Adverse Reactions:

* Skin irritation and burns under the electrodes are possible adverse reactions

*  Using the Infrex Plus on the interferential mode some patients have reported nausea and dizziness when treating themselves in excess of 90 minutes.
    This has been observed only on the interferential mode, not on the tens mode.

*  Some people do not enjoy the constant stimulation of interferential when used 24/7.   



Indications For Use:  

   The Infrex Plus is a combination Interferential and TENS ( Transcutaneous Electrical Nerve Stimulator ) medical device used for symptomatic relief and management of chronic intractable pain and/or as an adjunctive treatment in the management of post-surgical pain, post traumatic acute pain problems, as well as an adjunct for pain control due to rehabilitation exercises and is to be used during the rehab. activity.

Contraindications:

     *  Stimulation is contraindicated for patients using cardiac pacemakers.  It should not be used on patients with known myocardial arrhythmia without physician evaluation.

    *  Stimulation should not be applied transthoracically in any mode.

    *  Stimulation should not be applied transcerebrally.

    *  Stimulation should not be applied over the carotid sinus nerves particularly on a patient with a known sensitivity to carotid sinus reflex.

    *  Stimulation should not be applied over swollen, infected, or inflamed areas of skin eruptions, e.g. phlebitis, varicose veins, thrombophlebitis, etc.

    *  Stimulation should not be applied over or in proximity to cancerous regions.

    *  Stimulation should not be used during pregnancy without physician evaluation.



  In a nutshell, basic problems encountered by pain patients whose electrodes won't stick are:

(1)  skin debris on re-usable self-adhering electrodes,

(2) dried out adhesive, and

(3) too much water (over saturation) of adhesive. 

Additionally, the skin should be cleaned with soap and water. Never use alcohol, lotions, oils, or creams on the skin prior to placing the electrodes. Pre- and post-treatment skin care products are protect the skin and help to keep the treatment area healthy.  Read on and/or watch tens electrode care video.


    There have been relatively few books written dedicated exclusively to Interferential therapy.   The academic textbooks generally devote a chapter or two to interferential but as a stand alone it is extremely difficult to find an authoritative book.

    I was first introduced to interferential in the mid 80's reading the book,

                                               "Interferential Therapy" by Brenda Savage, MSc, MCSP, DipTP - ISBN # 0 571 13202 2; first published in 1984. 

In 2004 I tried to buy the book and could not find it still being published so I went on Amazon.com and Ebay and found 3 old copies of it.   At that time I assumed there had to be another book written since it was the most popular form of clinical electrotherapy so I just assumed more educators, especially physical therapists,  would be writing about one of the most used modalities in the profession.

  

Pain management is big business in the U.S. especially for those who make and distribute pharmaceuticals.  The use of drugs can be wonderful when the drugs help to alleviate the cause of the pain impulse for the patient,  but it becomes a problem if the drug is only used to mask the brain's ability to perceive pain.  This is one of the techniques that is used for pain management of the chronic pain patient however there are better options..

therapeutic ultrasound unitUltrasound is indicated for many acute and chronic injuries and in most instances the treatment is of short duration and done in a clinical or hospital setting.  The patient has to go to the office for a 20 minute treatment and then return as needed.  Ultrasound rentals can be less than the cost of two treatments in the hospital or clinic in most situations...

The below post was made on Dec. 31, 2007 in response to article, "The Truth Behind Electric Waves For Pain Relief"on one of the chronic pain blogs of MedFaxx.

Response:

    The author makes some interesting points here but the generalizations being made are without foundation or merit.

    The title insertion of "electric waves" is illustrative of the misunderstanding of the subject matter. I'm not criticizing the author but pointing out that many arguments  are made without knowledge of the way electricity interacts with the human body.

    The historic context of "electric waves" is one of the use of direct current, ie. the early Biblical references of "eels" and putting one's body part in the water for the shock effect which for some caused short/midterm pain relief. DC ( direct current ) is the form of electric waves upon which the historical context is discussed. Galvani used DC to stimulate frog legs to "jump",even after death, is one of the classics of "electric waves".


    There is a plethora of research articles, most not double blind due to the sensory effect of electrical stimulation being felt, that have supported the use of E-stim for pain relief, be it chronic or acute. HCFA - Medicare, most major insurance companies, state funded health care ( Medicaid , Worker's comp programs- local and national, all relied upon the research to make their decisions to cover the cost of tens and it's associated supplies as an effective, cost efficient method of pain control for chronic pain and in some cases for acute pain if used for post surgical applications.

    One of the most effective forms of electrotherapy , note I say electrotherapy, not electric waves, is the use of interferential therapy both clinically and now as an outpatient therapy. Electricity, interferential, is merely agents of the electromagnetic spectrum of which there are literally billions of combinations. Interferential is the use of 8,000+ pulses of electricity ( AC- alternatng current the difference in discussing electrotherapy now and in the past ) administered transcutaneously per second. This compares to "tens" which is generally 150 pulses per second.

     Interferential ( IF) gives immediate results and also tends to have long term carryover relief for the patient. Carryover is the time one has significant pain relief prior to needing another treatment. Now having said that Interferential is still regarded, 60 years later, as "experimental" by HCFA ( Medicare) but is the most used form of electrotherapy for pain relief. TENS is not  regarded as experimental nor is the efficicacy of the modality in question.







Interferential/Tens for Chronic Low Back Pain ( CLBP)

NIH report from NIH on use of above for rehab. and pain reduction using both forms of electrotherapy. Here is post.

Summary below:

Interferential and horizontal therapies in chronic low back pain: a randomized, double blind, clinical study.
Zambito A, Bianchini D, Gatti D, Viapiana O, Rossini M, Adami S.

Rheumatologic Rehabilitation, University of Verona, Italy.

OBJECTIVE: Chronic Low Back Pain (CLBP) is one of the most frequent medical problems. Electrical nerve stimulation is frequently used but its efficacy remains controversial.

METHODS: Twenty-six men and 94 women with CLBP associated with either degenerative disk disease or previous multiple vertebral osteoporotic fractures were randomly assigned to either interferential currents (IFT), horizontal therapy (HT) or sham HT administered for 10, 20 and 40 minutes, respectively, daily for 5 days per week for two weeks together with a standard flexion-extension stretching exercise program, Blind efficacy assessment were obtained at baseline and at week 2, 6 and 14 and included a functional questionnaire (Backill), the standard visual analog scale (VAS) and the mean analgesic consumption.

RESULTS: At week 2 a significant and similar improvement in both the VAS and Backill score was observed in all three groups. The Backill score continued to improve only in the two active groups with changes significantly greater than those observed in control patients at week 14. The pain VAS score returned to baseline values at week 6 and 14 in the control group while in the IFT and HT groups it continued to improve (p< 0.01 vs controls). The use of analgesic medications significantly improved at week 14 versus pretreatment assessment and over control patients only in the HT group.

CONCLUSION: This randomized double-blind controlled study provides the first evidence that IFT and HT therapy are significantly effective in alleviating both pain and disability in patients with CLBP. The placebo effect is remarkable at the beginning of the treatment but it tends to vanish within a couple of weeks.

Monday, December 10, 2007

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