Issue StoriesMaking Sense Of Pain Modalitiesby Stephen Noonoo Manufacturers share their trends, tips, and insights Physical Therapy Products spoke to various vendors to gauge the latest in products and trends across the gamut of pain-management modalities. EMPIIontophoresis; TENS PTP: What are some of your new product developments in iontophoresis? Do they reflect current industry trends? Empi: Therapists used to be forced to choose between the accurate dosage of box-and-wire (constant current) iontophoresis and the convenience of lower-powered battery-operated devices. The Hybresis Hybrid Iontophoresis System combines these technologies in one system. The key is the Hybresis Dose Controller, a constant current device that breaks down skin impedance through a proprietary 3-minute treatment. With skin impedance at a low level, the patch delivers an 80 mA-min dose with unmatched speed: 2 hours. PTP: How is the iontophoresis industry changing? Empi: PTs are challenged today by patients struggling to afford copays and payors trying to cut costs. In this environment, iontophoresis remains a nonsystemic, effective way to speed recovery for a variety of patients. By offering in-clinic dosage accuracy with take-home patch convenience, Hybresis can help clinicians achieve positive patient outcomes in accelerated time frames. PTP: What are some of your new product developments in TENS? Empi: Empi's product development focus has been on designs that are patient friendly and enhance patient compliance to therapy regimens. Empi developed the new Empi Active TENS unit to be very simple. With just three buttons and a single, advanced TENS waveform, the Empi Active can fit in the palm of your hand and is extremely easy to use. PTP: Are TENS units becoming more precise? Empi: Clinical understanding of the mechanism of action for TENS is advancing. Understanding the physiological effects of electrostimulation has helped to enhance waveforms' ability to elicit responses that promote pain relief. A review of research by Kathleen Sluka PhD, PT, is recommended. AlimedElectrotherapy; Hot/cold Modalities; Topicals PTP: How is the pain management industry changing? AliMed: As patients become more educated and open to alternative therapies, we have seen a shift away from traditional medication being used as the primary way to manage pain. Patients are looking toward nontraditional methods that include everything from electrotherapy to biofeedback, hot/cold therapy, topicals, stretching, exercise, massage, self-massage, and many more. PTP: What types of pain can iontophoresis treat? AliMed: Through transdermal delivery of Lidocaine, iontophoresis can be used to help manage pain associated with a variety of dysfunctions including tendinitis and musculoskeletal inflammation. The more common use, though, is in the delivery of anti-inflammatory medications, such as Dexamethasone, for plantar fasciitis, bursitis, medial/lateral epicondylitis, Achilles tendinitis, etc. In these cases, the resulting decrease in inflammation often leads to an associated decrease in pain levels. PTP: Can you explain how a PT might use an iontophoresis system in treatment? AliMed: Used early in a treatment session, iontophoresis can help reduce pain and inflammation, allowing the patient to progress to the next stage of their rehab and perform strengthening or flexibility exercises to help regain normal ROM and function. Iontophoresis can also be utilized at the end of therapy to control inflammation, especially using the newer integrated patches that can be applied in the clinic and removed by the patient at home. PTP: Can patients treat themselves with this modality at home? AliMed: Traditional systems require set-up and application by the therapist, typically confining them to clinical use. Newer integrated systems now offer greater flexibility, still requiring set-up and application in the clinic but because of their self-contained nature allow the patient to be active either in treatment or return to daily activities while still receiving treatment. OPTPHot/cold therapy PTP: What are some of the newest product developments in hot/cold therapy? OPTP: Cold and compression used in tandem. There are lots of new therapies that combine the two. PTP: What types of pain can cold therapy products treat? OPTP: Cold therapy is great for treating acute injuries and for myofascial and trigger-point therapy. Zimmer MedizinSystemsE-stim; TENS PTP: What are some of your latest product developments? Zimmer: We currently offer single-use electrodes, TENS, EMS, and are working on a new combo Sono/Stim unit for the US market. PTP: How is the e-stim industry changing? Zimmer: E-stim is becoming more and more popular, especially the use of single-use electrodes. The single-use electrodes are not only hygienic but they are also environmentally friendly, and clinics don't have to be concerned about the risk of cross contamination. PTP: Can you provide some tips for PTs using this modality for the first time? Zimmer: Using single-use electrodes allows you to perform unparalleled, comfortable, and hygienic treatments at an affordable price, enhancing the professional image of your practice. The Zimmer Trodes have a 2-year shelf life and are the most flexible electrodes in the market. Flexall by Ari-Med PharmaceuticalsTopicals PTP: What are some treatments that your company's topical can be used as an adjunct to? Ari-Med: Massage therapy, ultrasound, between TENS, with ice and heat therapy. PTP: What are your company's topical treatment's base