Tennis Elbow Can Be Treated With Iontophoresis Rather Than a Painful Shot or Injection

    Cortisone injections are often used for conditions such as "tennis elbow" and that entails a painful needle in the elbow procedure that is not fun and is indeed painful, but does not have to be that way.

    There's a non painful process called "iontophoresis" that will drive the cortisone into the joint capsule while you read a book.  Heck if it's a boring book you might sleep through the process!!

    Iontophoresis is the introduction of medicinal ions by electricity. The physical therapist does this as part of their treatments they are licensed to do because:

1.  Not painful,

2.  Does not require having to overdose using a systemic orally ingested drug in order to get the correct amount to the affected area,

3.  Localizes drug into area where it is needed,

4.  Drug can remain in affected area for longer time periods increasing absorption by tissues needing the medication.

    Let me elaborate on this.

  The physical therapist applies two stick-on electrodes, that have the medicine in the electrode pad along with what is called a "buffering" agent which is generally water, on each side of the elbow.  The water allows the dispersement of the medical ions within the pad so the medication is administered evenly under the self adhering electrode.  The patient feels nothing other than the sticking of the electrode on; which is equivalent to putting on a band aid.  Contrast this with a needle inserted into the joint!!

   Since the medication is being administered directly to the joint tissue a larger dose is not needed compared to oral drugs.  With oral drugs it's necessary to administer much higher doses since much of the actual drug is lost in our digestive system and does not get to the area it is needed.  The larger doses lead to adverse reactions and other complications.  Generally speaking the dosage for an iontophoresis treatment is 5 - 7% that of an ingested drug.

   Often a second medication is used, such as epinephrine (epi).  Epi is a vasoconstrictor which constricts the vein so the medication remains in the affected area for longer periods of time for tissue absorption.  This process elevates the relief from the treating medication, cortisone.

   The basic principle behind iontophoresis is like charges repel and unlike charges attract.  The cortisone ions have a specific charge, either positive or negative, and the iontophoresis machine is set to be the same charge as the ions.  If a negative (-) ion then the negative charge of the iontophoresis unit will repel the ions into the body and to the targeted joint. 

   If this is so much less painful and easier for the patient then why is it not done more often?

   The reimbursement rate for the procedure does not justify the time of the treating physical therapist or physician therefore it's rarely used.  That is unfortunate since many patients refuse to do treatments after the first one due to the pain of the injection itself.