Advertisement

Bioelectric Medicine: Electrotherapy and Transcutaneous Electromagnetic Stimulation—Clinical and Research Challenges

Published:August 12, 2022DOI:https://doi.org/10.1016/j.apmr.2022.08.001
      The Archives of Physical Medicine & Rehabilitation has a long-standing interest in the use of electricity to remediate health problems. Indeed, Archives of Physical Therapy, X-ray, Radium was the title for this journal from 1926 to 1938. The application of electrical and magnetic stimulation in health care has ebbed and flowed over the centuries, but it had fallen out of favor in recent times because of the lack of evidence for benefit.
      • Macklis RM.
      Magnetic healing, quackery, and the debate about the health effects of electromagnetic fields.
      ,
      • Basford JR.
      A historical perspective of the popular use of electric and magnetic therapy.
      However, recent years have seen a proliferation of devices providing electromagnetic stimulation, other than traditional transcutaneous electrical nerve stimulation (TENS) units, for use in the home to treat pain, and it has also seen a proliferation of research. Advances in technology and the opioid epidemic are key reasons for the enormous growth in types of transcutaneous electromagnetic devices. In 2018, the People's Republic of China, World Economic Forum, identified “electroceuticals” as 1 of the top 10 emerging technologies.

      World Economic Forum. Top 10 emerging technologies 2018. Available at: https://www3.weforum.org/docs/Top10_Emerging_Technologies_report_2018.pdf. Accessed September 12, 2022.

      The swift rise in the use of such electroceutical devices, and the ensuing profits to be made, has given rise to a “Wild West” market environment. The rapid proliferation of these devices has led to the coining of several new terms, such as “bioelectric medicine,” “electroceuticals,” “electrotherapy,” and “electrophysical agents.” It has also produced a situation where the claims of many devices have yet to be fully substantiated in the literature, as well as gain regulatory approval and acceptance in the market.

      List of abbreviations:

      AC (alternating current), DC (direct current), FDA (Food and Drug Administration), PC (pulsed current), PMA (premarket application), TENS (transcutaneous electrical nerve stimulation)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Macklis RM.
        Magnetic healing, quackery, and the debate about the health effects of electromagnetic fields.
        Ann Intern Med. 1993; 118: 376-383
        • Basford JR.
        A historical perspective of the popular use of electric and magnetic therapy.
        Arch Phys Med Rehabil. 2001; 82: 1261-1269
      1. World Economic Forum. Top 10 emerging technologies 2018. Available at: https://www3.weforum.org/docs/Top10_Emerging_Technologies_report_2018.pdf. Accessed September 12, 2022.

      2. Small Business Innovation Research. The US patent application process. Available at: https://www.sbir.gov/sites/all/themes/sbir/dawnbreaker/img/documents/Course16-Tutorial1.pdf. Accessed December 29, 2021.

      3. US Patent and Trademark Office. 2107 Guidelines for examination of applications for compliance with the utility requirement [R-11.2013]. Available at: https://www.uspto.gov/web/offices/pac/mpep/s2107.html. Accessed December 29, 2021.

      4. US Food & Drug Administration. Classify your medical device. Available at: https://www.fda.gov/medical-devices/overview-device-regulation/classify-your-medical-device. Accessed December 29, 2021.

      5. US Food & Drug Administration. Step 3: pathway to approval. Available at: https://www.fda.gov/patients/device-development-process/step-3-pathway-approval. Accessed December 29, 2021.

      6. US Food & Drug Administration. Transcutaneous electrical nerve stimulators. Available at: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfCFR/CFRSearch.cfm?fr=882.5890. Accessed December 29, 2021.

