Journal of Orthopedics


Microcurrents in the treatment of chronic pain: biological, symptomatological and life quality effects

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AUTHORS

Giovanni Barassi1*, Alì Younes1, Piera A. Di Felice1, Antonella Di Iulio 2, Sergio Guerri1, Loris Prosperi1, Amerigo Stamile3, Angelo Di Iorio4.

 

AFFILIATIONS

1Physiotherapy Center for Rehabilitation and Reeducation (Ce.Fi.R.R.) venue “G. d’Annunzio University” Chieti-Pescara.
2UOC Thoracic Surgery. Hospital “Santo Spirito” Pescara – ASL Pescara
3University Hospital Polyclinic “G. Martino “, University of Messina
4Department of Aging Sciences – “G. Annunzio” University Chieti-Pescara

Corresponding Author
Giovanni Barassi
Physiotherapy Center for Rehabilitation and Reeducation (Ce.Fi.R.R.) venue “G. d’Annunzio University” Chieti-Pescara,
Viale Abruzzo, 322,
Chieti Scalo, 66100, Italy
coordftgb@unich.it /dottgiovannibarassi@gmail.com

Microcurrents could help patients learn how to deal with chronic pain or functional somatic syndromes and reduce the burden of symptoms.
Biological cellular regulation is a type of microcurrent therapy based on the principle of cellular bioregulation which can analyze the patient’s cellular metabolism through an internal impedance meter and then to stimulate the achievement of a homeostasis status.
The aim of this study is to investigate the effects of the application of microcurrent therapy (MCT) in affected fibromyalgia patients.
Materials and methods
A total of 24 subjects affected chronic pain (CP) or functional somatic syndrome were recruited (4 males and 20 females, Caucasians).
All patients received a total of 10 MCT treatments, 2 times a week for 5 weeks. Outcome were measured using the Visual Analogue Scale (VAS), the European Quality of Life-5D (EQ-5D), the Fibromyalgia Severity Scale (FSS) and the Bioelectrical Impedance Analysis (BIA).
Results
There was an increment of lean mass and total body water and a decrement of fat mass. Probably biochemical regulation of tissues, which come from MCT, are able to stimulate the body to reach a more fit state. Finally, a statistically significant reduction in the score of the FSS has been detected in terms of number of painful areas and of severity of symptoms.
Conclusion
Overall, the application of MCT system is an effective therapy to reduce the pain and improve the quality of life of individuals affected by a functional somatic syndrome like fibromyalgia.
Keywords: cronic pain, fibromyalgia, microcurrent therapy, functional somatic syndrome.

Introduction
CP is a condition, with or without a specific organic cause, that persists longer than a usual 3- to 6-months of organic recovery.
An functional somatic syndrome is characterized by a persistent pattern of bodily symptoms that cannot be sufficiently pathologically explained after adequate physical examination . (1)
Close to 1 in 5 adults has intense pain (ie, rating 5/10 or more, for at least 6 months) .
Functional somatic syndrome characterized by irritable bowels (11%), chronic fatigue (1%), tension headache (2%), or tinnitus (10%-15%) are prevalent as well.
The severity and chronicity of lower back pain, which is the most common symptom of both CP and functional somatic syndrome, may be associated with more functional disturbance during people’s lifetime than any other disease. (2)
CP and functional somatic syndrome include fibromyalgia and often involve psychological or social burdens. Comorbid mental disorders were found in 35% of patients with CP.
Compared with individuals without pain, those who experience more than 3 months of disabling pain (7.4%) are about six times more likely to be absent from work and two times more likely to visit a doctor. (3)
In addition, economic costs of sick leave and early retirement exceed the total amount of medical expenditures associated with both CP and fibromyalgia. (4)
The hyperalgesia (or allodynia) that characterize fibromyalgia is able to greatly influence the social functions and quality of life of the patient. (5)
Many different approaches have been proposed during time for the management of CP and fibromyalgia.6)
To date, the most effective electrotherapies for the management of CP in functional somatic syndrome appears to be electrical stimulation, in particular transcutaneous electrical nerve stimulation (TENS) and transcranial stimulation, both as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS).
These electrical applications appear to be very effective in the management of the diffuse pain present in fibromyalgic patients, probably due to their ability to influence the bioelectric activities of the body, rebalancing the central sensitization to pain and the diffuse neuroinflammation that apper to be the main causes of fibromyalgia.(7,8)
Recognition of the role of bioelectricity in tissue healing provides a rationale for the therapeutic application of electrical stimulation. Microcurrent therapy (MCT) is an example. (9)
Luxxamed is a therapy based on the principle of cellular bioregulation. It is a type of MCT which is able to analyze the patient’s cellular metabolism through an internal impedance meter and then to stimulate the achievement of a homeostasis status in the treated tissue through the application of microcurrents characterized by low intensities (variable between 1μA and 999μA) and modulated frequencies (variable between 0,1Hz and 10kHz).
Because, to date, there is very little knowledge about the efficacy of MCT as an effective treatment of the pain associated to conditions like fibromyalgia, the aim of this study is to investigate the effects of the application of Luxxamed BCR therapy in patients with, functional somatic syndrome. (10)

