Electrophoresis as part of physiotherapy is offered for the treatment of numerous pathologies both in public clinics and in private medical centers. We decided to check whether this method has proven scientific effectiveness.
Electrophoresis (also known as iontophoresis) is a non-invasive method administering drugs through the skin using electricity. Using this method, healthcare institutions offer to treat diseases of the nervous system (meningitis, meningoencephalitis, encephalitis, encephalopathy, consequences of traumatic brain injuries and cerebrovascular accidents), gastrointestinal tract (gastritis, peptic ulcer, colitis, irritable bowel syndrome), cardiovascular systems (hypertension, atrial fibrillation, ischemic disease), respiratory systems (bronchial asthma, pneumonia, chronic obstructive pulmonary disease), ophthalmological, dental, gynecological and ENT diseases, injuries, arthritis, arthrosis and fractures.
Most medicinal drugs are weak organic acids or bases that exist in the aqueous environment in non-ionized or ionized forms. The former are usually fat-soluble and therefore easily penetrate cell membranes; the latter, on the contrary, are almost insoluble in fats, but are soluble in water, and their charged ions cannot overcome the electrical barrier at the tissue boundaries. To facilitate this process we offer procedure electrophoresis - drug-impregnated tissue is placed on an undamaged area of skin, and two electrodes are placed on top. When an electric current is passed through the electrodes, the voltage between them provides additional potential and the ions in the drug are supposed to be able to penetrate through the skin into the blood and on to the desired organ. In essence, the electrodes should act as a springboard, giving substances sufficient acceleration.
However, not every substance is suitable for electrophoresis. Firstly, this procedure is not applicable to the “delivery” of non-ionized drugs that do not carry ions. The second limitation is the size of the molecule. What is he more, the more difficult it is for a molecule to overcome the percutaneous barrier. The most difficult to deliver are peptides and macromolecules, as well as drugs based on DNA and small interfering RNA. At the same time, drugs, the molecular size of which is already small, can overcome the percutaneous barrier without additional acceleration. For example, this is how they work transdermal patches - hormonal (with estradiol or testosterone), against motion sickness (with scopolamine), to overcome nicotine addiction and pain relief (with fentanyl). To date 15 substances and five combinations drugs are available for transdermal administration. That is, for drugs to be effective specifically for electrophoresis, they must have a certain molecular size (about 1000 Daltons).
There is not much evidence of the effectiveness of electrophoresis in the treatment of various diseases. According to the National Library of Medicine (USA), its use specifically as a method of treatment justified only in case of hyperhidrosis (excessive sweating in the palms, soles or armpits). Moreover, to treat this disease in the process of electrophoresis, it is not medicine that is used, but ordinary water. Presumably electric current cheats Nervous system signals that overstimulate the sweat glands. Typically, 10–12 sessions are required to achieve a pronounced effect, then the patient does the procedures less frequently.
Although electrophoresis is proposed as a treatment option for diseases of many internal organs, the charged ions of the drug simply do not have a chance to reach the site of the planned effect. This is confirmed experiments on the development of delivery systems using electrophoresis for highly toxic drugs for the treatment of certain types of cancer. Appropriate tests were conducted on volunteers to use this method in the treatment of malignant tumors located on the surface of the skin. 25 out of 26 patients with basal cell carcinoma and squamous cell carcinoma who took part in the experiment went into stable remission. In experiments with animals, electrophoresis was used to treat retinoblastoma (neoplasm of the retina), tumors of the bladder and pancreas. These experiments also showed a significant reduction in the tumor process, but only if the electrodes were placed directly into the affected organ. Otherwise, the concentration of the active substance was not enough even to inhibit the process of division of pathological cells, not to mention reducing the tumor.
In other words, electrophoresis used in oncology differs significantly from that which is usually offered in clinics and private centers. It is possible that the use of this method in the treatment of malignant neoplasms is a new step in the treatment of cancer, but clinical trials are still ongoing.
Electrophoresis is also actively promoted as a means for the treatment of diseases of the musculoskeletal system, in particular with the help of drugs from the class of chondroprotectors. However, they are, firstly, in principle don't have proven effectiveness, and secondly, their molecules are too big (8000 - 16,000 Dalton) for delivery to the body using electrophoresis. According to Cochrane reviews, electrophoresis does not help with pain in the neck. neck, in the rotator cuff shoulder or with adhesive capsulitis (formation of excess scar tissue in the glenohumeral joint). As an addition to standard treatment consisting of exercise and cryotherapy, electrophoresis with diclofenac (a popular non-steroidal anti-inflammatory drug) didn't show effectiveness for shoulder tendinitis compared with placebo. However, electrophoresis with lidocaine and dexamethasone for plantar fasciitis (inflammation of the connective tissue that supports the arch of the foot) gave results similar to shock wave therapy - after six weeks of using either of the two methods, the pain went away. However, taking into account the possible recurrent character disease, the long-term effectiveness of both treatment methods has not yet been assessed. A similar technique (electrophoresis with lidocaine and dexamethasone) also made it easier pain in patients with lateral epicondylitis (“tennis elbow”). Electrophoresis with lidocaine only turned out to be effective in relieving spasticity in patients with cerebral palsy. These data are consistent with the fact that lidocaine, like the stronger fentanyl, has good absorbed through the skin and has an analgesic effect - more narrowly targeted in the case of lidocaine and generalized in the case of the opioid fentanyl.
There is also some evidence of the effectiveness of electrophoresis in cosmetology. Treatments with vitamin C can improve the appearance of atrophic acne scars. However, these data require additional evidence, and the effectiveness of electrophoresis for other cosmetic problems does not have similar insufficient evidence.
Thus, electrical impulses can indeed improve the transdermal absorption of some drugs, but they must meet certain criteria to do so. At the same time, it is possible to influence internal organs using this method only by placing the electrodes of the device in close proximity to the impact zone. Therefore, treatment of internal organs using electrophoresis at the moment seems difficult to implement. For a number of diseases of the musculoskeletal system, it can relieve pain, but not cure. To date, electrophoresis has proven itself exclusively for the fight against hyperhidrosis. However, animal experiments show that this method of drug administration has great potential - for example, in oncology.
Cover image: MedClinic
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