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ElectroAnalgesic
An alternative for Pain Management and Rehab


                        Dr. Jose I. Delgado
Purpose
Pain by the numbers
Who has Pain?
Physical pain is a natural force in our lives that all of us will
  experience & have to deal with.
 It can be caused in a number of ways:
     Injury
     Posture
     Stress
     Illness
     Others
How can pain be dealt with?
Viability of “living with the pain”
Viability of Pharmaceuticals
Viability of injections
Viability of Electroanalgesia
What is Electroanalgesia?
Is This New Technology?
 One of the oldest and most documented medical
 sciences known.
    Cellular function has long been known and accepted to be
     influenced by specific bioelectric fields.
 Based upon the concept that any medical treatment can
 only stimulate, facilitate, or inhibit electrical or chemical
 processes in the body.
How does Electroanalgesia work?
Theory of Electromedicine
   Successful treatments have been documented for nearly
    2,000 years
   Wider acceptance gained after publication of “Gate
    Control Theory of Pain” (Science 150, 1965)(T.E.N.S.)
       Certain cells in the spinal cord act as gates through which pain
        signals travel to the brain;
       Overloading these cells will block electrochemical pain
        impulses and thus relieve pain.
   The Gate Control Theory accepted by the Medical
    Community
       Helped establish the use of transcutaneous electric nerve
        stimulation (TENS) in the United States
Classifications
1.    Action Potential (depolarization and repolarization
     of a cell membrane, opens and closes)
2.   No Action Potential (sustained depolarization of a
     cell membrane, closed)
Affecting the Nerve with Electromedicine
3.       Neuron Function Interruption*
            Signals that are so fast that they cannot be physiologically
             followed by the nervous system
            Signals must be faster that 2,000 pps
              Used for stopping or interrupting the axon transport of the action
               impulse.
            Blocking the pain signal is necessary in cases of heavy
             (severe) pain.
Pain Relieving Effect
   As a Primary Effect *
       Counter-irritation by means of action potential generation
        synchronous to the modulation frequency
        A block of the transmission of pain information by means of
        sustained reactive depolarization in the region of the higher
        intensity unmodulated middle frequency (Mf) electric field.
Science of Pain Relief
1.       Motor Nerve and Muscle Stimulation
         Action Potential Generation
         Physiological Muscle Contracture
         Generation of Spontaneous action Potential Activity
Science of Pain Relief
2. Increase of Local Blood Flow *
     Effect of Motor Nerve and Muscle Stimulation
     CO2, Lactate, adenosine are End-Products of Metabolism
     ATP Consumption is Initiated
     Electromedical currents depolarize excitable and non-excitable
      cells
Science of Pain Relief
3. Local Circulation - Increase in the distribution of
  electrically charge substances (ions) and water
  Electro-osmosis within the tissue, resulting in:
  • Dilution of toxic, pain, and/or inflammation causing substances.
  • Increase of tissue clearance (filtration and diffusion processes).
  • Increasing local blood circulation.
  • Improvement of exchange (diffusion) processes: the intro-and
  extracapillary fluids.
  • Improvement of resorption processes, important for prevention or
  retardation of disuse atrophy.
Science of Pain Relief
4.       Effects on Muscle *
          Motor Nerve and Muscle Excitation
           Followed by: (Relaxation of muscle spasms comparable to
           the effect of post-isometric muscle relaxation)
          Interrupting the vicious cycle of pain
Science of Pain Relief
5. Biological Influence *
     Increase of the mitosis rate of germinative cells within tissues
      having regenerative functions.
     Effect on non-excitable cells by depolarization of the resting
      potential.
     One end Product of the ATP consumption is adenosine.
Reimbursement
 Average patient treatment regimen is 12 – 16 treatment
 per diagnosis.
 Actual reimbursement varies according to patient mix,
 specialty and regional reimbursement average.
       Medicare, Workers Comp and auto coverage may be an
        option
    Note: Always verify with individual insurance carrier (in respective area) for
    carrier direction concerning the preferred billing codes for proper reimbursement
    of Physical Medicine Treatment.
Example of Diagnosis and codes
Based on International Classification of Diseases version 9 (ICD-9)

   PAIN, Low Back                            724.2
   PAIN, Back/Shoulder                       724.9
   PAIN, Knee                                719.46
   PAIN, Shoulder/Joint                      719.41
   PAIN, Atypical Facial                     350.2
   PAIN, Lower Extremity                     729.5
   PAIN in Thoracic Spine                    724.1
   Muscle Spasms                             728.85
   Edema                                     782.3
Commonly used Codes
Based on Current Procedural Terminology -2012

   97032 – Electrical Stimulation (each 15 min. treatment) attended
   97014 – Electrical Stimulation (unattended)
   G0283 – Electrical Stimulation (Medicare only)
   97016 – Vasopheumatic Device
   97139 – Unlisted Therapeutic Procedure
   GPKX – Modifier with code (Medicare only)
Recap of Benefits
Project Pain


    Pain is
   inevitable,
but suffering is
    optional

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Electro analgesic introduction