Materials and Methods
The patients were recruited at the physiotherapy, rehabilitation and re-education center (CeFiRR) venue of the University of Chieti-Pescara to allow interested parties to assess their suitability.
All the patients gave informed written consent to the experimental procedure, which was in accordance with the latest revision of the Helsinki Declaration for Human Research and with the procedures concerning the privacy protection of subjects participating in biomedical research, as defined by ISO 9001-2015 standards for research and experimentation.
A total of 24 subjects affected by fibromyalgia were recruited (4 males and 20 females, Caucasians).
All patients received a total of 10 MCT treatments, 2 times a week for 5 weeks.
Each session consisted in the administration of microcurrents through the BCR system.
The BCR is a multitherapy device able to provide MCT and phototherapy, both as single therapies and in combination.
The microcurrent provided by the device work in the range of 0,1Hz-10kHz (in 0,1Hz steps) and 1μA-999μA (in 1μA steps) and can be administered through 4 channels, each one able to transmit microcurrents through 2 electrodes.
Patients of the sample underwent a treatment of 24 minutes per session with the presented “Inflammation” program. The “Inflammation” program is divided in 6 steps.
Each step is 4 minutes. All channels have the same setup in this program.
The steps are programmed as following in table 1:
Table 1: 6 steps of the “Inflammation” program

Table 1: 6 steps of the “Inflammation” program
– Step 1: current = 150 µA, frequency = 40 Hz, rising time = 0,8 seconds, polarity = + (plus);

 

– Step 2: current = 150 µA, frequency = 81 Hz, rising time = 0,8 seconds, polarity = + (plus);

– Step 3: current = 150 µA, frequency = 284 Hz, rising time = 0,8 seconds, polarity = + (plus);

 

– Step 4: current = 150 µA, frequency = 396 Hz, rising time = 0,8 seconds, polarity = + (plus);

 

– Step 5: current = 150 µA, frequency = 91 Hz, rising time = 0,8 seconds, polarity = +/- (bi-polar);

 

– Step 6: current = 150 µA, frequency = 9 Hz, rising time = 0,8 seconds, polarity = +/- (bi-polar);

All the 4 channels were used, and the electrodes were placed as following (table 2):
Table 2: electrode positioning

Table 2: electrode positioning
– Channel A: from right plantar fascia to the right lumbar area (approximately at the level of L1);
– Channel B: from left plantar fascia to the left lumbar area (approximately at the level of L1);
– Channel C: from the right to the left paravertebral area (approximately at the level of T5);
– Channel D: from the right to the left handpalm.

Outcome were measured using the Visual Analogue Scale (VAS), the European Quality of Life-5D (EQ-5D), the Fibromyalgia Severity Scale (FSS) and the Bioelectrical Impedance Analysis (BIA).
The VAS is well-known scale used for assessment of the subjective perceived pain, indicated as numerical number or as a visual level on a predefined scale (normally ranging between 0 to 10).
The EQ-5D is widely used health status instrument.
The FSS is a diagnostic and evaluative instrument for fibromyalgia.
The Body Impendence Analysis (BIA) measures body composition by sending a low, safe electrical current through the body. Parameters considered for this study were the Basal Metabolic Rate (BMR), the percentage of Lean Mass and Fat Mass (%LEAN and %FAT) and the Total Body Water in Liters (Water).

Results
Statistical analysis of outcome measures showed that there was a statistically significant improvement on VAS scale. The data showed a decrease in the level of perceived pain of a better feeling that promotes the recovery and reduces the discomfort.
A statistically significant improvement should be noted also in the EQ-5D measure of health-related quality of life (Table 3). The results confirmed that this kind of approach is not detrimental to the wellbeing of patients in term of autonomy and perception of themselves.

Table 3: Comparison of the significance of changes in health status and pain variables from T0 to T1
Variables Mean±SD p*
(T0) EQ-5D index 0,47±0,27  
(T1) EQ-5D index 0,81±0,17 0.00003
(T0) VAS 4,41±1,8  
(T1) VAS 6,9±2,4 0.001
EQ-5D index: European Quality of Life-5D index

VAS: Visual Analogue Scale for pain

p value is referred to the difference between T0-T1 of variables

(Wilkoxon matched-pairs signed rank test)

Moreover, BIA measures showed that there was an increment of lean mass and total body water and a decrement of fat mass, even if none of these variations resulted statistically significant (Table 4).

