Electrophoresis

Medicinal electrophoresis (iontophoresis, iontophoresis) is a method of combined influence on the body of a direct electric current and a medicinal substance administered with its help. In this case, a significant role in the mechanism of action of medicinal electrophoresis is given to electric current as an active biological stimulus. In this case, 90 – 92% of the drug substance is introduced due to electrogenic movement, 1-3% – due to electroosmosis and 5-8% – as a result of diffusion. The pharmacokinetics of drugs during electrophoresis, compared with other methods of their administration, has a number of differences. In this case, the drug enters the body through the skin, less often through mucous membranes or the wound surface. The place of entry of the drug when passing through the skin is the ducts of the sweat and sebaceous glands, as well as interepithelial gaps. 

 During electrophoresis of drugs, they are deposited in the skin for a period of 1 to 2 days. From the skin depots, due to osmosis, diffusion and electrogenic movement, the medicinal substance slowly and gradually penetrates into deeper tissues, spreading with the bloodstream throughout the body. Subsequently, the medicine is distributed in various organs, according to the laws of hemodynamics and pharmacological tropism. However, due to the action of the electric field, the highest concentration of the drug is determined in the tissues lying in the interelectrode space. 

Medicine is most often removed from the body by the kidneys. Drug electrophoresis, unlike other methods of pharmacotherapy, has its own characteristics. With electrophoresis, the medicine is administered in a small amount, which is usually calculated in milligrams or fractions thereof. However, even in this case, the drug turns out to be quite active to obtain a good therapeutic effect. 

The increase in the pharmacological activity of the drug is explained by the influence of current, which increases the functioning of the most important organs and systems of the body and creates a favorable background for the action of the drug, as well as the introduction of the most active part of the medicinal compounds, the presence of an electrical charge in the latter (ion, mole-ion), allowing them to enter into not only chemical, but also electrical interaction with the tissues of the body. Depositing drugs in the skin during electrophoresis contributes to their long-term residence in the body, slow excretion in the urine and prolonged action. As a rule, there are no adverse reactions characteristic of medicinal substances when administered by other means, since small quantities enter the body. In addition, the ballast part of the drug and the solvent, which often cause side effects, do not enter the body – they remain on the gasket. 

  The drug electrophoresis method makes it possible to introduce a pharmacological drug directly into the lesion, if the latter is located in the superficial tissues (skin, subcutaneous adipose tissue, mucous membranes). At the same time, medicinal substances during electrophoresis with circulating blood also reach deeply located tissues, concentrating in large quantities in the organs located in the space between the electrodes. 

  Along with the indicated advantages of this treatment method, some of its disadvantages should be noted. Not all medicinal substances can be used for electrophoresis. Of the huge number of pharmacopoeial drugs, only a limited number (about 200) are electrophoretic. When treating a number of diseases in which it is necessary to obtain a large concentration of medication in the body, the use of electrophoresis is inappropriate. 

Most often, electrophoresis is used to introduce electrolyte drugs into the body, which dissociate in solutions into ions – particles that carry an electrical charge. Positively charged ions are introduced from the positive pole (anode), negatively charged ones – from the negative pole (cathode). The ideal solvent for such substances is distilled water. The possibility of electrophoresis of a number of complex organic compounds has been proven. In specially prepared, so-called buffer solutions, neutral molecules of these drugs adsorb solvent ions (H+ or OH) on their surface, acquiring a positive electrical charge in an acidic environment, and a negative electrical charge in an alkaline environment. Some substances (amino acids, proteins) are amphoteric polyelectrolytes and can be introduced from both poles. However, they enter the body in large quantities from the anode. The composition of the acetate (acidic) buffer solution is represented by sodium acetate (or citrate) 11.4 g, glacial acetic acid – 0.91 ml, distilled water – 1000 ml. Acetate buffer solution is mainly used to administer lidase. For electrophoresis of trypsin and chymotrypsin, a borate buffer with a pH of 8.0 – 9.0 (alkaline medium) is used, which is introduced from the negative pole. Its composition: boric acid 6.2 g, potassium chloride 7.4 g, sodium (or potassium) hydroxide 3 g, distilled water 500 ml. Chymotrypsin at a dose of 10 mg is dissolved in 15-20 ml of borate buffer. If the drug has poor solubility in water, dimexide (dimethyl sulfoxide – DMSO) or ethyl alcohol is used as a solvent. At the same time, not only the medicine, but also the solvent penetrates through the skin in the body due to the processes of osmosis and electroosmosis. These phenomena are insignificant for water, but noticeably increase when using alcohol and especially DMSO, which should be taken into account in medical practice. 

