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TENS unit with acetic acid

Posted by Scott R on 5/24/00 at 15:42 (020787)

TENS units may be purchasable by patients without a prescription outside of the U.S.

Dr. Simon P (and some patients) reminded me of the journal article (abstract below) on using TENS units to deliver acetic acid (vinegar) across the skin barrier for heel pain. Using an electrical current to transmit polarized compounds (ions) across the skin barrier is called iontophoresis. It may be that only 'anionic' (negative ions) compounds work. Dr. Simon P (who was treated by the OssaTron twice, I believe) posted a message that said it should be 5% acetic acid in non-ionic distilled water. Presumably, ions in regular water and distilled water (not all distilled water is non-ionic) gets in the way of the ions of the acetic acid. Since vinegar is 5% acetic acid, I'm willing to bet it was initially discovered to be useful by someone experimenting with vinegar, so I would bet plain vinegar is just as useful as non-ionic distilled water. A post made by a a 'Mike' (probably not Mike W), a physical therapist, said it needs to be 90% acetic acid and claims vinegar is '70%'. My bottle of vinegar says 5%. However, the MSDS sheet says it can cause severe burns and blindness if it gets in the eyes, so Mike the P.T. could have been wrong on the 90% and 5% is the safe thing to do (after all, some people drink it straight at 5%. The acetic acid has to be placed on the negative electrode, I read. I believe this would be the black lead, if you can find one with colors. Or a voltmeter could tell. Or just apply it to both pads. The positive or negative charge of the ion being delivered has to match up with the positive or negative pad of the unit.

A message board search on iontophorisis (use 'iont' to get all the different spellings) yielded some interesting results along with 'tens' and 'acetic acid'. Put a space after 'tens' to prevent 'intense' etc from showing up in the results.

Iontophoresis was said to also be useful for transmitting DMSO across the skin. DSMO is great by itself and this is probably not needed but it may reduce the amount of DMSO needed (remember DMSO has some serious drying of the skin problems and I certainly wouldn't want an unborn child to be subjected to this solvent). It is also used to transmit dexamethosone across the skin, but it might also work with NSAIDS, if they are polarized compounds. Naproxen (aleve) and ketaprophen is reported to work. I read it goes only 1/2' which hardly is able to reach the spur area.

Here's an excerpt from a good article on this:
Kahn: Primarily, I use acetic acid iontophoresis to soften or eliminate calcific deposits. It is just a fabulous thing. There's an exchange of acetate ions for the carbonate ions and you get a dissolving of the calcium deposit. I also use a lot of the lithium iontophoresis in the treatment of gouty tophi and down the line, we use calcium for spasm, we use magnesium for spasm, we use mecholyl for vasodilation and vascular disease, zinc for healing. In other words, iontophoresis is not a treatment. In fact, I get a kick out of an insurance company that says, 'We don't pay for iontophoresis.' Iontophoresis with what, for what? Iontophoresis with acetic acid is a lot different than iontophoresis with hydrocortisone. So I like to go after specific items plantar fasciitis, tennis elbow, calcific tendinitis all of these things lend themselves beautifully to a noninvasive, nonoral type of treatment.

another:
Investigators have examined the tissue permeation of anionic anti-inflammatory agents following both passive permeation11,12,16 and iontophoretic permeation.14,28,33 Local passive transcutaneous permeation has been shown for diclofenac, hydrocortisone, indomethacin, naproxen, piroxicam, and salicylic acid

Iontophoresis of ketoprofen at 4 mA for 40 minutes (0.28 mA/cm2) resulted in approximately twice the ketoprofen delivery when compared with 2 mA for 80 minutes (0.14 mA/cm2). The enhanced iontophoretic delivery of ketoprofen appeared to be dependent on the higher current density (ie, 0.28 versus 0.14 mA/cm2), as the dosage for these 2 iontophoretic regimens remained constant at 160 mA x min
(TENS units have a max of 45 to 80 mA which appears to be plenty and the pads are about 20 cm2)

Ketoprofen is an anionic nonsteroidal anti-inflammatory drug (NSAID) with approximately 160 times the anti-inflammatory potency of aspirin on a per weight basis.