components/key ingredients? Ari-Med: Aloe vera gel base. PTP: Can your topical be combined with any other topical product for simultaneous treatment? Ari-Med: It can be combined with any neutral ultrasound coupling gel. International Medical Electronics (IME)Diathermy PTP: What are some of your company's main diathermy products? IME: International Medical Electronics manufactures the Magnatherm pulsed shortwave diathermy. The Magnatherm has two independent induction treatment heads that heat muscle preferentially over fat 2 ½ times. This allows for heating the deep musculature where the heat does the most good. PTP: Can you provide some tips for PTs using this modality for the first time? IME: The surface metal that will be in the treatment field (such as necklaces, bracelets, etc) should be removed, and dry toweling should be used to absorb perspiration. The treatment head should be placed directly in contact with dry toweling, which is directly in contact with the patient (no air spacing). PTP: What are some treatments that your product can be used as an adjunct to? IME: The deep heat produced by the Magnatherm results in increased blood flow; increased metabolic rate; improved oxygenation; relief of pain, edema, and inflammation; and makes collagenous tissues more pliable. Magnatherm can help relax muscle spasms and tension, allowing for easier spinal manipulation and/or massage. Treating a patient before exercise allows the patient to exercise more easily and with less pain. Sore No MoreTopicals PTP: What are some of your latest product developments? Sore No More: We have received several new patents on Sore No More, including ones for the treatment of Fibromyalgia, tinnitus, and cluster headaches. PTP: What are some treatments that this modality can be used as an adjunct to? Sore No More: Sore No More is used in pain clinics, hospitals, and other medical clinics for stress using water therapy: ie, add a tablespoon into a warm bath along with application directly to any painful or stiff area and soak for 45 minutes to an hour (also same for Fibromyalgia treatment). PTP: What are your base components/key ingredients? Sore No More: We have 36 herbal, natural ingredients, with capsaicin and camphor being the most active component. We feel that the combination of all the elements, however, is what makes Sore No More unique and most effective. AMREXTENS; E-stim; Ultrasound PTP: What are some of your latest product developments? Amrex: The MS324C low-volt AC muscle stimulator, which has digital-displayed output parameters. PTP: What are some current industry trends? Amrex: Offering competitive pricing for quality product purchases and having the proper maintenance of older equipment by sending them in for periodic inspection and certification of output calibration. PTP: What are some treatments that electronic stimulation can be used as an adjunct to? Amrex: Pain, muscle rehab, can be used with Amrex ultrasound therapy. Mettler ElectronicsE-stim; Hot/cold therapy; Diathermy; Topicals; Ultrasound PTP: What types of pain is electrical stimulation effective for treating? Mettler: Interferential and pre-modulated currents seem to be the most effective for pain management in the clinic. They are comfortable because of the high carrier frequency, and most devices with these waveforms also allow the clinician to modulate both the frequency and the amplitude to prevent accommodation. PTP: What are some of the applications for electrical stimulation PTs might find useful beyond pain management? Mettler: PTs frequently use electrical stimulation for the rehabilitation of muscles using on/off cycles to contract and relax muscles. PTP: What are some of your new product developments in hot/cold therapy? Mettler: We have hot and cold packs that can be used for either heat or cold. PTP: What are some treatments that your company's hot and cold packs can be used as an adjunct to? Mettler: Cold is very effective when used with elevation and compression. This helps reduce swelling from the injury. PTP: What types of pain can diathermy treat? Mettler: Diathermy can be very effective over a large area. The heat from diathermy penetrates more deeply than superficial heat. The therapist can control the amount of heat that they give a patient using the device's controls for frequency, pulse duration, and intensity. PTP: What types of pain can topicals treat? Mettler: Topical analgesics provide soothing relief for soft-tissue injuries, stress injuries, muscle tension, inflammation, and stiffness contributed to arthritis, among many other indications. PTP: Can patients treat themselves with topicals at home? Mettler: Topical analgesics are ideal for home use. They are formulated so that the patient can get full relief from pain with very little risk of side effects. PTP: How do ultrasound units provide a sound investment for practices? Mettler: When ultrasound is combined with electrical stimulation in a single device, the practice has the ability to provide good pain relief to their patients as well as assistance with the rehabilitation process. Pro-Tec AthleticsHot/cold therapy PTP: What are some of your newest hot/cold therapy product developments? Pro-Tec: The Ice-Up Portable Ice Massager offers effective treatment in 5 to 7 minutes versus 15 to 20 minutes for passive ice packs and quick, deep tissue relief for ligament, tendon, and muscular injuries. Our Hot/Cold Therapy Wrap is form fitting and provides penetrating cold and/or heat for therapeutic relief. The Ice/Cold Therapy Wrap can be filled