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A PRACTICAL PROTOCOL FOR Daniel L. Kirsch, Ph.D., D.A.A.P.M. Chapter Reprint from:
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Basic Treatment Protocol for The following section is intended as a practical guide for clinicians to utilize the principles discussed in this chapter. The methods of treatment provided herein have been developed by the author based on three decades of experience in electromedicine. The reader is cautioned to remember that not all brands of microcurrent devices are equally efficacious. Always check the manufacturer’s specific instructions before using a medical device. As medicine is not an exact science, the author can not assume responsibility for the clinical efficacy, or liability for the methods and treatments found in this text. Step One: History and Brief Exam It is important to take a comprehensive history and do a brief analysis of the patient’s current condition before beginning each session of MET treatment. A diagnosis is not enough. One should determine when the pain first presented, its frequency, duration, intensity, limitations-of-motion, positions which exacerbate the pain and any precipitating factors. Ask about the specifics of previous treatments and details of all surgical scars and traumatic injuries. Microcurrent electrical therapy is a very holistic procedure. It may be necessary to clear the body of any and all electrical "blocks" in order to achieve the best results. Even brief 10 to 20 second treatments of other problems and/or old injuries may reverse a refractory case. Immediately before each treatment determine the patient's present pain level, and positions that exacerbate the pain. Ask the patient to rate their present pain on a scale of 0 (no pain) to 10, with 10 being excruciating, debilitating pain. Tell the patient to consider 10 as "the worst this condition has been". Also note any immediate limitations-of-motion, positive orthopedic and neurologic test findings, and objective signs of psychological distress. Because the results of MET can be seen after only a minute or so of treatment in most people, these indicators are necessary reference parameters to determine effectiveness throughout a single treatment session. Adjust the Settings Use 0.5 Hz frequency most of the time. It is unusual ever to need other frequency settings. However, if 0.5 Hz doesn't work, and a number of electrode placements sites have been attempted, try 1.5 Hz. 100 Hz sometimes produces faster results when treating inflammatory articular problems (e.g., arthritis, bursitis, tendonitis, etc.). However, 100 Hz does not contribute much to long term results so treatment should always be completed using a low frequency. Set the current intensity level at the highest comfortable position which is usually 500 to 600 µA for probes, although sometimes less for the silver electrodes used with MET. Do not use standard TENS electrodes except in the initial treatment of hypersensitive patients. Carbon TENS electrodes have a resistance of about 200 ohms, while silver electrodes have a resistance of about 20 ohms. Only silver electrodes will work effectively with MET devices. When using probes, first affix new felt electrodes and saturate them with an appropriate electromedical conducting solution. Then apply firm pressure, but less than that which would cause more pain. Tap water does not work well in some places anymore because of recent advances in desalination during water processing. Saline solution may be used if a conducting solution is not available. For extremely hypersensitive people, such as fibromyalgia patients, it is better to start with a minimal amount of current. Even low level MET currents may be uncomfortable in some patients. For these patients it may be necessary to initially reduce the conductivity by using more resistive electrodes. Over the course of a few weeks, the therapeutic dosage of electricity can gradually be increased. Start with standard carbon electrodes, followed by silver electrodes, then probes with tap water, until the area is desensitized enough to use probes with conducting solution. Fortunately this is rarely necessary. Most people will not even feel MET stimulation at a current of 600 µA. Basic Treatment Strategy There are only a few principles one must remember when treating patients with MET. The patient should be in a relaxed position to receive maximum beneficial effects. For example, do not let the patient help with the treatment of their hands by holding up their arms, which would cause the arm muscles to tense. In this case, it is better to place both hands on a table. The most important variable is the position of the probes, or silver electrode pads. Place the probes, or pads, in such a way that if a line were drawn between them, that line would travel through the problem area. Keep in mind that the body is three-dimensional. Therefore, there will be many possible lines that can be drawn through the problem area. Some lines will work much better than others. The correct electrode location is the one that works! However, the one that works may be transient, working well one day, but ineffective another day. As the problem begins to resolve, the electrode locations may require frequent adjustments. A common mistake made by clinicians familiar with traditional TENS is placing the electrodes on each side of the spine for back pain. This is a two dimensional approach. With such a placement microcurrent will travel just under the skin between the electrodes and never reach the spine. Nor can the electrodes be effectively placed "between the pain and the brain". These are common placements for TENS electrodes, but MET is not TENS. A better way is to place one electrode next to the spine at the level where the problem is, and the other on the contralateral side, anteriolaterally (front and opposite side). A line drawn between those will go right through the spinal nerves. Next, reverse the sides. Then follow-up by doing another set of contralateral placements one spinal level above, and one below the problem to accommodate overlap in the dorsolateral fasciculus. Always treat bilaterally. Bilateral treatment includes the spinal cord thereby involving dermatomes, myotomes, and sclerotomes. Also if the problem is within the axial skeleton and the contralateral side is ignored, there is a good chance that the primary location of a pain problem will have been missed. Pain often presents itself on the tense side which may be compensating for muscular weakness on the other side. Quick Probe Treatments When using probes, set the timer on a probe setting, or if one is not available, treat about 10 seconds per site. In other words, move the probes to the next location every 10 seconds. Consider one treatment "set" to be 12 to 20 of these ten-second stimulation’s, each at a different angle of approach. The first set should take about two minutes, but then additional treatment may be done at one-minute intervals. The patient should be reevaluated between each set.