The quantity of ions that are made to cross the skin barrier is directly proportional to the current density and to the amount of time the current flows through the solution. Current density is determined by the strength of electric field and electrode size. Most units use a current strength of 0.4mA, or 1mA per square inch of electrode surface. This current strength is just below sensory perception. Smaller electrodes concentrate the current, making it more readily felt by the patient.

Several investigators have demonstrated that medication at concentrations of between 1 and 5 percent are optimal for ion transfer.

Continuous direct current is the current of choice for iontophoresis, since this mode ensures the maximum ion transfer per unit of applied current. It provides a constant, unidirectional electrostatic field between the electrodes to allow continuous transmission of drug. Other forms of current, such as high-voltage galvanic, sine wave, interferential, and microcurrent are not effective in iontophoresis. (this is important because most tens units are pulsed direct current (not continuous - this quote could be just plain wrong)

Calcific deposits are amenable to treatment with the acetate ion found in acetic acid. A reduction in the density of the deposit and in the size of the deposit was confirmed by x-ray. Two investigators reported the results of applying acetic acid solution to bursal calcification, tendon sites, and myositis ossificans. Radiographs three months after treatments showed complete absorption of the heavy calcific deposits seen before treatment.

5% acetic acid solution via the negative electrode, 5mA galvanic current, 20 minutes) followed by continuous ultrasound (0.8w/cm2, 1MHz, 5 minutes).

more of the first quote at http://www.biomech.com/db_area/archives/1998/9810round.25-29.bio-.html
the MSDS sheet:
http://www.millenniumpetro.com/amsds.htm
a company in the UK that sells them: http://www.allied-health.com/tens.html#total (i would get the TENS total unit, but a friend has given me his - I have to order electrodes)
other chemicals that can be carried through the skin: http://www.vannhealthcare.com/ionto.htm
here's an article telling the polarity of compounds commonly used, but I don't understand them using salt because it degrades to chlorine gas on one electrode and sodium hydroxide on the other, both of which are extremely toxic. In fact, the salt on the skin degrades to sodium hydroxide under the negative electrode which 'burns' the skin because it is alkaline (opposite of being an acid) http://www.earthen.com/iontophoresis1.html
the best but most difficult reading is http://www.apta.org/pt_journal/Jan99/v79n1p40.html
http://www.wehn.com/WEVR/V2N1/Innovations/Innovations2.html

Mike W did some research for me and found the following in Canada:
I called around re; tens pricing; There are lots of choices. I called 3 stores and got the following Store 1- Biomed 2000 $170 no continuous pulse, Eclipse plus $600 and Epix xl $625(both made by EMPI) Store 2- Maxima 2 $265, Maxima 3 $595 Both made by Rehabilcare The main price difference ishigher amplitude and wider range.
Store 3- Everway $386, Tens Plus $210.00 made by AMG. There is a 7% sales tax on all of these and with the sorry state of the Canadian $ multiply these by about .65.

I need a Canadian company that has a web page, will sell to the US, willing to advertise on heelspurs.com, and knows the legalities well enough to know I would not be breaking any American laws in advertising for something that can't be bought in the U.S.


