresis group had significant improvement in grip strength as well as return to work status. However at 6 months, all groups had equal outcome measures. These results show that iontophoresis is effective in producing short-term benefits with patients with lateral epicondylitis. Clinically this applies because corticosteroid injection remains the leading intervention for lateral epicondylitis, yet this study suggests that iontophoresis may be a more effective and less invasive option.
Stefanou A. A randomized study comparing corticosteroid injection to corticosteroid iontophoresis for lateral epicondylitis. The Journal of hand surgery (American ed.). 2012-01;37:104-9.
Assessment of phonophoresis and iontophoresis in the treatment of carpal tunnel syndrome: a randomized controlled trial
This study was a prospective, randomized controlled trial that aimed to study the effects of phonophoresis and iontophoresis of corticosteroids in conjunction with wrist splint use in the treatment of carpal tunnel syndrome compared to wrist splint use alone. 52 patients with bilateral symptoms were included in this study, but only the dominant hand was analyzed. Inclusion criteria included female patients that were only mildly or moderately affected. Exclusion criteria included systemic diseases, axonal degeneration of the median nerve, previous steroid therapy or surgical treatment for carpal tunnel, or any contraindications for steroid use. The 52 patients were randomized into 3 groups: (1) 3 weeks of phonophoresis with betamethasone in conjunction with wrist splint use (2) 3 weeks of iontophoresis with betamethasone in conjunction with wrist splint use and (3) wrist splint use alone. Patients were assessed using the Boston Symptom Severity Scale (BSSS,) grip strength and a nine hole peg test at initial visit and 3 months after treatment.
Each group showed significant improvement in the BSSS at the 3rd month compared to baseline. No significant change was observed in grip strength or with the nine hole peg test. The phonophoresis group showed statistically significant improvement on the BSSS scale after treatment compared to the control group. Based on these results, the researchers concluded that the use of wrist splints in conjunction with phonophoresis is the best intervention for Carpal Tunnel Syndrome. They also concluded that steroid treatments are not effective in increasing motor skills and hand dexterity.
Gurcay E. Assessment of phonophoresis and iontophoresis in the treatment of carpal tunnel syndrome: a randomized controlled trial. Rheumatology international. 2012-03;32:717-22.
I have read many blogs but never came across such a well written blog.Thanks for posting.click here to visit my website
ReplyDeleteThis is nice post which I was awaiting for such an article and I have gained some useful information.
ReplyDeleteFailed Back Surgery
Hip Pain Treatments
Chronic Headache Causes
Joint Pain Frankfort
Musculoskeletal Pain Frankfort
Neck Pain Frankfort
Pelvic Pain Frankfort
Irrespective of receiving daily oral or future injectable depot therapies, these require health care visits for medication and monitoring of safety and response. If patients are treated early enough, before a lot of immune system damage has occurred, life expectancy is close to normal, as long as they remain on successful treatment. However, when patients stop therapy, virus rebounds to high levels in most patients, sometimes associated with severe illness because i have gone through this and even an increased risk of death. The aim of “cure”is ongoing but i still do believe my government made millions of ARV drugs instead of finding a cure. for ongoing therapy and monitoring. ARV alone cannot cure HIV as among the cells that are infected are very long-living CD4 memory cells and possibly other cells that act as long-term reservoirs. HIV can hide in these cells without being detected by the body’s immune system. Therefore even when ART completely blocks subsequent rounds of infection of cells, reservoirs that have been infected before therapy initiation persist and from these reservoirs HIV rebounds if therapy is stopped. “Cure” could either mean an eradication cure, which means to completely rid the body of reservoir virus or a functional HIV cure, where HIV may remain in reservoir cells but rebound to high levels is prevented after therapy interruption.Dr Itua Herbal Medicine makes me believes there is a hope for people suffering from,Parkinson's disease,Schizophrenia,Lung Cancer,Breast Cancer,psoriasis,Colo-Rectal Cancer,Blood Cancer,Prostate Cancer,siva.Fatal Familial Insomnia Factor V Leiden Mutation ,Epilepsy Dupuytren's disease,Desmoplastic small-round-cell tumor Diabetes ,Coeliac disease,Creutzfeldt–Jakob disease,Cerebral Amyloid Angiopathy, Ataxia,Arthritis,Amyotrophic Lateral Scoliosis,Fibromyalgia,Fluoroquinolone Toxicity
ReplyDeleteSyndrome Fibrodysplasia Ossificans ProgresSclerosis,Alzheimer's disease,Adrenocortical carcinoma.Asthma,Allergic diseases.Hiv_ Aids,Herpe ,Copd,Glaucoma., Cataracts,Macular degeneration,Cardiovascular disease,Lung disease.Enlarged prostate,Osteoporosis.Alzheimer's disease,
Dementia.(measles, tetanus, whooping cough, tuberculosis, polio and diphtheria),Chronic Diarrhea,
Hpv,All Cancer Types,Diabetes,Hepatitis,I read about him online how he cure Tasha and Tara so i contacted him on drituaherbalcenter@gmail.com / info@drituaherbalcenter.com. even talked on whatsapps +2348149277967 believe me it was easy i drank his herbal medicine for two weeks and i was cured just like that isn't Dr Itua a wonder man? Yes he is! I thank him so much so i will advise if you are suffering from one of those diseases Pls do contact him he's a nice man.