Image of knee prosthesis for knee replacement surgery

Knee Prosthesis

     Knee replacement surgery is an option many consider when pain is inhibiting movement or the knee itself or the knee is so unstable that a patient is incapable of function such as walking.    In some cases the damage to the bone itself, or supporting tissues, is so severe that only knee replacement surgery is viable.   In other cases the cause of the pain may be the lack of strength of the musculature and that lack of strength is allowing the compression of nerves or support tissue. IN many cases the lack of muscle strength has allowed bone on bone which is a destructive process.   In the latter case the use of functional restoration training may avoid the necessity of any prosthetic knee implant surgery. 

    In either case it's necessary to understand there is a rehabilitation that must occur before a patient can restore the function of the knee joint.

 

Diagram of where demanc cardiac pacemaker is put in body

Diagram of traditional pacemaker and wire placements

 

    One of the more common questions a patient has when using electrotherapy devices is whether it will interfere with their implanted demand cardiac pacemaker.   The question is very reasonable due to the way a demand heart pacemaker works. 

How A Demand Cardiac Pacemaker Works:

    A heart demand pacemaker is an implanted device that uses a battery powered stimulator, connected to wires, and the wires are strategically placed to stimulate heart muscles.   The pacemaker itself is also what is called a "biofeedback" type device because the pacemaker actually is monitoring the continuing electrical output of the heart muscles as they contract.  The pacemaker detects the electrical charges emitted by the heart muscles when they pump, contract to move the blood. 

 

   Video on one massage method to treat Sciatic Piriformis Syndrome.    

 

   Often the pain can be reduced or eliminated using daily 20 - 40 minute at home interferential therapy but the interferential electrotherapy should be supplemented with exercise and stretching.  This video explains massage technique, including trigger point stimulation,  that helps increase muscle elasticity, decrease pain, as well as increased blood flow for rapid healing following stretching.  The negative charge of interferential therapy may also reduce the swelling due to the inflammatory response of sciatic nerve bruising.

Image of the Norovirus    

 

   The Norovirus is a very serious virus that causes gastroenteritis.   The virus is extremely communicable and, unchecked, results in closing down hospitals, work and other places due to the extreme contagiousness of the virus itself.  

 The Norwalk-like virus is easily transferable.   In some communities in the U.S. hospitals have to shut down visitors to the facility due to the real possibility of bringing the virus into the hospital and exposing patients, already sick, and staff to the disease.   If there is a large caseload of patients within the hospital who have the virus it may become necessary to prohibit visitors as the virus can be transferred to the general population and spread rapidly.  In either case the hospitals end up overloaded with more patients with Norovirus than they can accommodate.

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Image of Herpes Shingles Virus On Skin Causing Pain                                       Will Shingles Last For Days, Weeks or Months? 

 

     Shingles is a herpes virus and generally has a longevity of a few days, maybe couple of weeks.   Generally speaking most people take oral and topical medications for shingles pain and the virus runs it's course quickly and the pain and discomfort is over.   Immediately upon suspecting one has Shingles then the best option is to treat immediately.   As with a cold virus the symptoms are generally what is being treated, not the virus itself.

 

    With recent developments in new topical ointments, and new oral medications, it appears the life of the virus may be shortened due to the new treatments.   Today that is the reason to immediately begin treating at any hint one has contracted the shingles virus.   Stop the spread of the virus to healthy, non affected cells.   Viruses need host cells to live and when an area is "quarantined" against the healthy tissues becoming hosts then the duration is shortened.   New hosts mean longer time periods of infection from the shingles virus.

Image of bone growth stimulator with cast on leg.  

     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. 

Peripheral Nerve Block Injection For Chronic Pain Not Necessary with Electroanalgesia

 

      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. 
 

Medicare Logo image and information on HCFA codes for billing Infrex FRM treatments   

 

   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.

 

  If the link does not work then copy and paste this into your browser: https://www.cms.gov/MLNProducts/downloads/Medicare_Outpatient_Therapy_Billing_ICN903663.pdf

 

  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. 

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