Simply put, peripheral neuropathy is a condition in which the nerves tasked with transporting information to and from the brain and spinal cord do not function properly. The result is pain, loss of sensation, and lack of muscle control.

Damage to the nerves can come from a number of sources: hereditary disorders such as Friedreich's ataxia; exposure to toxins, like those administered during chemotherapy; or as a result of systemic or metabolic disorders, like diabetes.

In addition to managing or treating the underlying condition causing peripheral neuropathy, the goal of treatment is to provide relief from the symptoms. A technique that is seeing success, both in clinical trials and anecdotally among clinicians, in caring for many of these patients is Anodyne® Therapy.

Anodyne is a noninvasive treatment "used to temporarily improve circulation and reduce pain, stiffness, and muscle spasm anywhere the pads are placed on the body," according to Anodyne Therapy LLC, Tampa, Fla, the sole manufacturer and worldwide distributor of Anodyne Therapy Systems.

"For peripheral neuropathy there are medicinal treatments, but there is no other PT treatment besides Anodyne," says Debra Layne, PT, owner of North Boulder Physical Therapy, Boulder, Colo. For the last 4 years, Layne has offered Anodyne Therapy to her patients after treating a physician working at Boulder Medical Center. "He had peripheral neuropathy from diabetes, and he asked me to check on the Anodyne to determine what could be done for him.

"At the same time I was treating him, I used the Anodyne on two other patients who had peripheral neuropathy to determine for myself if this worked or if it didn't work," she continues. "It worked on all of them extremely well."

In fact, the results were so successful that the clinician ended up purchasing an Anodyne unit that she continues to use to this day.

In addition to the North Boulder offices, Layne owns three other locations around the state: Coal Creek Physical Therapy in Louisville, Layne Physical Therapy (Golden), and North Boulder Pilates.

ANODYNE: WHAT IT IS, HOW IT WORKS

Anodyne treatments are delivered using therapy pads, each of which boasts 60 superluminous light-emitting diodes giving off infrared rays, which is light at a wavelength of 890 nm.

Applied directly to the skin, the flexible pads product photon energy that helps release nitric oxide (NO) from hemoglobin in the red blood cells. NO is a free radical that increases local microcirculation, helping to deliver oxygen and nutrients as well as reducing pain, stiffness, and muscle spasm.

"What we see with the Anodyne is that the area of sensation identified during the initial assessment increases, while the area where they lack sensation gets smaller," Layne says. This is especially important to those who have peripheral neuropathy as a result of diabetes. "The more sensation they have, the more they can feel the floor or the ground—and the better their balance is going to be."

PTs use the small, portable systems to administer between eight and 10 treatments to these patients, with the ultimate goal of sending them home with their own Anodyne unit. This trial period is required to demonstrate that the technique is going to provide benefit to the individual.

"In order for the insurance company to pay for it, they have to have objective information that says, ‘This is how the person is when you started, and this is how the person is at eight visits. It's working,' " Layne says. "They don't want to spend the money to buy a unit—nor should they—unless it's proven that it works for that patient."

It's also a vital part of the process for the patients themselves, according to Layne, who sees greater at-home compliance with the somewhat time-consuming process from those who have experienced firsthand what it can deliver.

"If they get this expensive unit that just sits in their closet, it's not going to make them any better, but when we can show them that their sensation will return—they get excited about it," says Layne, noting that while most pursue a home unit, "some people go through the process and they've told me they don't want to do it at home. They're being honest and maybe in another year, their life changes and they can go back and do it again."

To this end, the therapy sessions are interactive, designed to teach patients how and where pads should be placed on the body and for how long. The PTs take the time to demonstrate how to hold the pads, participating in the entire process.

All of Layne's locations make the Anodyne treatments affordable, employing a sliding scale for those whose insurance does not cover the procedure. She adds that, in most cases, Anodyne is commonly covered by insurance because it is prescribed by a physician.

"It is a modality, so it's not reimbursed at a particularly high level," she says. "And the Anodyne Therapy company is excellent about working with the physical therapists and the patient's insurance company to get home units for people—or making it economically possible for them to have a unit at home, because it's something they're going to use for life."

