NeuroModulation Therapy

Jun , 13 , 2019 admin

What is it;

Neuromodulation therapy is the introduction of a high-intensity electrical field to create a magnetic field which causes a physiological change within the body. Studies have shown that this can be as dynamic as reducing pain , releasing endorphins ,reducing inflammation, reducing swelling, improving circulation, helping with bone healing, neutralizing the venom of Brown recluse spider bites(patent pending), reduce sciatica or radiculopathy, treat neuropathies, improve healing process by stimulating mitochondria in the production of ATP, and a number of other physiological responses. The physiological effects on the body will depend upon the frequency, pad placement, and field strength.

What it’s not;

It is not a muscle stimulator, it’s not EMS, it’s not a TENS unit, it’s not ultrasound, and it’s not physical therapy.

How it’s applied;

Depending on how it’s applied it has different names. PNT, percutaneous neuralmodular therapy, PENS, percutaneous nerve electrical stimulation therapy, surface neural modular therapy, neural regeneration therapy, and a number of other names. The only difference in all of these types of therapies is the mode in which the electrical field is applied. The different modes are, surface electrodes, temporary needle electrodes, permanently surgically implanted electrodes.

I personally have found that the most effective in my practice is the use of surface electrodes which allows me to quickly and easily readjust the field as indicated by the patient’s response to the therapy. In my clinical practice patients tolerated the surface electrodes better than needles and patient comfort was greatly improved by using surface electrode versus needles. This also greatly reduce the possibility of introducing infection, as well as, patients compliance to complete the course of therapies

What it treats;

Electromedicine, neuralmodular therapy, is as diversified in treatment/pathologies that it treats, as our pharmaceutical preparations are. It can be used to treat venomous spider bites, to increasing bone density, to help increasing circulation. The effects of the therapy depend upon the placement of the electrodes, the frequency and the intensity. The proper utilization of the equipment requires knowledge of neuroanatomy , physiology, and human anatomy. Successful outcome is directly related to the physicians experience, knowledge and training.

In recent years, a number of studies have been performed in regards to chronic low back pain. A recent study was performed comparing neuromodulation therapy to acupuncture, physical therapy, narcotics oxycodone/hydrocodone, chiropractic manipulation, and exercise for the treatment of patients with chronic low back pain. In the study 91% of the patients reported better improvement with neuromodulation therapy than any of the other modalities or treatment protocols. They felt their pain level greatly decreased, their mobility greatly increased, their well-being increased, and their ability to sleep improved.(References available upon request to the editor). The study has been repeated with similar results.

Neuromodulation therapy has been used successfully to treat, peripheral neuropathy, sciatica, acute and chronic low back pain, plantar fasciitis(foot pain), increase circulation in the lower extremities, increase circulation in the upper extremities, headaches, neck pain, degenerative disc disease, arthritis, connective tissue disease, improve bone healing (fractures), thoracic outlet syndrome, carpal tunnel syndrome, Sudecks atrophy, and a number of other orthopedic, neuromuscular, bone, joint and muscle diseases/pathologies. However is important to recognize that this is not a cure-all or a panacea, when indicated it can be an effective tool to treat orthopedic and neuromuscular pathologies, however not all patients respond, and even patients with the same diagnosis; some get excellent results others do not respond at all, and requiring more invasive procedures.

Is a Covered by Insurance Companies?

Because insurance companies over the past 20 years have classified it as experimental or call it physical therapy, the reimbursement rate for the therapy is either nonexistent or minimal. Therefore the reimbursement rate does not offset the cost of the equipment nor the amount of training required for a physician to properly apply the equipment/treatment. As a result, the art is slowly becoming extinct. An example of this is when I first started teaching the procedures, the demand far exceeded the available spaces for training, at that time the reimbursement rate was between hundred $175-$265 per session, with the average equipment cost between $60,000 and $90,000. Once the insurance companies reclassified it as experimental or physical therapy the reimbursement rate was dropped to $0 to approximately $20 a visit. As a result, these types of fellowships are no longer offered, and the only training is by existing physicians which their numbers are decreasing and minimal.

To properly perform the treatments and intricate knowledge of neurology is required as well is an understanding of the equipment. This is not a muscle stimulator which you applied to the back turned up and the patient says that feels fine. This creates a physiological change within the body with subsequent results in a chemical change, with the releasing of endorphins, increase production of ATP for healing, and a physiological change within the body.

