TENS units achieve their effects by decreasing the body's sensitivity to pain. They may also be used to treat acute pain by delivering steroid drugs through the skin. Gideon Hoyle is a writer living outside of Houston. Previously, he produced brochures and a wide variety of other materials for a nonprofit educational foundation.
He now specializes in topics related to health, exercise and nutrition, publishing for various websites. What Is a Dental Bone Graft? Few trials had more than 80 patients; for example, there were only 10 patients in DC and IC and 1 patient in CC, which was for spinal fusion see patient number in Tables 3—5.
Only 3 studies compared the clinical efficacy of different methods of ES, 49 , 63 , 86 which may be due to small number of patients used in ES studies. These studies are required, as they offer the potential to illustrate the most beneficial mode of ES for each orthopedic clinical problem.
In conclusion, the exact mechanism by which ES enhances bone repair is still not fully understood and needs more investigation. However, to date, DC has been documented to work by an electrochemical reaction at the cathode, and CC and IC have shown to work by alteration of growth factors and transmembrane signaling. In an era of evidence-based medicine, fracture-healing management should be based on the best available evidence to ensure high-quality, safe, and cost-effective treatment.
Therefore, considering the widespread usage of ES to aid bone healing in clinical practice, our analysis shows that there have been few good quality clinical studies to support their use.
Therefore, the optimal regime for ES treatment for bone healing needs to be further defined and standardized. Moreover, clinical studies need to have uniform outcomes and defined criteria on the effect of ES on clinical outcomes including improvement in pain, activities of daily living, and need for revision surgery. Overall, the evidence to date implies that further studies are needed to support and optimize the clinical application of ES for bone healing.
National Center for Biotechnology Information , U. Journal List Eplasty v. Author information Copyright and License information Disclaimer. Correspondence: ku. This is an open-access article whereby the authors retain copyright of the work. The article is distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
This article has been cited by other articles in PMC. Abstract Objectives: Direct current, capacitive coupling, and inductive coupling are modes of electrical stimulation ES used to enhance bone healing. Open in a separate window. Figure 1. Table 1 A table illustrating some of the clinical electrical stimulation devices used today which have been FDA approved. In brief, the criteria used was as follows: Table 2 Grade of recommendation for each mode of electrical stimulation for each type of bone healing diagnosis based on Oxford Centre Level of Evidence Recommendation.
Figure 2. Figure 3. Table 4 Clinical studies reviewed for capacitive coupling CC. Table 5 Clinical studies reviewed for Inductive coupling IC which is also referred to as pulsed electromagnetic field. Table 6 Analysis of heterogeneity of clinical studies, including evaluation of treatment time, outcome measure, and assessment time follow-up for all 3 types of electrical stimulation.
Direct current Using DC for spinal fusion has shown to be inconsistent with 2 LOE-1 studies 51 , 50 supporting its efficacy particularly in high risk patients smokers, those with multiple back surgeries, and multilevel fusions and 2 LOE-1 studies showing no difference in the older patient population leaving DC only level B recommendation.
Inductive coupling The use of ICs for treating nonunion and delayed union has been successful. There were certain limitations found in the studies during evaluation including the following: Randomization of the RCTs was generally maintained but the allocation methods was not well-defined for the RCTs.
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Prospective comparison of the effect of direct current electrical stimulation and pulsed electromagnetic fields on instrumented posterolateral lumbar arthrodesis. J Spinal Disord. Kane WJ. Direct current electrical bone growth stimulation for spinal fusion. Rogozinski A, Rogozinski C. Efficacy of implanted bone growth stimulation in instrumented lumbosacral spinal fusion. Meril AJ. Direct current stimulation of allograft in anterior and posterior lumbar interbody fusions. While using a TENS unit to relieve your pain, you have a variety of options for controlling the electrical stimulation.
There are controls for changing the duration, intensity, and frequency of the electrical impulses. The frequency is the number of electrical pulses per second; high-frequency pulses help manage acute short-term pain whereas low-frequency is better for treating chronic pain. Tolerance can also be developed if the unit is used daily. But alternating between low and high frequency can help with preventing tolerance from building up. While TENS units are good for treating pain, a bone growth stimulator is more effective for healing broken bones and also can provide pain relief.
Bone growth stimulators heal fractures with either electrical or ultrasound energy. Ultrasound energy uses sound waves to transmit vibrations through soft tissue and through and around the bone. Bone stimulators are particularly effective for healing non-union fractures. Electrical stimulations can cause bone cells to proliferate and divide, which accelerates healing of the fracture.
Ultrasound energy enhances bone healing by increasing the incorporation of calcium ions in cartilage and bone cells and stimulating the expression of numerous genes involved in the healing process. Bone growth stimulators that use ultrasound energy also impact chondrocytes, the cells found in healthy cartilage, increasing the formation of soft callus on the fracture.
Although electrical stimulators are effective, they often require longer treatments over a longer period of time and are harmful when used with metal hardware.
Bone growth stimulators come in a variety of sizes, shapes, and technologies. The units are either put on the skin externally or implanted in the body during surgery. A handheld unit is the least invasive and easy to use. Bone stimulators can be connected to electrodes placed on the skin at the location of the fracture, similar to a TENS unit, or as a brace or belt to wear or recline on.
They are small, portable devices that can be used in the home, office or on the road, and only need to be used for twenty minutes a day for results. TENS units are good for soft tissue and primarily used for pain relief, though results vary by person. Bone growth stimulators can speed up the healing of fractures and allow you to get back to normal activities sooner.
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