Anodyne Therapy makes two different models: the 480 Professional System and the 120 Home System, both of which can be used on any part of the body, metal implants, pacemakers, and defibrillators. The only contraindications are for pregnancy and active malignancy.

The manufacturer provides training to those who will be administering treatments and, in Layne's experience, is readily available to answer patient-specific questions.

OTHER POTENTIAL CANDIDATES

In addition to peripheral neuropathy, Anodyne Therapy can also serve those who are dealing with pain, usually acute, soft-tissue discomfort or postoperative pain. Working with those who are recovering from total knee replacement surgery is a growing area for Layne's team.

"We use it when other approaches haven't worked. For total knee patients, if we have done all things we usually do and it still hurts so much they can't bend their knee, then we will use Anodyne on them," she says. "It allows us to give the person's neat range of motion back faster as a result of the pain control."

Even with knee replacements, the Anodyne is used only occasionally for pain management by most of the PTs, who are able to obtain the desired results using usual treatment techniques, according to Layne. She sees it as one more tool the therapists have access to as they design their treatment plans.

Another area for the Anodyne is in healing chronic wounds. One patient Layne recalls had suffered from a diabetic ulcer for more than 10 years. After just 6 weeks of treatment—coming into the clinic between three and four times per week—the wound healed.

"With wound care, we work very closely with their physician to learn how he wants the wound managed and bandaged, because today there are special gel materials that can be placed on wounds," Layne says. Coordinating closely with the clinician ensures the PT will have the appropriate materials on hand. Some physicians go as far as to write prescriptions that read, "physical therapy for wound care; call me." "He wants us to call because we either need to have what the patient needs on hand or we need to make sure the patient brings everything with him," Layne says.

The latter option is happening more often, with patients being dispensed what they need by their physicians prior to reporting for physical therapy.

All Anodyne treatments in each of Layne's locations are administered on two units by three of the PTs on staff. The PTs specialize primarily in rebalance training.

SPREADING THE WORD

While Layne estimates the Anodyne Therapy treatments account for less than 5% of her total client base, she believes there would be much more demand for it if people were aware it existed.

"There is a huge population that is available for treatment and the diabetic population only grows, so that population is just getting larger," Layne says. She believes the diabetic population and the other kinds of peripheral neuropathy are the best patients to whom to market the product. "The potential for adding a number of patients to your business is there. Having this particular proficiency is also a way you can stand out from the other physical therapists in town."

After installing her first Anodyne unit, and again when she purchased a second system, Layne sent targeted mailings to all the physicians in the practice's database. The greatest response came from those who regularly treat diabetics, as well as neurologists.

To spread the word on an ongoing basis, Layne also built a robust Web site, which includes detailed information about the technique. The Internet has proven to be a huge referral source. The majority of the Anodyne business in Layne's Colorado locations is driven by positive word of mouth, including a profile placed in a local newspaper.

Other patients find the North Boulder Physical Therapy site online after either specifically seeking out Anodyne or while researching treatment options for peripheral neuropathy.

Read our July/August 2005 article, "A New Hope," for more information about Anodyne Therapy used in a practice setting.

Layne also periodically gives a 20-minute presentation at diabetes support groups, bringing the Anodyne system for attendees to see and explaining how the process works, along with what they might expect to experience from treatments. Layne became aware of the local meetings through a nurse at the medical center.

"There are probably only going to be about eight people at the meeting, but those people are there because they are really interested," she says. She also distributes pamphlets for patients to take home and review. "If you do go to that type of meeting, you can almost guarantee to you were going to get at lease one patient from that."

Taking time to meet with such groups is a true win-win for physical therapy practices and patients alike, according to Layne.

"I recommend you set them up every 6 months or so, because there is going to be a different group of people each time," she says. "The most important part is to allow at least half of the time of the presentation to answer questions, because that's why they're there: They have questions and they want answers—and we can provide that for them."

Dana Hinesly is a contributing writer for Physical Therapy Products. For more information, contact .