Case 3715

This is a 62-year-old male who presents chronic left shoulder pain for over 30 years. He states he’s had treatments from various other physicians which give him some temporary relief. He states the pain never goes away, only decreases in severity. He states in the last 2 weeks the pain has reached an all-time high. Evaluation of the shoulder show the patient has limited motion and partial adhesive capsulitis. Further evaluation determine inflammation within the joint, however the rotator cuff was intact. Specific treatment was introduced to reduce the swelling and fluid within the joint. Mobilization techniques were utilized to reduce the adhesive capsulitis. The patient noted improvement immediately. After 3 weeks of therapy the patient states his pain was 90% reduced. His therapies were then modified to increase both anti-inflammatory as well as therapies that help to improve mobility of the shoulder. An additional 3 weeks of therapy was performed and the patient stated his pain was 100% gone, The first time in 30 years. Follow-up therapies were continued every 2 weeks for the next 6 weeks and the pain never returned. Patient was also instructed on home exercise programs.

Case 2878

This is a 58-year-old female who presents with debilitating frequent headaches. She states a history that she’s had headaches since she’s been a teenager. However the headaches continue to increase in duration and severity. She has recently undergone a complete neurological workup with numerous scans. She was told that she has migraine headaches. She was given medications which she states would take the edge off the severe headaches but generally they would persist for days at a time. Recently the headaches have been reoccurring more frequently and becoming more severe. She states she has 2 to 3 debilitating headaches per month that last up to 4 days, and numerous small headaches.

Case 122

This is a 48-year-old female who presents with chronic debilitating low back pain. She’s had this problem for over 13 years. She states a history were activities such as bending sneezing or lifting sets off her low back pain which radiates into both hips and down her leg. Initially this would resolve with rest and exercises, medications and chiropractic manipulation. Recently it has become worse and is not responding to treatment. She recently has seen a number of chiropractors and this has not help. Her medical evaluation revealed disc disease with compression, surgery was recommended. The pain now is currently causing numbness in her right leg and she feels it is getting more difficult to walk. The patient at the time of examination did not present with a foot drop. There is a generalized weakness of the right leg. The pain and the weakness is progressing. Therapies and medications are having no effect. Patient was referral for evaluation and treatment. Following evaluation, it was determined that the patient had nerve root compression on the right side causing radiculopathy down the right leg. It was also determined that she had pars fracture of L4 and L5, old, leading to instability. We began treatment for the radiculopathy and the patient began to respond after a few visits. Within 2 weeks the majority of her pain down her leg was gone but the low back pain still persisted. The weakness in her leg was completely gone and she was now walking normal. After an additional 4 weeks of therapy the spasm in her lower back disappeared. She returned back to work. She continues intermittently to have pain and receives additional therapies but was able to continue working. The low back pain and radiculopathy was relieved. In this case neuromodulation therapy was able to 1^st reduce the inflammation down the sciatic nerve, secondly reduce the spasm in the glutes and lower back area. Once the pain was controlled, therapies were changed to help promote healing of the spine. The patient’s symptoms following a workday were just the stiffness in her lower back.

Case 3612

This is a 57-year-old female who presents with neck pain radiating down her right arm, numbness in her right arms and hand, difficulty turning her neck. Patient states this has been going on for approximately the last 6 to 7 years. She has tried acupuncture, chiropractic manipulation, extensive physical therapy, orthopedic consultation with injection therapies, pain management therapies, and none of these give any substantial relief, some give temporary relief. Patient was referred for evaluation and treatment. Review of her medical records along with additional diagnostic tests reveal the patient was suffering from degenerative disc disease in the lower cervical area combined with brachial neuritis. Additionally she was developing symptoms consistent with nerve root compression. Both surgical and mechanical decompression therapies were discussed. The decision was made to start a course of neuromodulation therapy to see if we could reduce some of the compression of the brachial plexus, thereby reducing the radiculopathy/pain down her right arm. Therapy began and the patient had immediately improvement. Initially the improvement only lasted a day or so and then started to return. Following 2 weeks of therapy the patient noticed she was getting relief for up to 3 days without any return of her symptoms. Mobilization techniques were now introduced. By 4 weeks 80% of the patient’s symptomatology had reduced. She no longer had numbness in her hand or arm on the right side and all pain down the right side was now gone. She still had partial cervical complaints with tightness in her shoulders. Additional therapies were performed and all pain within the shoulder and neck area stopped. She is no longer woken up at nights with discomfort. She’s able to do overhead work without discomfort, and her cervical range of motion dramatically improved. She still had some residual discomfort in the neck area however was more of an annoyance and no longer stopped her from doing the activity. This case demonstrates the ability of the treatment to reduce the inflammation and thereby the compression of the nerve thereby reduce the patient’s symptomatology/pain. Additionally once the muscle spasm was reduced the cervical spine was able to go to more of a homeostasis position and this allowed additional clearance of the nerve, combined with reduction of inflammation, thereby relieving the compression. The patient’s degenerative disc disease will continue and most likely will result in some form of surgical decompression in the future, however at this point the therapy was able to reduce her symptomology and postpone the event.

Electromedicine

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