Instead of buffer solutions, you can use distilled water: acidified with a 0.1N solution of hydrochloric acid to pH 5.2 or alkalized with a 0.1N solution of caustic alkali: to pH 8.0. In labile electrophoresis on the face, gelatin is used as a contact medium, in which one or another enzyme is dissolved. The concentration of solutions of medicinal substances for electrophoresis is most often used in the range of 0.5 – 5.0%. The use of solutions of higher concentrations is impractical. Medicine consumption for every 100 sq.cm. The area of ​​the spacer is approximately 10-15 ml of solution. Potent agents are administered from solutions of concentration 1:1000 or applied to the pad in an amount equal to the highest single dose (adrenaline, atropine, platiphylline, etc.). Data on medicinal substances administered by electrophoresis are given in physical therapy manuals. 

 After the electrophoresis procedure, it is necessary to thoroughly rinse the pads with running water (8 – 10 liters per pad) to wash out the medicinal substances from them and sterilize them by boiling. Pads soaked in various medicinal substances should be washed and boiled separately to avoid contamination by parasitic ions. The medicinal electrophoresis procedure is dosed according to the current strength, which is prescribed according to the physiological density, as in galvanization. On average from 0.01 to 0.1 – 0.2 mA/sq. cm area of ​​the hydrophilic pad. The duration of the procedure is from 10 to 20 – 30 minutes. The course of treatment consists of 10 – 20 procedures performed daily or every other day. To reduce the resistance to electric current and improve the administration of the drug, before the electrophoresis procedure, you can prescribe infrared irradiation with the Spectr-LC apparatus or a thermal procedure with a Sollux lamp, as well as myostimulation with pulsed currents. The indications and techniques for medicinal electrophoresis are similar to those for galvanization. 

The patient should receive specific recommendations on the location of the electrodes and the use of medicinal preparations for electrophoresis from his attending physician or physiotherapist.

The most common diseases of the musculoskeletal system are deforming osteoarthritis and chronic spondylosis, as well as post-traumatic arthrosis and arthrosis-arthritis, which most often affects the large joints of the lower extremities (knee, ankle, hip). With spondylosis, the joints of the transverse processes of the vertebrae are affected. Deforming osteoarthritis and chronic spondylosis occur after 45-50 years and they reach their greatest severity in elderly and senile people. The incidence of this disease is 35-40% among people over 45 years of age. Post-traumatic arthrosis is a consequence of mechanical damage. The main reason for the development of deforming osteoarthritis and chronic spondylosis is the degeneration of articular cartilage and their gradual replacement by bone tissue. This occurs as a result of the impact of the patient’s excess body weight (obesity) on the initially healthy cartilage of the joints or as a consequence of previous injuries, diseases or hereditary “failure” of cartilage tissue. Damage to cartilage leads to periodic occurrence of an inflammatory reaction in the joints, which manifests itself as an exacerbation of deforming osteoarthritis. During an exacerbation, pain sharply intensifies, local swelling occurs, and the perimeter of the joints increases. With many years of steady development of the disease, the joints are deformed, disfigured, and multiple bone outgrowths – osteophytes – appear along their edges. Torn off necrotic pieces of articular cartilage (“articular mice”) cause jamming of the joints. The final result of the disease is complete disability of patients. Joint injuries lead to the development of post-traumatic arthrosis, which is similar in nature, but milder than deforming osteoarthritis. For deforming osteoarthritis, chronic spondylosis and post-traumatic arthrosis of the knee, ankle, elbow, shoulder, wrist joints, small joints of the hands and feet in the acute phase, LE of local anesthetics, analgesics and anti-inflammatory drugs (novocaine, analgin, baralgin, sodium salicylate) is used. Outside the period of exacerbation, patients with arthrosis are shown LE of means that improve the condition and nutrition of articular cartilage and periarticular tissues, local blood circulation (sulfur, zinc, lithium, iodine, nicotinic acid, aloe extract, therapeutic mud or mud squeezes).