The journal article abstract:
===========
NLM CIT. ID: 99278906
TITLE: Management of heel pain syndrome with acetic acid iontophoresis. AUTHORS: Japour CJ; Vohra R; Vohra PK; Garfunkel L; Chin N AUTHOR AFFILIATION: Department of Surgery, Veterans Affairs Medical Center, Brooklyn, NY 11209, USA. PUBLICATION TYPES: JOURNAL ARTICLE REGISTRY NUMBERS: 64-19-7 (acetic acid)
ABSTRACT: This study was undertaken to determine the effectiveness of acetic acid iontophoresis in the treatment of heel pain. Thirty-five patients with chronic heel pain were treated with acetic acid iontophoresis over a 4- year period. Ninety-four percent of patients had complete or substantial relief of heel pain after an average of 5.7 sessions of acetic acid iontophoresis over an average period of 2.8 weeks. Heel pain levels were rated from 0 to 10, with 10 representing the most severe pain. Heel pain prior to iontophoresis treatment received an average rating of 7.5; by the end of therapy, the average rating had decreased to 1.8. At an average follow-up time of 27 months, heel pain levels averaged 0.64, indicating continued reduction in heel pain. Ninety-four percent of participants said that they would recommend acetic acid iontophoresis to someone with similar heel pain. NLM PUBMED CIT. ID: 10349289 SOURCE: J Am Podiatr Med Assoc 1999 May;89(5):251-7 7


Re: also for tendonitis

Scott R on 5/24/00 at 16:56 (020793)

Two more links about the science and dangers of using TENS units:
http://www.advanteq.com/tensunit.html
http://www.epemag.wimborne.co.uk/aecctens.htm

Re: acetic acid ionto

GinaC on 5/24/00 at 17:26 (020795)

Although the physical therapist who did acetic acid ionto was very enthusiastic, the final results were pretty dismal: I really didn't have any improvement. The PT wanted to do before and after x-rays to evaluate spur size, but the MD didn't approve it, so I have no idea how it effected the size of the spur, but it did nothing for pain level in my case.

Re: TENS unit with acetic acid

Laurie R on 5/24/00 at 17:43 (020796)

Hi To all,
I had this at my PT ,it did not help my pain at all.My Pod really believes in the acetic acid ,it is supposed to help with the inflammation.It can sometimes burn your skin which in my case it did alot of the times ,it would make little marks on my foot.It is pretty safe tho.....my therapist would use it with the ionto freze.Laurie R

Re: TENS unit with acetic acid

iris on 5/24/00 at 18:31 (020799)

i tried both acetic acid and cortisone treatments with tens unit at pt's office. neither made any difference in reducing the pain of my heel spurs and pf condition. sorry to disappoint so many that might hope that this would help. iris

Re: TENS unit purchase

Gordon on 5/24/00 at 19:15 (020804)

I bought my TENS unit from my acupunturist in Kent Wa several years ago for around $130. It looks like the same unit as the one featured in the first link listed. I used to use it a lot when my pain was bad. Provided mild relief.

Re: TENS unit purchase

john h on 5/25/00 at 15:01 (020867)

i purchased a tens unit (by prescription) about 12 years ago. a high end unit with adjustable pulse and band width with four outputs probably cost on the order of $600 or more dollars today. the newer electrodes can be used for some time now-weeks. power is of course adjustable and separate for each output. a major manufacturer is EMPI and can only be purchased with a prescription. never have tried it on my foot but after reading scotts post may try it.

Re: TENS unit with acetic acid

john h on 5/26/00 at 10:41 (020915)

scott: in reading info about the tens use i understand the negative electrode is placed directly over the effected area but where is the positve electrode placed? can acetic acid be purchased at a drug store in some form? also: the empi unit i have has numerous adjustments as to pulse per second and wave length. the power can be turned up to a point where you can not tolerate it. most of us develop calcification throughout our body over a life time including such places as the intestine. some of the small nodules i feel on my fascia feel very much like calcifications. my understanding is they are very benign but who knows what effect they might have on the fascia. if use of a tens with whatever can reduce or remove these calcifications i will sure give it a try.

Re: TENS unit with acetic acid

John h on 5/26/00 at 10:44 (020916)

when at the PT's office a few year ago i had treatment with whatever subustance they used. having my own tens unit i can say without question they had their unit set so low that i could not even feel the voltage/amp.