Table 4: Comparison of the significance of changes in Body Impendence Analysis variables from T0 to T1
Variables Mean±SD p*
(T0) BMR 1510,8±49,4  
(T1) BMR 1578,4±37,3 n.s.
(T0) %FAT 34,7±10,5  
(T1) %FAT 31,6±11,1 n.s.
(T0) %LEAN 63,7±13,78  
(T1) %LEAN 68,19±11,2 n.s.
(T0) Water 35,125 5,23  
(T1) Water 36,2±6,31 n.s.
BMR: Basal Metabolic Rate (Kcal)

%FAT: Fat Mass Percentage

%LEAN: Lean Mass Percentage

Water: Total Body Water (Liters)

p value is referred to the difference between T0-T1 of variables

(Wilkoxon matched-pairs signed rank test)

Probably biochemical regulation of tissues, which come from MCT, are able to stimulate the body to reach a more fit state. Finally, a statistically significant reduction in the score of the FSS has been detected, indicating an improvement of the symptomatology connected to the fibromyalgia, both in terms of number of painful areas and of severity of symptoms (Table 5).

Table 5: Comparison of the significance of changes in Fibromyalgia variables from T0 to T1
Variables Mean±SD p*
(T0) FSS 21,45±3,97  
(T1) FSS 16,83±3,46 0.00002
FSS: Fibromyalgia Severit Scala

p value is referred to the difference between T0-T1 of variables

(Wilkoxon matched-pairs signed rank test)

Discussion
Micro current therapy (MCT) is an innovative treatment for different pain disorders, defined as a low-intensity direct current delivering monophasic or biphasic pulsed micro amperage currents across the skin. (11)
Furthermore, precise frequencies seem to interact through resonance with biological tissues and biochemical regulators in such a way as to neutralize specific conditions, and address specific tissues, possibly by altering membrane configuration..(12)Considering all the above-mentioned positive effects of MCT we can bring back the positive results obtained in this study on fibromyalgic patients to a moltitude of possible explenations.
MCT proved to be effective in the management of CP in fibromyalgia, with mechanism involving the reduction of central pain sensitization mediated by the increase of inflammatory factors like IL-1, Il-6 and TNF-α17. (13) Further studies confirmed the ability of MCT to reduce the generalized inflammatory status of fibromyalgic patients through a decrease of inflammatory factors IL-1, Il-6 and TNF-α and an increase in serum cortisol and beta-endorphin release. (14)
Other possible explanations for the antalgic effects of MCT can depend on the ability of low frequency electrical impulses to influence nervous activity, expecially at the level B and C fibers, that are very sensitive to a wide range of physical and chemical stimuli, determining an effect of reduction of pain . (15)
Conclusions
Moreover, the quality of life of patients improved after the MCT intervention, as showed by the changes in the EQ-5D. Lastly MCT proved to be effective in modifying the body composition of fibromyalgic patients, particularly increasing their lean body mass and their general hydration status. This finding is in accordance with some animal studies which found positive effect from MCT in terms of muscular recovery and regeneration, probably through a mechanism involving the ribosomal S6 protein kinase p70 S6 kinase that is known for its role in modulating cell-cycle progression, cell size, cell survival and as important regulators of muscular catabolism, systemic inflammation and increased general oxidative stress.(16)
Overall the application of MCT through the Luxxamed BCR system is an effective therapy to reduce the pain and improve the quality of life of individuals affected by a complex functional somatic syndrome,like in fibromyalgia. The main limitations of this experimental study are the short duration (for a chronic condition), the heterogeneous patient population and the lack of a control group. Further trials, with a larger sample, could corroborate these findings and include the assessment of patients and follow up, in order to establish the effectiveness on a large scale of this therapeutic approach.
Statements
All papers must contain the following statements after the main body of the text and before the reference list:
Acknowledgement
The authors have no acknowledgement to declare
Statement of Ethics
All participants signed the informed consent for the experimental procedure, which complies with the latest revision of the Helsinki Declaration and with the procedures defined by the ISO 9001-2015 standards for “Research and Experimentation”; this procedure also protects the privacy of subjects participating in biomedical research.
Disclosure Statement
The authors have no conflicts of interest to declare.
Funding Sources
This research received no grant from any funding agency in the public, commercial, or not-for-profit sectors
Author Contributions
G.B. and A.Y. conceived the idea presented. A.D.Iu. and S.G. developed the theory and performed the calculations. L.P. and V.G. verified the analytical methods. A.D.Io. and S.A. they investigated and supervised the results of this work. All authors discussed the results and contributed to the final manuscript.

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