HFES inhibits the release of neuroinflammatory mediators that contribute to pain and dysfunction, such as CGRP, substance P, and HMGB1. These include CGRP, substance P and HMGB1.
SENZA-RCT clinical trial results demonstrated that HF10 was superior to placebo for improving functional outcomes on 6MWT and TUG tests as well as decreasing opioid analgesic usage for back and leg pain relief, thanks to both central and peripheral actions.
Low Voltage
EMS works on the principle of stimulating and altering electrical charges within nerves and muscle, leading to depolarisation and producing contractions or twitches in nerves or muscle fibers, producing depolarisation which produces muscle twitch or contraction. Patients can customize this experience through various parameters that control pulse repetition frequency and power. It is generally advised to start slowly, gradually increasing dosage until maximum comfort and compliance with therapy are reached.
Controlling the intensity of pulses can be done through pads/electrodes that are placed directly onto the body to apply electric current directly into tissues. Electrodes can be made of single patient use sticky plastic (which must be stored in its Teflon coated seal when purchased) or rubber and placed anywhere from just above or on muscles to stimulate, to being attached to external devices that feature built-in electrodes with timer controls that determine when the pulses come on or off.
Studies have demonstrated the value of high frequency impulse therapy as an effective tool to combat chronic pain by altering how our brain perceives pain signals from nerves. When nerves transmit a pain signal to the brain, activation of large diameter fibers release excitatory neurotransmitters that travel directly into our brains where they cause it to send an inhibitory message which overrides and overrules any initial signal for pain.
E-stim can not only alleviate pain, but it can also improve mobility by activating foot muscles to contract while walking and relaxing those that remain relaxed at rest. Stronger foot muscles can improve gait and load distribution which in turn reduce stress on plantar fascia.
Over-the-counter TENS devices may help treat plantar fasciitis, but their limited pulses do not yield as effective results as an EMS machine administered professionally. Selecting an EMS machine with flexible programs and pre-set options is critical to effective plantar fasciitis treatment; The Relatyv team offers customized Neurofunctional Pain Management programs using high-pulse EMS.
Biphasic Pulse
High frequency impulse therapy utilizes two phases of electric current – anodic and cathodic pulses – for therapeutic purposes, typically for tumor ablation, cardiac tissue ablation and electroconvulsive therapy (ECT). According to one recent study, biphasic pulses demonstrated equal tissue ablation efficiency as monophasic pulses while avoiding action potential triggering in nerve fibers around stimulation sites42; they also produced muscle contraction response similar to monophasic pulses without pain sensation associated with them.
In their study, the authors of the research evaluated various biphasic pulse protocols by altering interphase and interpulse delay values. They discovered that factors like duration of positive and negative phases, length of each phase, number of pulses per session and interval between positive and negative pulses all played an integral part in determining muscle contraction response and pain index of subjects. Each participant completed a short-form McGill pain questionnaire (SF-MPQ) prior and following each of the tested biphasic pulse protocols.
Researchers used HFS sequences delivered with bipolar electrodes on Schaffer collaterals and alveus fibers in the CA1 region of rats’ hippocampi to induce neuronal responses using orthodromically evoked population spikes (OPS). Antidromic test stimuli were applied prior to every O-HFS to establish baseline neuronal activity levels.
SD events were observed in four out of five rats exposed to monophasic O-HFS, whereas none were recorded during 1-min 200-Hz biphasic O-HFS. At first, large OPS were noted in all rats during initial stages followed by dense multiple unit activity (MUA). Once completed, several seconds of silence followed before another O-HFS cycle began.
As part of O-HFS monophasic anodic pulses, monophasic O-HFS caused an extreme elevation in [K+]o and glutamate concentrations to rise rapidly during an anodic pulse anodic pulse; these changes may contribute to SD in the brain; however, by switching over to biphasic anodic pulses the balance in your ionic ecosystem can be restored again.
Interpulse Delay
High frequency impulse therapy involves electric fields producing pulsed electric fields which create an uncomfortable combination of muscle contractions and pain sensations for some patients, attributed to stimulation of A-alpha motor fibers responsible for muscle movement as well as C-fibers which transmit nociceptive signals. In order to alleviate such discomforts, various strategies have been devised such as increasing pulse repetition rate or shortening pulse duration – however these may lead to more severe contractions as well as decrease electroporation efficacy.
This study sought to find a way to reduce both muscle contraction and pain while still maintaining electroporation efficacy by employing an interpulse delay between pulses. A high-frequency biphasic pulse generator from University of Ljubljana’s mPOR facility in Slovenia was employed for this task and delivered electrical impulses directly into phrenic nerves to measure compound nerve action potentials (CNAPs).
Results demonstrated that an interpulse delay of more than 10 us significantly reduced both muscle contraction and pain; however, this result was also accompanied by an increase in EPSCs at the synapse, most likely as a result of reduced threshold levels for activating nerve fibers, thus increasing EPSC amplitude at the synapse.
To achieve this, a series of experiments was performed that varied the number and duration of pulses while monitoring elicited CNAPs with differential DAQ system. After collecting all this data, it was analyzed using linear model to fit responses elicited with pulse duration, pulse number and repetition rate resulting in high R2 values without overfitting for both training and test sets.
This model predicted that repetition rate, pulse duration, and pulse frequency all played an integral part in predicting EFT occurrence in hiPSC-CMs; while number of pulses had only moderate effects. We then used this information to develop an open-source calculator tool that estimates EFT incidence as well as associated AH temperature increases for various parameter combinations; offering us another means for preclinical evaluation of H-FIRE ablation devices without animal models.
Modes
Use of an EMS device with appropriate settings allows for muscle stimulation and pain relief. There are multiple dials on the unit that can be adjusted, including frequency, amplitude and pulse width; clinicians must be confident manipulating these parameters to get maximum benefit out of this device; for instance a longer pulse duration could allow more contraction but at the cost of patient comfort; it is wiser to begin at lower stimulation levels to build familiarity with this tool over time.
HF10 therapy is an innovative spinal cord stimulation system that delivers electrical stimulation directly to the epidural space rather than lower dorsal region as in traditional SCS systems. By targeting stimulation to this space instead, its application negates paresthesia mapping while treating pain without needing additional lead electrodes to be placed in lower dorsal regions.
HF10 demonstrated its superior long-term pain control capability through its initial RCT, exceeding traditional SCS by over 50% when assessed over one month. At this time, VAS pain was reduced and function improved clinically meaningfully for patients; exceeding any previous studies’ minimum clinically important difference (MCID) of 50% pain reduction.
These findings support the use of HF10 in combination with physical therapy-guided exercise, patient education and healthy behavior change coaching as an adjunct treatment for MSK pain, providing immediate and long-term relief. Unfortunately, though effective these modalities can be, they often aren’t enough for patients to achieve total relief; hence there remains an urgent need for more suitable interventions.
As the initial step, clinicians should familiarize themselves with the evidence supporting EMS as an effective treatment for chronic MSK pain. This can be accomplished in several ways, such as consulting a local EMS representative, attending regional or national continuing education courses or reading literature from online resources. But ultimately the best method is hands-on experience of the device on oneself or with colleagues – this allows a deeper understanding of how each dial setting affects muscle contraction and comfort while building confidence when manipulating these parameters.