anywhere ice is available, which provides cold therapy for longer time periods than most gel packs. PTP: Can patients treat themselves with this modality at home? Pro-Tec: All our products are designed so that patients can use them and treat themselves. They are very easy to use and don't require anyone's help. PTP: Do you manufacture any products intended for both hot and cold use? Pro-Tec: Yes, Pro-Tec Athletics' Hot/Cold Therapy wrap can either be frozen for cold therapy or heated up in the microwave for heat therapy. The benefit is that you only need one product to do both things. The same gel pack that can go in the freezer can go in the microwave, and then it is placed in the wrap and can be wrapped around the area of the body that needs to be treated. JTECH MedicalPain measurement devices PTP: What are some of your latest product developments? JTECH: Integrated wireless technology built into an algometer that facilitates precise measurement of pain thresholds and tolerances. The algometer works seamlessly with our Tracker Version 5 software to compare the patient's pain thresholds and tolerances to established norms, aid in fibromyalgia determinations, and track the efficacy of your treatments over time. The Tracker software includes a pacer to assist the clinician in applying the correct amount of force consistent with established pain-measurement protocols. PTP: Can you provide some tips for PTs using this modality for the first time? JTECH: Be open-minded about all the various different ways that the tool can be utilized. In standard clinical applications, we are assessing the patient's pain threshold/tolerance, comparing various tender points to reference norms. The ability to customize the standard algometry protocol allows for assessment of a variety of clinical issues, such as patellofemoral arthralgia (chondromalacia patella), rotator cuff tenderness, epicondylosis/tendinopathies, etc. PTP: What are some current industry trends? JTECH: Current trends are generally directed toward "evidence-based medicine" and documenting positive functional outcomes with any treatment intervention. This is no longer the exclusive domain of satisfying third-party payors or referral sources. The patient population that we service are generally more educated, have greater access to health care information, and are thus more actively involved with their own health care decision-making process. Tropical BioMedicsTopicals PTP: What are some of your latest product developments? Topical BioMedics: Topical BioMedics' product Topricin, a patented FDA-regulated pain relief and healing cream, provides adjunctive support to PTs nationwide. The Topricin technology works by enhancing the body's ability to heal itself and providing a wide range of benefits to the therapist and his/her patients, with measurable improvements in patient care. Our two newest products, Topricin Foot Therapy and Topricin Junior, target challenging areas in both podiatric and pediatric care. PTP: What are your base components/key ingredients? Topical BioMedics: Topricin is an FDA-regulated OTC medicine that contains a combination of homeopathic biomedicines. Our base is very clean, nongreasy, nonirritating, and odorless, as it does not contain petroleum parabens, volatile oils, or other irritation chemicals typically found in topical analgesics. Instead, Topricin's base is a combination of purified water, vegetable oils, vegetable glycerin, and a medium-chain triglyceride. PTP: Can your topical be combined with any other topical product for simultaneous treatment? Topical BioMedics: Topricin is a healing technology and is a true stand-alone treatment. It does not mask pain symptoms, but stimulates a strong healing response deep in the tissue, so there is no advantage to combining Topricin. However for phonophoresis (ultrasound), it is often used applied first with a coupling gel over it. It can also be combined with the gel for this treatment protocol. Topricin is not contraindicated with any other medications, and can reduced need/dependency of oral pain medications. Multi Radiance MedicalLaser therapy PTP: What are some of your latest product developments? Multi Radiance: Multi Radiance Medical's laser therapy products accelerate pain relief and healing. The new Pro Sport Package provides pain-relieving treatment in the field and in-clinic for sports applications. There are no drugs or side effects, and the treatment is noninvasive. PTP: What are some current trends in laser therapy? Multi Radiance: The biggest trend seems to be in power output and how it's delivered. Some products have too little power and act no better than laser pointers, while others swing too far onto the other spectrum and can harm patients. We are now starting to understand what dose rate is and how it affects clinical outcomes. Super pulsed lasers provide the correct energy density but with greater safety than most continuous-wave lasers. PTP: Can you provide some tips for PTs using this modality for the first time? Multi Radiance: Do your research! There is no one-size-fits-all laser. Understanding the five parameters—wavelength, power, diode construction, classification (safety), and frequency—is critical for successful outcomes. Be sure to try several different lasers, as outcomes can vary greatly. Reference
Product ResourcesHere's a brief list of companies that manufacture and/or provide products in the pain management niche. For a more complete list, visit our Online Buyer's Guide.
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