Indications: arthrosis and spondylosis with moderate pain and inflammatory manifestations. Two long rectangular electrodes with an area of ​​20-100 cm2 (depending on the caliber of the joint) are placed transversely in the projection of the joint space of the affected joint. The electrodes are pre-moistened with warm running water and wrung out, so that during their subsequent tight fixation the sub-electrode liquid does not spread. The positive electrode (anode) is placed in the area of ​​maximum pain. The electrodes are fixed, ensuring their tight contact with the skin while making the patient feel comfortable. The device is turned on and the current strength is adjusted using a potentiometer until the patient experiences a pleasant tingling (burning) sensation. The current strength is adjusted during the procedure according to the patient’s subjective sensations. If discomfort, pain, or severe burning occurs in the area of ​​the electrodes, it is necessary to immediately reduce the current strength. The duration of the procedure is 10-20 minutes. The procedures are carried out daily, for persistent pain 2 times a day. The course is 10-20 procedures, depending on the dynamics of the pain syndrome. 

Indications: arthrosis and spondylosis with pain in the phase of moderate exacerbation, that is, without clear local signs of inflammation.

Novocaine is a local anesthetic substance that gives an analgesic effect. The methodology for carrying out the procedures is the same as when performing galvanization (see paragraph 1.1.). The positive electrode (anode) is placed in the area of ​​maximum pain. A medicinal pad of 3-4 layers of gauze or filter paper moistened with a 0.5% ampoule solution of novocaine hydrochloride in an amount of 2-10 ml is placed between it and the body. The amount of medicinal substance, as well as the area of ​​the electrodes, depends on the caliber of the affected joint (2-4 ml for the ankle joint, 8-10 ml for the hip joint). The duration of the procedure is 15-30 minutes. The procedures are carried out daily, for persistent pain 2 times a day. The course is 10-20 procedures, depending on the dynamics of the pain syndrome. 

Indications: arthrosis and spondylosis in the acute phase with a picture of acute inflammation and severe pain.

Analgin, baralgin and sodium salicylate provide not only an anti-inflammatory, but also a noticeable analgesic effect. The procedure is carried out according to the method described in paragraph 1.1., however, a cathode electrode (-) with a medicinal pad moistened 10 times with a 50% analgin ampoule solution, 5% sodium salicylate solution or 2% baralgin in an amount of 2-15 ml (depending on the caliber of the affected joint) is placed on the area of ​​maximum pain. The duration of the procedure is 15-30 minutes. Course – 10-20 daily procedures. 

Indications: arthrosis and spondylosis in the acute phase, occurring with persistent and severe pain and local inflammatory manifestations. The method is carried out according to clause 1.1., however, between the electrode-cathode (-) and the body, a medicinal pad is placed, moistened with a 10-fold diluted 50% ampoule solution of analgin in an amount of 2-15 ml (depending on the caliber of the affected joint), and under the electrode-anode (+) – a medicinal pad moistened with a 0.5% solution of novocaine hydrochloride in an amount of 2-10 ml. The duration of the procedure is 15-30 minutes. Course – 10-20 daily procedures.

Indications: progressive course of arthrosis and spondylosis outside the period of exacerbation.

Sulfur is part of complex organic substances that form the basis of cartilage tissue. The purpose of using LE sulfur is to preserve the integrity and structure of articular cartilage. The technique is performed according to clause 1.1, however, a medicinal pad moistened with a 10-30% aqueous solution in an amount of 2-8 ml is placed between the cathode electrode (-) and the body, depending on the caliber of the affected joint. The duration of the procedure is 15-30 minutes. Course – 10-20 daily procedures. 

Indications: progressive course of arthrosis and spondylosis outside the period of exacerbation.

