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Traumatic injuries

Denas therapy with complex therapy of diseases of musculoskeletal system and peripheral nervous system, and traumatic  injuries

Rodin U.A., Ushakov A.A.

Academician N.N. Burdenko central military clinical hospital

Moscow, Russia

 

All musculoskeletal system and peripheral nervous system diseases and traumatic injuries in acute period are characterized by acute pain, edema, soft tissues hemorrhage, extravasations and infusions into joint cavity, inflammatory reaction and dysfunction. Analgesics use doesn’t always resolve the problem of acute pain syndrome stop.

Last few years new low-frequency electrotherapy method (DENAS)– is implemented; it has clearly defined analgesic, antiedema, anti-inflammatory, and vasoactive influence.

DENAS is method of impact on coverlet receptor system, on biologically active points, on sensitive afferent conductors in pain zones by very short-termed (400 mcs) neuron-like (bipolar) electroimpulses of low frequency (10 to 200 Hz) and low intensity (on average 200 to 400 mcA).

Duration and frequency of current pulses used for DENAS are comparable with frequency and duration of pulses in thick myelinated afferent fibers having big velocity of pulsation. Thanks to flow of rhythm regulated afferent electric pulsation created during the procedure neurons of posterior horns substantia gelatinosa are stimulated, and their perception of nocigenic (pain) information coming from pathology center through thing non-myelinated nervous fibers with low velocity of pulses conducting is blocked.

Analgetic structures neurons activation is accompanied with supraspinal system stimulation and discharge of endorphins by putamen, by digestive device, endocrine glands; the result is pain pulsation inhibition. Acute pain weakening and, to a lesser degree, chronic pain weakening is marked already during the procedure and then is kept during 1 to 2 hours after the procedure.

Appearing as an answer on rhythmic stimulation the coverlet muscles and skin arteriole unstriped muscle fibrillation activates destruction process of algogenic substances (bradykinin) and mediators (acetylcholine, histamine) in pain center. Besides, analgesic effect from DENAS is also related to local blood-flow enforcement, and trophy activation that remove perineural edema and thus have pathogenetic influence on reason of the pain syndrome.

Besides the analgesia appearing during the procedure, as a result of clear vasoactive effect blood circulation in ischemic tissues intensifies, metabolic and trophic processes in impact zone and deeply located tissues segmental connected with corresponding skin areas. Because of local, segmental and general organism reactions its regulatory systems synchronization is reached. Stimulating impulses have regulative influence on organism, mobilize reserve functional tissue elements and recover disturbed functions, help to switch rapidly the humoral and immune mechanism, remove energy and information block, and restore lost links between pathologic zones and all control systems of the organism.

During DENAS following medical effects are clearly defined: analgesic, anti-edema, anti-inflammatory, trophic, resolving, metabolism stimulating, stimulating regenerative process of trophic ulcer and weakly healing injuries, normalizing hormone state, and immunomodulating.

After the DENAS application for therapy of musculoskeletal system and peripheral nervous system diseases and  traumatic injuries for 2 to 4 hours pronounced analgesic effect appears. Repeated application of 3-4 procedures a day during several days may completely remove acute pain syndrome or, as a last resort, effectively reinforce analgesic and anti-inflammatory preparations influence, contribute to lost function recover.

Repeated application during 24 hours of the DENAS method is allowed because of low intensity of impulse electrical current. The method is easily transmitted by patients and having traumatic injuries of different severity degree, older people and children. The method application is not contra-indicated when there is Ilisarov’s device on fracture, intraosteal or on-bone osteosynthesis. During impact of low frequency and intensity impulse, generated by DENAS devices on metal implants electrolysis products in the amount that can evoke cauterizing effect (chemical injury) next to metal foreign element don’t form.

During several years home industry produces devices for dynamic electrotherapy of DENAS. Devices are made in several modifications, and widely used in clinics and at home. The devices are portable and electrically safe.

The more interesting model for us is “DiaDens-PC”. The device lets conduct “testing” – diagnostic investigation of skin ohm resistance and identify pain zones and zones of “latent pain”. The testing conducted before and after the procedure, at the beginning and in the end of therapy course, is objective method of conducted therapy efficiency control.

In the device frequency range is widened from 1 Hz to 200 Hz, that allows DENAS method use in case of acute pain (140 and 200 Hz frequencies), chronic pain syndrome (60 and 77 Hz frequencies), have regulative effect on tone of unstriped muscles of blood vessel and lymphatic and internal (10 Hz frequency). “DiaDens-PC” model has a regime of frequency modulation “77 10”. Output for external punctual electrode connection is provided for electropuncture (reflex therapy) and diagnostic by Voll conduction. Besides there is an output for paraorbital electrode connection to impact on skin receptor system around eyes.

During period from 2003 year to 2006 year 287 patients aged from 28 to 68 with musculoskeletal system and peripheral nervous system diseases and traumatic injuries were under our observation.

In cases of contusion, sprain, and rupture of joint-ligament device and joint meniscus injuries (27 persons) after intensive DENAS therapy during 10-14 days hemorrhage dissolved, soft tissues edema and joint coats irritation (synovitis) disappeared, pain syndrome significantly regressed, and joint and extremity function restored. Pain syndrome regress, hemorrhage dissolving, and function restoration began 5-7 days faster than similar traumatic injuries in persons who didn’t get DENAS and other physiotherapeutic methods.

In case of open and simple long bones fractures (47 persons) DENAS was combined with exercise therapy. Rehabilitation period reduced on average for 5 days in comparison with patients of similar group who didn’t get DENAS within complex therapy.

Good results were got in 87% of patients, satisfactory – in 13%. There were not negative results.

Group of patients with joint diseases was formed of people with deforming arthrosis of big joints, with gouty and psoriatic arthritis (58 persons). Good DENAS efficiency was got in 76% of patients, satisfactory – in 24%. Negative results of the DENAS application were not marked.

The larger group got DENAS were patients with spinal degenerative injuries (129 persons). After the DENAS method course therapy, including “DiaDens-PC”, in 75% of patients with dorsopatia there was a good therapeutic effect, appearing in acute pain syndrome regression, muscle-tone syndrome liquidation, spine and injured nerve function improvement and blood circulation in vertebral arteries improvement. In 19.1% of cases there was satisfactory result, when pain and muscle-tone syndrome intensity significantly reduced, but didn’t disappear. In complex therapy of such patients other physiotherapeutic methods were included. 5,3% of patients haven’t got noticeable effect.

This group included patients with spinal discogenic injuries when herniations of intervertebral disks in neck zone were, according to MRT, 4 mm, and in lumbosacral zone – 8-12 mm.

The rest group included patients with traumatic compressive-ischemic plexopatia of upper and lower extremity (12 per.), traumatic vertebrogenic neuropathy of median nerve (8 per.), polyneuropathy of viral aeteology (shingles) – 6 persons. In all cases good clinical effect was got that exceeded therapy results of patients who didn’t get DENAS.

Summary:

1. DENAS application for therapy musculoskeletal system and peripheral nervous systems diseases and traumatic injuries is highly effective physiotherapeutic method.

2. “DiaDens-PC” model is a multifunctional device allowing conducting an assessment of organism systems functional state and therapy in different medicine areas. The device has good design; it is electrically safe, simple and comfortable in use.

3. DENAS may be recommended for application in wide clinical practice by doctors of different specialties as effective method of analgesia by urgent indication, and for use DENAS method by patients at home after consultation with physiotherapist.

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