Using Energy to Relieve Pain

We use energy sources to drive cars, light homes and talk on the phone.  Everywhere you look, there is energy working to power our world.  Can energy be used to improve our health?  Absolutely—energy sources make twenty-first-century healthcare possible. Can you imagine a hospital without electricity? However, many people don’t realize that energy can be used as a therapy to improve pain. 

I am a physiatrist, a medical doctor who specializes in physical medicine and rehabilitation (PM&R for short).  Sometimes physiatrists are called “pain doctors” because we do a lot of work in treating pain.  Some of our expertise comes from the first part of our specialty’s name: physical medicine.  Energy therapies are part of physical medicine, and they can be quite effective in relieving pain under the right circumstances. 

There is not enough space here to really describe all of the different energy therapies, but here are some examples:

Iontophoresis: Most of my patients have never heard of iontophoresis or if they have, they don’t really understand what it does. This is one of my favorite pain therapies, and I love to explain it to people because it has some really incredible potential—not only in pain medicine but in other areas of healthcare. 

Iontophoresis works by using a direct electrical current to transfer medication from the skin’s surface to inside of the body. One method of using iontophoresis is to apply a large band-aid that has a battery source and some medicine placed in the center of it over an area that hurts.  It doesn’t make sense to use iontophoresis for every pain problem, but if the pain is due to inflammation, say from tendonitis, then iontophoresis with some corticosteroid as the medicine being delivered, can be very effective. 

Iontophoresis has been used many different ways to deliver drugs without puncturing the skin by giving a shot.  For example, the other day I was at a neighborhood pool with a six-year-old girl who has diabetes.  Her brother, my teenage son’s friend, checked her blood sugar by sticking her finger.  She gets her finger stuck several times a day and then takes insulin shots.  Theoretically, something called reverse iontophoresis could be used to draw fluid out of her body and check her blood sugar without sticking her finger and then iontophoresis could be used to give her the insulin she needs without a shot.  I say theoretically because we don’t yet have the technology to be precise enough to treat diabetes in this manner, though it is being studied. For pain medicine iontophoresis doesn’t have to deliver an exact amount of medicine, but for diabetes it does.  If you have pain, talk to your doctor about whether you might be able to get relief from “ionto.”

 
Phonophoresis is similar to iontophoresis but instead of using electrical current, the energy source is sound waves (ultrasound).  Ultrasound has been used to diagnose many conditions (new parents usually get to see at least one ultrasound of their baby in the womb to assess size and general health), heal bones, and treat pain.  Ultrasound can be used with or without medication to treat pain related to soft tissue inflammation such as bursitis or tendonitis.  When it is used without medication (just using a lubricant gel), it is called therapeutic ultrasound.  When it is used to deliver medications, it is called phonophoresis.

Transcutaneous Electrical Nerve Stimulation (TENS): This therapy, similar to iontophoresis and phonophoresis, is generally thought to be a safe and non-invasive treatment.  It has been used quite effectively to treat many types of acute pain such a labor pain, back pain, migraine and menstrual pain.  Whether it works in chronic pain, such as chronic low back pain, is more controversial, with some studies suggesting that it does work well and others negating this claim. 

The way TENS works is that there is a little machine similar in size to a cell phone that can be clipped onto your belt or a strap around the waist.  There are wires that go from the machine to sticky attachments that go right over the skin where it hurts.  The machine creates an electrical impulse that is not painful and tends to move more quickly to the brain than the pain signals.  The idea (it’s a theory, really, and one that has been disputed) is that the non-painful signals from the TENS unit “crowd the gate” in the brain and don’t allow the painful signals to get through.

For those of you who are really energy-savvy, you probably realize that I left out lots of therapies, including acupuncture and electroacupuncture.  I can go on and on about how exciting medicine will be in the 21^st century, but my blog space is up.  If you like this article, let me know, and I’ll write more the next time it’s my turn to blog about different ways to treat pain.

Julie K. Silver, M.D., is an assistant professor in the Department of Physical Medicine and Rehabilitation at Harvard Medical School. She is also the Chief Editor of Books for Harvard Health Publications.

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