  • 1. ElectroAnalgesic An alternative for Pain Management and Rehab Dr. Jose I. Delgado
  • 3. Pain by the numbers
  • 4. Who has Pain? Physical pain is a natural force in our lives that all of us will experience & have to deal with.  It can be caused in a number of ways:  Injury  Posture  Stress  Illness  Others
  • 5. How can pain be dealt with?
  • 6. Viability of “living with the pain”
  • 11. Is This New Technology?  One of the oldest and most documented medical sciences known.  Cellular function has long been known and accepted to be influenced by specific bioelectric fields.  Based upon the concept that any medical treatment can only stimulate, facilitate, or inhibit electrical or chemical processes in the body.
  • 13. Theory of Electromedicine  Successful treatments have been documented for nearly 2,000 years  Wider acceptance gained after publication of “Gate Control Theory of Pain” (Science 150, 1965)(T.E.N.S.)  Certain cells in the spinal cord act as gates through which pain signals travel to the brain;  Overloading these cells will block electrochemical pain impulses and thus relieve pain.  The Gate Control Theory accepted by the Medical Community  Helped establish the use of transcutaneous electric nerve stimulation (TENS) in the United States
  • 14. Classifications 1. Action Potential (depolarization and repolarization of a cell membrane, opens and closes) 2. No Action Potential (sustained depolarization of a cell membrane, closed)
  • 15. Affecting the Nerve with Electromedicine 3. Neuron Function Interruption*  Signals that are so fast that they cannot be physiologically followed by the nervous system  Signals must be faster that 2,000 pps  Used for stopping or interrupting the axon transport of the action impulse.  Blocking the pain signal is necessary in cases of heavy (severe) pain.
  • 16. Pain Relieving Effect  As a Primary Effect *  Counter-irritation by means of action potential generation synchronous to the modulation frequency  A block of the transmission of pain information by means of sustained reactive depolarization in the region of the higher intensity unmodulated middle frequency (Mf) electric field.
  • 17. Science of Pain Relief 1. Motor Nerve and Muscle Stimulation  Action Potential Generation  Physiological Muscle Contracture  Generation of Spontaneous action Potential Activity
  • 18. Science of Pain Relief 2. Increase of Local Blood Flow *  Effect of Motor Nerve and Muscle Stimulation  CO2, Lactate, adenosine are End-Products of Metabolism  ATP Consumption is Initiated  Electromedical currents depolarize excitable and non-excitable cells
  • 19. Science of Pain Relief 3. Local Circulation - Increase in the distribution of electrically charge substances (ions) and water Electro-osmosis within the tissue, resulting in: • Dilution of toxic, pain, and/or inflammation causing substances. • Increase of tissue clearance (filtration and diffusion processes). • Increasing local blood circulation. • Improvement of exchange (diffusion) processes: the intro-and extracapillary fluids. • Improvement of resorption processes, important for prevention or retardation of disuse atrophy.
  • 20. Science of Pain Relief 4. Effects on Muscle *  Motor Nerve and Muscle Excitation Followed by: (Relaxation of muscle spasms comparable to the effect of post-isometric muscle relaxation)  Interrupting the vicious cycle of pain
  • 21. Science of Pain Relief 5. Biological Influence *  Increase of the mitosis rate of germinative cells within tissues having regenerative functions.  Effect on non-excitable cells by depolarization of the resting potential.  One end Product of the ATP consumption is adenosine.
  • 22. Reimbursement  Average patient treatment regimen is 12 – 16 treatment per diagnosis.  Actual reimbursement varies according to patient mix, specialty and regional reimbursement average.  Medicare, Workers Comp and auto coverage may be an option Note: Always verify with individual insurance carrier (in respective area) for carrier direction concerning the preferred billing codes for proper reimbursement of Physical Medicine Treatment.
  • 23. Example of Diagnosis and codes Based on International Classification of Diseases version 9 (ICD-9)  PAIN, Low Back 724.2  PAIN, Back/Shoulder 724.9  PAIN, Knee 719.46  PAIN, Shoulder/Joint 719.41  PAIN, Atypical Facial 350.2  PAIN, Lower Extremity 729.5  PAIN in Thoracic Spine 724.1  Muscle Spasms 728.85  Edema 782.3
  • 24. Commonly used Codes Based on Current Procedural Terminology -2012  97032 – Electrical Stimulation (each 15 min. treatment) attended  97014 – Electrical Stimulation (unattended)  G0283 – Electrical Stimulation (Medicare only)  97016 – Vasopheumatic Device  97139 – Unlisted Therapeutic Procedure  GPKX – Modifier with code (Medicare only)
  • 26. Project Pain Pain is inevitable, but suffering is optional

