Bone growth stimulators were developed by Dr. Robert Becker and Dr. Andy Basset, orthopedic surgeons, to prevent the need to amputate limbs because the crushed bones were not healing. The science behind what lead to the discovery of using electrical stimulation is presented in Dr. Becker's book, "The Body Electric - Electromagnetism and The Foundation of LIfe".
In a nutshell version a basic premise of cell growth ( note this is not related only to bones but to cells in general) is you have a physical attraction of opposite charges between cells. With electromagnetism it's similar to having two magnets and placing the north end of one magnet beside the south end of the other magnet. The two magnets will attract each other and if close enough they join together. Reverse the setting so both ends are north and the magnets repel/repulse each other and there is no union occurring. Of course with electrotherapy the terms are the positive and negative charges. Opposite charges attract, and same charges repel.
When a bone is fractured or broken the two ends of the bone facing each other will have one distal end with a positive charge, and the other proximal end with a negative charge. That is normal and in that electromagnetic field the two bones are trying to unionize or heal. Often the actual cellular charges of one end of either bone will "reverse polarity" or simply put both ends have the same charge so there is no unionization, or bone healing. A bone stimulator is applied to reverse the polarity and healing begins again. It is this process that helps non healing bones fuse together and regain form and function.
Some orthopedic surgeons use different types of bone growth stimulators knowing the bone will unionize with nothing being done, but desire a faster healing rate than normal and use bone growth stimulators to advance the healing. This is done by Yale Univ. hospital on many of the neck fracture patients simply because of the fear of further injury in the neck spinal region. It's a safeguard to accelerate bone unionization. The bone stimulators are also used in sports medicine for athletic injuries where a player needs to heal quicker in order to return to competition.
The process of furthering healing with electrotherapy is similar for soft tissue cells, such as bed sores, sprained/strainked ankles etc. as the physics are of cells, not structures.
Nerve Blocks For Paraesthesia May Be Obsolete with Electroanalgesia High Frequency Stimulation
What does the term mean, "electroanalgesia"?
Wikipedia describes this way:
"Electroanalgesia is a form of analgesia, or pain relief, that uses electricity to ease pain. Electrical devices can be internal or external, at the site of pain (local) or delocalized throughout the whole body. It works by interfering with the electrical currents of pain signals, inhibiting them from reaching the brain and inducing a response;
different from traditional analgesics, such as opiates which mimic natural endorphins and NSAIDS (non-steroidal anti-inflammatory drugs) that help relieve inflammation and stop pain at the source. Electroanalgesia has a lower addictive potential and poses less health threats to the general public, but can cause serious health problems, even death, in people with other electrical devices such as pacemakers or internal hearing aids, or with heart problems."
"Analgesia that is induced by the passage of an electric current."
.......The American Heritage® Medical Dictionary
"the reduction of pain by electrical stimulation of a peripheral nerve or the dorsal column of the spinal cord,"
...Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health
Are those definitions correct?
Well not exactly sure, as the concept is not new, but is actually very old. Just so you know you may see these terms being used that imply a similar concept, "electroceutical" and "electroanalgesic". What is becoming exciting about this form of electrotherapy is rather than do an invasive "nerve block" ( I'll let you check that out on Wikipedia!!), the new non invasive concept is to do an electroanalgesia nerve block using an external device. The block does not have to occur in the spinal area but can be done on peripheral nerves.
A patient comes to the clinic, generally in pain, and while on a treatment table one, two or three electrodes are placed along the spine and the other electrode is place in the stomach area. The power is turned up to a comfortable sensation and the patient is treated for approximately 20 minutes. During the electroanalgesia procedure the pain sensation is lost and there is a general anesthesia felt in the area of stimulation.
Upon completion of the treatment the patient no longer feels the pain,much like one experiences who has undergone a nerve block. The results are very promising that chronic pain can be controlled by using external high frequency, interferential type stimulators for pain control.
Several of the companies producing the equipment are claiming the paraesthesia is due to the high frequency which seems to vary from 4,000 to 20,000 pulses per second (frequency). Problem with that logic is for decades clinicians have been able to produce similar paresthesia effects with a tens unit, which is only 150 pulses per second. Now for clarity I'm talking paraesthesia in a digit, using a tens unit on high amplitude ( power) and 150 pps ( pulses per second or frequency).
With a tens unit ( transcutaneous electrical nerve stimulator) one takes a finger, wraps two electrodes around the digit, making sure they do not touch, and turns the power ( amplitude ) up to a point where it is somewhat uncomfortable for approximately 20 minutes. After treatment most people can then have a pin/needle inserted into their finger that was stimulated, and feel no or very little pain due to the paraesthesia of the tens stimulation. "Pressure" is felt but not pain and that is generally due to the transmission of the pressure sensation is due to non pain fibers, not pain fibers.
Tens has not been able to produce a paraesthesia in the spinal area as does interferential high frequency, nor does Tens stimulation work effectively for any form of carryover or residual pain relief ( see video below) . The question that is not answered is whether the electroanalgesia is due to the higher frequency, higher amplitude, or electrode placement or some other reason.
As the Functional Restoration clinics that are opening up continues the hope is for a more definitive answer, based upon patient - clinician experience and research by The American College of Physical Medicine.
Electroanalgesia is real, it's the how we need to obtain more knowledge about.
Often we get inquiries as to what HCFA codes can the Infrex FRM treatments and instruction for functional restoration be used in the clinic. We will continue to address this issue and update as new information becomes available. Unfortunately some of the information provided by the Department Health and Human Services refers you to other regional providers for allowances, codes and conditions. This is the "regional" aspect of the Medicare system.
Here is a link to the information for your use. We caution all that it's not enough to know a code, but one must also understand under what conditions does the billing code apply, for how many visits, documentation before, during, after etc. before anyone believes whether there is coverage or not. The other factor is even if one has all the proverbial "ducks in a row" then how difficult is it to get paid and is the cost of billing going to offset the predetermined reimbursement.
The two cods we see used most often for billing for estim in the clinic are: 97112 and 97032. Both of these codes are for "services" and not to be confused with different codes for rental or purchase of the Infrex FRM unit.
Peripheral Neuropathy Treated With Functional Restoration
Ted is one of our patients who has suffered from peripheral neuropathy in his right calf and foot since 1987. Ted today is 77 years old and in good health but for the lack of sensation, and some pain, from the peripheral neuropathy. Let me tell you a little about Ted and his methods.
Ted was a pharmaceutical sales rep. over 35 years ago and always had a keen interest in the way our body works chemically. His pharma training helped him understand the intricacies of chemical actions in healing and disease. But Ted is a true "doubting Thomas". Over the years Ted has always shown an interest in helping himself by understanding what is going on with his body, and not accepting anyone's advice without seriously questioning the logic, positive and negative outcomes, if he chooses to abide by the recommended treatment of his physicians. The plural is used as Ted does not go see one doctor, but several, when he has an issue. He listens to general practitioners, neurologists, orthopedic surgeons, Chiropractors, physical therapists, etc. and then compiles his own understanding of the health issues and forms his own opinion for his personal treatments.