Trace elements zinc and lithium are necessary for the normal life and functioning of connective tissue, ligaments, tendons, joint capsule and joint capsules. The method is performed according to clause 1.1, however, a medicinal pad moistened with a 2% solution of zinc sulfate or a 3-5% solution of lithium chloride in an amount of 2-5 ml is placed between the anode electrode (+) and the body, depending on the caliber of the affected joint. The duration of the procedure is 15-30 minutes. Course – 10-20 daily procedures. 

Indications: progressive course of arthrosis and spondylosis outside the period of exacerbation, pronounced fibrous and bone changes, proliferation of connective tissue in the joint area. Iodine has a good absorbent effect. The method is performed according to clause 1.1, however, a medicinal pad moistened with a 2% aqueous solution of potassium iodide in an amount of 2-8 ml is placed under the cathode electrode (-), depending on the caliber of the affected joint. The duration of the procedure is 15-30 minutes. Course – 10-20 daily procedures. 

Indications: progressive course of arthrosis and spondylosis outside the period of exacerbation, pronounced fibrous and bone changes, proliferation of connective tissue in the joint area, combined with local circulation disorders in the extremities, manifested by chilliness, numbness and coldness of the feet and calves.

Nicotinic acid has a pronounced vasodilating effect. The method is performed according to clause 1.1, however, a medicinal pad moistened with a 0.5% aqueous solution of nicotinic acid in an amount of 2-8 ml is placed under the cathode electrode (-), depending on the caliber of the affected joint. The duration of the procedure is 15-30 minutes. Course – 10-20 daily procedures. 

1.9. Electrophoresis of aloe or mud extracts. Indications: progressive course of arthrosis and spondylosis outside the period of exacerbation, pain syndrome, pronounced fibrous and bone changes, proliferation of connective tissue in the joint area, local circulation disorders, degenerative changes.

Aloe, healing mud and its components have a trophic and absorbable effect, improve nutrition and blood circulation of tissues, and relieve pain. The method is performed according to clause 1.1, however, under both electrodes – the anode and the cathode (between the electrode and the body) medicinal pads are placed, moistened with aloe extract diluted 4 times with water or a native squeeze of medicinal mud obtained using a gauze napkin, in an amount of 5-15 ml, depending on the caliber of the affected joint. The duration of the procedure is 15-30 minutes. Course – 10-20 daily procedures. 

Indications: progressive course of arthrosis and spondylosis outside the period of exacerbation, pain syndrome, pronounced fibrous and bone changes, proliferation of connective tissue in the joint area, local circulation disorders, degenerative changes.

Therapeutic mud has a trophic and absorbable effect, improves nutrition and blood circulation of tissues, and relieves pain. They use packaged gythium mud from the Sestroretsk Resort deposit. Various therapeutic components of mud have bipolar mobility in an electric field, so electrophoresis of mud is carried out from both electrodes – the cathode (-) and the anode (+). The method is carried out according to clause 1.1, however, mud cakes wrapped in 3-4 layers of gauze are placed under both electrodes – the anode and the cathode. The thickness of the mud cake is 1.5-2 cm, the temperature of the mud is 40-42°C. The duration of the procedure is 15-30 minutes. Course – 10-20 daily procedures. 

Indications: see clause 1.10.

Bishofite is a natural mineral, a product of bottom sediments, mined in the Volgograd region. Contains a complex of mineral salts with a high content of Ca2+, Mg2+, K+, Cl—, HCO3—, HSO4—. It is mined in the Volgograd region. It is used for treatment using the method of applications (compresses), is electrophoretic, and is introduced by galvanic current from both poles (from the cathode and from the anode). Bishofite has a trophic and absorbable effect, improves nutrition and blood circulation of tissues, and reduces the severity of pain. The method is carried out according to clause 1.1, however, medicinal pads moistened with a 10% aqueous solution of bischofite are placed under both electrodes – the anode and the cathode. After the electrophoresis procedure, the skin in the affected area is not cleaned or washed to remove the salt “mantle”, but rather, it is covered with clean gauze napkins and wrapped for 2-8 hours. The duration of the procedure is 15-30 minutes. Course – 10-20 daily procedures.