Re: TENS unit with acetic acid

Melody on 5/26/00 at 13:26 (020921)

I have never used a TENS for my feet...but couldn't live without it cos of pain in my hand!

One electrode (+) goes over the pain site and the other up my arm towards my brain! I think!!!*S* The best thing is to put them where they seem to help. Keep moving them around until you get some relief.

You can buy them in a chemist (drugstore) over here and don;t need a prescription. I LOVE mine!!!!


Mel


Re: test

scott r on 5/31/00 at 09:40 (021103)

eswt

Re: also for tendonitis

Scott R on 5/24/00 at 16:56 (020793)

Two more links about the science and dangers of using TENS units:
http://www.advanteq.com/tensunit.html
http://www.epemag.wimborne.co.uk/aecctens.htm

Re: acetic acid ionto

GinaC on 5/24/00 at 17:26 (020795)

Although the physical therapist who did acetic acid ionto was very enthusiastic, the final results were pretty dismal: I really didn't have any improvement. The PT wanted to do before and after x-rays to evaluate spur size, but the MD didn't approve it, so I have no idea how it effected the size of the spur, but it did nothing for pain level in my case.

Re: TENS unit with acetic acid

Laurie R on 5/24/00 at 17:43 (020796)

Hi To all,
I had this at my PT ,it did not help my pain at all.My Pod really believes in the acetic acid ,it is supposed to help with the inflammation.It can sometimes burn your skin which in my case it did alot of the times ,it would make little marks on my foot.It is pretty safe tho.....my therapist would use it with the ionto freze.Laurie R

Re: TENS unit with acetic acid

iris on 5/24/00 at 18:31 (020799)

i tried both acetic acid and cortisone treatments with tens unit at pt's office. neither made any difference in reducing the pain of my heel spurs and pf condition. sorry to disappoint so many that might hope that this would help. iris

Re: TENS unit purchase

Gordon on 5/24/00 at 19:15 (020804)

I bought my TENS unit from my acupunturist in Kent Wa several years ago for around $130. It looks like the same unit as the one featured in the first link listed. I used to use it a lot when my pain was bad. Provided mild relief.

Re: TENS unit purchase

john h on 5/25/00 at 15:01 (020867)

i purchased a tens unit (by prescription) about 12 years ago. a high end unit with adjustable pulse and band width with four outputs probably cost on the order of $600 or more dollars today. the newer electrodes can be used for some time now-weeks. power is of course adjustable and separate for each output. a major manufacturer is EMPI and can only be purchased with a prescription. never have tried it on my foot but after reading scotts post may try it.

Re: TENS unit with acetic acid

john h on 5/26/00 at 10:41 (020915)

scott: in reading info about the tens use i understand the negative electrode is placed directly over the effected area but where is the positve electrode placed? can acetic acid be purchased at a drug store in some form? also: the empi unit i have has numerous adjustments as to pulse per second and wave length. the power can be turned up to a point where you can not tolerate it. most of us develop calcification throughout our body over a life time including such places as the intestine. some of the small nodules i feel on my fascia feel very much like calcifications. my understanding is they are very benign but who knows what effect they might have on the fascia. if use of a tens with whatever can reduce or remove these calcifications i will sure give it a try.

Re: TENS unit with acetic acid

John h on 5/26/00 at 10:44 (020916)

when at the PT's office a few year ago i had treatment with whatever subustance they used. having my own tens unit i can say without question they had their unit set so low that i could not even feel the voltage/amp.

Re: TENS unit with acetic acid

Melody on 5/26/00 at 13:26 (020921)

I have never used a TENS for my feet...but couldn't live without it cos of pain in my hand!

One electrode (+) goes over the pain site and the other up my arm towards my brain! I think!!!*S* The best thing is to put them where they seem to help. Keep moving them around until you get some relief.

You can buy them in a chemist (drugstore) over here and don;t need a prescription. I LOVE mine!!!!


Mel


Re: test

scott r on 5/31/00 at 09:40 (021103)

eswt