        • Selkowitz DM.
        Foundations of electrical stimulation.
        in: Watson T Nussbaum EL Electrophysical agents: evidence-based practice. Elsevier, New York2021: 70-92
        • Liebano RE
        • Rakel B
        • Vance CGT
        • Walsh DM
        • Sluka KA.
        An investigation of the development of analgesic tolerance to TENS in humans.
        Pain. 2011; 152: 335-342
        • Claydon LS
        • Chesterton LS.
        Does transcutaneous electrical nerve stimulation (TENS) produce “dose-responses”? A review of systematic reviews on chronic pain.
        Phys Ther Rev. 2008; 13: 450-463
        • Gozani SN.
        Remote analgesic effects of conventional transcutaneous electrical nerve stimulation: a scientific and clinical review with a focus on chronic pain.
        J Pain Res. 2019; 12: 3185-3201
        • Watson T
        • Nussbaum EL.
        Introduction and general concepts.
        in: Watson T Nussbaum EL Electrophysical agents: evidence-based practice. Elsevier, New York2021: 2-9
        • Gibson W
        • Wand BM
        • Meads C
        • Catley MJ
        • O'Connell NE
        Transcutaneous electrical nerve stimulation (TENS) for chronic pain—an overview of Cochrane Reviews.
        Cochrane Database Syst Rev. 2019; 4CD011890
        • Bjordal JM
        • Johnson MI
        • Ljunggreen AE.
        Transcutaneous electrical nerve stimulation (TENS) can reduce postoperative analgesic consumption. A meta-analysis with assessment of optimal treatment parameters for postoperative pain.
        Eur J Pain. 2003; 7: 181-188
        • Fuentes JP
        • Armijo Olivo S
        • Magee DJ
        • Gross DP
        Effectiveness of interferential current therapy in the management of musculoskeletal pain: a systematic review and meta-analysis.
        Phys Ther. 2010; 90: 1219-1238
        • de Almeida CC
        • da Silva VZ
        • Júnior GC
        • Liebano RE
        • Durigan JL.
        Transcutaneous electrical nerve stimulation and interferential current demonstrate similar effects in relieving acute and chronic pain: a systematic review with meta-analysis.
        Braz J Phys Ther. 2018; 22: 347-354
        • Shanahan C
        • Ward AR
        • Robertson VJ.
        Comparison of the analgesic efficacy of interferential therapy and transcutaneous electrical nerve stimulation.
        Physiotherapy. 2006; 92: 247-253
      7. Watson T. Electrotherapy on the web. Available at: http://www.electrotherapy.org/. Accessed January 4, 2022.

      8. AETNA. Medical clinical policy bulletins. Available at: https://www.aetna.com/health-care-professionals/clinical-policy-bulletins/medical-clinical-policy-bulletins.html. Accessed January 4, 2022.

      9. Kansas City Blue Cross Blue Shield. Medical policies. Available at: https://www.bcbsks.com/providers/medical-policies. Accessed January 4, 2022.

        • Arienti C
        • Armijo-Olivo S
        • Minozzi S
        • et al.
        Methodological issues in rehabilitation research: a scoping review.
        Arch Phys Med Rehabil. 2021; 102: 1614-1622
      10. The EQUATOR Network. Enhancing the QUAlity and Transparency Of health Research. Available at: https://www.equator-network.org/. Accessed May 26, 2022.

        • Laskin JJ
        • Waheed Z
        • Thorogood NP
        • Nightingale TE
        • Noonan VK.
        Spinal cord stimulation research in the restoration of motor, sensory and autonomic function for individuals living with spinal cord injuries: a scoping review.
        Arch Phys Med Rehabil. 2022; 103: 1387-1397
      11. Himmelfarb Health Sciences Library. What is evidence-based practice? Available at: https://guides.himmelfarb.gwu.edu/ebm/ebmintro. Accessed January 4, 2022.

        • Chan L
        • Heinemann AW
        • Roberts J.
        Elevating the quality of disability and rehabilitation research: mandatory use of the reporting guidelines.
        Arch Phys Med Rehabil. 2014; 95: 415-417
      12. Hoffmann T, Glasziou P, Boutron I, et al., Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide, BMJ 2014;348:g1687. Available at: https://www.equator-network.org/reporting-guidelines/tidier/. Accessed January 4, 2022.