Klinische rol van iontoforese
Enkele jaren geleden verscheen een artikel over de rol van iontoforese met de titel ‘The clinical use of iontophoresis, uit het PHYSICAL THERAPY PRODUCTS MARCH 1990, door Susan W. Stralka, Director of Physical Therapy, Penny L Head en Kathy Mohr, RN, PT, CMT uit ‘The Campbell Clinic, Inc., Memphis, Tennessee’ in de VS.
Uit dat overzicht citeren we het volgende:
Iontophoresis, is ithe use of continuous direct curèrent to move ions through the skin Over the last decade, iontophoresis has become popular in rehabilitation settings as an alternative to oral and injected delivery of corticosteroids, because it is non-invasive, non-traumatic, and painless and can be directed at a specific site In addition to rehabilitation, iontophoresis is of particular interest in the areas of dentistry, dermatology, and oncology.
Iontophoresis often is used to treat conditions such as tendinitis, bursitis, tenosynovitis, arthritis, carpal tunnel syndrome, DeQuervain’s syndrome, scar tissue, temporomandibular joint dysfunction, and other soft tissue and muscular inflammatory conditions Numerous authors have reported positive clinical results with the use of iontophoresis, but to date, these have only been case reports or anecdotal observations and no well-controlled, double blind studies have been published.
One reason for the increasing use of iontophoresis in rehabilitation may be that the treatment time is minimal; only a maximum of five minutes is required to set up the unit on the patiënt and constant supervision is not necessary Other advantages of iontophoresis include a rapid, non-invasive drug entry into the skin and underlying tissue; avoidance of pain associated with tissue distortion during injections; elimination of the risk of infection and controllable rate of drug administration.
Carpaal tunnel syndroom
Banta reported the use of iontophoresis in the early phases of mild carpal tunnel syndrome This study was a prospective non-randomized study of 23 patients with mild carpal tunnel syndrome treated initially with wrist splinting and anti-inflammatory medications, which was successful in only 4 (17%) The 19 patients with continued symptoms received dexa- methasone through iontophoresis, and 11 (58%) had a positive response The article suggested that iontophoresis may be an alternate to steroid injection in the carpal tunnel area.
A 42 year-old orthopedic surgeon with a diagnosis of right lateral epicondylitis had been on non-steroidal anti-inflammatory drugs for two months before coming to physical therapy The medication had upset his stomach so he de- cided to seek alternate treatment. He was started on iontophoresis with dexamethasone over the lateral epicondyle followed by a friction massage and an ice cup massage and was instructed in a home program of stretching in general, wrist extension and flexion, strengthening exercises, and nervous system mobilization tech- niques After five treatments of iontophoresis in a two-week period, he was totally asymptomatic and was pleased with his excellent response to iontophoresis Needless to say, our referrals have increased for lateral and medial epicondylitis.
Dit artikel geeft slechts enkele indicaties over de rol van iontoforese weer, omdat het geschreven is vanuit het perspectief van een revalidatie-instituut. Maar de genoemde indicaties zijn wel boeiend.
Referenties over de rol van Iontoforese
- PetelenzTJ, ButtkeJA, Bonds C, Lloyd LB, Beck JE, Stephen RL, Jacobsen SC, Rodriguez P: Iontophoresis of dexemethasone: laboratory stud- ies journal of Controlled Release 20 (1992) 55- 66 Elsevier Science Publishers
- Cummings C: Clinical Electrotherapy; Iontophoresis RM Nelson and DP Currier eds Ch 11: 317-327 Appletonand Lange, 1991
- Hasson SH, Henderson GH, Daniels JC, Schieb DA: Exercise Training and Dexamethasone Iontophoresis in Rheumatoid Arthritis-ACaseStudy. Physiotherapy Canada, Vol 43, No 2, April 1991
- Class |M, Stephen RL, Jacobsen SC: The quantity and distribution of radio-labeled dexemethasone delivered to tissue by iontophoresis Int J Dermatol 19:519-525,1980
- Banta C : A Prospective Nonrandomized Study Of Iontophoresis, Wrist Splinting, and Antiinflam- matory Medication in the Treatment of Early-Mild Carpal Tunnel ) Occ Med 36:166-168
- Braun BL:The Treatment of anAcuteAnterior Disk Displacement in the Temporomandibular Joint Physical Therapy, 1234-1236, Nov 1986
- Gangarosa LP, Mahan PE: Pharmacological Man- agement of TTMJ-MPDS Ent Jour., 61:30-41,1982
- Hong D, Byers MR, Oswald RJ: Dexamethasone treatment reduces sensory neuropeptides and nerve sprouting reaction in injured teeth Pain jour- nal, 55:171-181, 1993
- Kahn J: A Case Report: Lithium iontophoresis for gouty arthritis JOSPTVol 4,No 2,113-114,1982
- Chien YW, Siddiqui O, Shi W-M: Direct current iontophoretic transdermal delivery of peptide and protein drugs J Pharmol Sci 78:376-383,1989
- Wieder DL: Treatment of Traumatic Myositis Ossificans with Acetic Acid Iontophoresis Physi- cal Therapy, Vol 72, No 2,133-137,1992
- Psaki CG, Carroll J : Acetic Acid loniozation: a study to determine the absorptive effects upon cal- cified tendinitis of the shoulder. Physical Therapy Review 35:84-87, 1955
- KahnJ Acetic Acid Iontophoresis for Calcium Deposits Physical Therapy, 57: 658-660, 1977
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