Editor's Notes

  1. Although electromedicine may seem like a new technology to many practitioners, it is actually one of the oldest and most documented medical sciences know. Cellular function has long been known and accepted to be influenced by specific bioelectric fields. The science of clinical electromedicine is based upon the concept that any medical treatment, regardless of the specialty or avenue of approach, can only stimulate, facilitate, or inhibit electrical or chemical processes in the body. The science of clinical electromedicine is based upon the concept that any medical treatment, regardless of the specialty or avenue of approach, can only stimulate, facilitate, or inhibit electrical or chemical processes in the body.
  2. A wide variety of medical conditions have been succesfully treated with electrical stimulation for nearly 2,000 years. Electromedicine gained wider acceptance in our day when Canadian psychologist Ronald Melzack and British physiologists Patrick Wall published their influential findings on the “Gate Control Theory of Pain” (Science 150, 1965)(T.E.N.S.) These scientists found that certain cells in the spinal cord act as gates through which pain signals travel to the brain. Overloading these neural transmitter cells will block the naturally occurring electrochemical pain impulses and thus relieve pain. The Gate Control Theory was accepted by the Medical Community and helped establish the use of transcutaneous electric nerve stimulation (TENS) in the United States. Since that time, we have refined and perfected electromedical processes to the point where comprehensive electroanalgesic medicine has emerged as an important adjunct discipline in the management and control of pain.
  3. Action Potential – These effects in bioelectric procedures and treatment are biophysiological effects that are induced by repeated synchronous action potentials in excitable cells (1 to 200 pps– pulses per second). This involves membrane depolarization and repolarization activity. (“Gate Control Theory of Pain”, Science 150., 1965; Melzack and Wall) No Action Potential – These effect in bioelectric procedures and treatment are biophysiological effects that are induced without action potential (i.e., faster than 2,000 pps). This involves sustained depolarization – that is, no repetitive membrane depolarization and repolarization activity. (Wendensky Inhibition)
  4. These are signals that are so fast that they cannot be physiologically followed by the nervous system (multiple stimulations falling within the absolute refractory period of the cell membrane). These signals must be faster that 2,000 pps and are used for stopping or interrupting the axon transport of the action impulse. Blocking the pain signal is necessary in cases of heavy (severe) pain. (Wendensky Inhibition) *These mechanisms of action are only theory and have not yet been proved with valid scientific data.
  5. Counter-irritation by means of action potential generation synchronous to the modulation frequency (beat frequency or pulse per second frequency; gate control theory; Melzack and Wall, et al). A block of the transmission of pain information by means of sustained reactive depolarization in the region of the higher intensity unmodulated middle frequency (Mf) electric field. (The resulting continuous refractory state is called Wendensky Inhibition.) *These mechanisms of action are only theory and have not yet been proved with valid scientific data.
  6. Action Potential generation in motor nerves and/or muscle cells synchronous to the modulation frequency (beat frequency, pulses per second frequency), with low frequency single twitches or tetanic contractions dependent on the modulation frequency (direct and indirect muscle stimulation). Physiological muscle contracture during distinct superthreshold simulation with sustained unmodulated middle frequency currents (direct muscle fiber stimulation). Generation of spontaneous action potential activity with statistically distributed intervals between the ingle action potentials in nerves and muscle cells during stimulation with sustained unmodulated middle frequency currents moderately above motor threshold or in the range of motor threshold intensity (direct and indirect muscle stimulation). *These mechanisms of action are only theory and have not yet been proved with valid scientific data.
  7. Effect of motor nerve and muscle stimulation with an increase in metabolism, followed by autoregulatory vascular mechanism resulting in a decrease of local peripheral resistance of the vasculature in the stimulated muscle. CO2, lactate, and adenosine are end-products of metabolism. The autoregulatory vascular mechanisms are controlled by CO2, lactate (pH decrease), and adenosine release. ATP consumption is initiated by depolarization of both excitable and non-excitable cells, because the cells try to repolarize their membrane potential. For this pupose they need ATP as the source of energy. *These mechanisms of action are only theory and have not yet been proved with valid scientific data.
  8. Increase in the distribution of electrically charge substances (ions) and water Electro-osmosis within the tissue, resulting in: Dilution of toxic, pain, and/or inflammation causing substances. Increase of tissue clearance (filtration and diffusion processes). Increasing local blood circulation. Improvement of exchange (diffusion) processes: the intro-and extracapillary fluids. Improvement of resorption processes, important for prevention or retardation of disuse atrophy. *These mechanisms of action are only theory and have not yet been proved with valid scientific data.
  9. *These mechanisms of action are only theory and have not yet been proved with valid scientific data.
  10. Effect on non-excitable cells by depolarization of the resting potential: A reversible increase in the electrical membrane resistance takes place after a certain latency period. This is a stimulation for mitosis. The consumption of ATP is increased due to the tendency of the cell to rebuild the resting potential. Repolarization is realized with the aid of the potassium pump. The energy needed for this is obtained from ATP hydrolysis. One end product of the ATP consumption is adenosine, which: Penetrates the cell membrane and acts as a strong local vasodilator. Causes an activation of cyclase, resulting in the generation of the substance cAMP (cyclic adenosine monophosphate) and the activation of the cell-specific metabolism. *These mechanisms of action are only theory and have not yet been proved with valid scientific data.
  11. NOTE: Always verify with individual insurance carrier (in your respective area) for carrier direction concerning the preferred billing codes for proper reimbursement of Physical Medicine Treatments for this product or any other product.
  12. NOTE: Always verify with individual insurance carrier (in your respective area) for carrier direction concerning the preferred billing codes for proper reimbursement of Physical Medicine Treatments for this product or any other product.