The protocol involves four steps: The above example takes two minutes. A big X beyond the area (20 seconds), a star through the chief complaint (40 seconds), treat the opposite side with one small X (20 seconds), and connect the two sides (40 seconds). Then reevaluate the pain based on the original criteria. If the pain is gone, stop for the day. If it is reduced, ask the patient to point to where it hurts with one finger and treat for another minute or so directly through the area of pain, which may have moved after the original two minute treatment. Think in terms of symmetry. Look, palpate, and otherwise examine areas above, below, and to the left and right of the primary area undergoing treatment. Always treat the opposite side and connect both sides. Silver Self-Adhesive Electrodes These are used following the same strategy as the probes, except for a longer period of time. The probes and brief electrode treatments assume MET is working as a catalyst for the patient’s own bioelectrical system, whereas keeping electrodes in place can be viewed as using MET to augment endogenous bioelectricity. For optimum results, silver electrodes may also be moved around the problem area. Whereas the probes are used for 10 seconds a site, silver electrodes should be left at each location for at least 5 to 10 minutes. Some cases will require an hour or even several hours of stimulation daily. Accordingly, silver electrodes are best used for home care. However, if brief stimulation works, do not continue treatment at that session. More is not better when using MET technology to manage pain! When to Stop Reevaluate the patient after the two-minute protocol using the original criteria. It is not enough to ask if the patient feels better; ask for a specific percentage of how much better. If the patient has difficulty with a 0 to 10 scale, to facilitate communication, ask, “If you had a dollar’s worth of pain when we began, how many cents do you have left?” Also, reexamine for improvement in objective signs, such as range-of-motion increases, etc. Stop when the pain is completely gone, or when the improvement has reached a plateau after several treatment sets. Continuing to treat the area at this time may cause the pain to return! If the pain is gone, it is far better to stop treatment for that day even if the patient only had one or two minutes of treatment. If the patient can no longer identify any pain, but complains of stiffness, this indicates that it is time to stop treatment for the day. Microcurrent may not reduce residual stiffness. Post-pain stiffness usually wears off by itself. Yoga, Tai Ch'i, or simple stretching exercises are good means of controlling chronic stiffness. Although most patients will have an immediate response to treatment, in some the effects will be delayed, continuing to improve over a day or two after the treatment. In these patients relief will generally occur one to three hours post treatment or even as late as the next morning. Some patients will experience a cumulative effect, continuing to improve over time. Patients who experience a delayed effect are more difficult to treat due to lack of immediate feedback. Usually, patients who experience a delayed effect from microcurrent treatment also have a delayed effect with anesthetics. Ask the non-responsive patient if their dentist had to wait more than 10 minutes after injecting anesthetic prior to doing dental procedures. Because treating patients who exhibit delayed responses can be viewed as a type of "blind" treatment, one must rely on experience with other patients who exhibited an immediate response in order to develop the skills to treat those few who have a delayed response. A post-treatment diary is also helpful in analyzing the response of these patients. Follow-up Most patients should be given at least three to seven treatments before evaluating their response to microcurrent electrical therapy. It helps to explain to the patient that the effects of MET treatment are cumulative. Like antibiotics, one must take several doses over a period of time to get results. Although results will usually be seen during or subsequent to the first treatment, the longevity of the results can only be evaluated after a series of treatments. Fortunately most patients will experience long lasting results. However, in some cases the results will plateau to a similar time period regardless of treatment. For example, a patient may only get one or two days of relief no matter what combination of treatment strategies are employed. For these, and cases of severe pathology, the effectiveness may be only short-lived, so a MET device should be prescribed for home care. After an initial series of up to ten clinical treatments, a good rule of thumb is to prescribe a unit for anyone with a chronic condition who requires more than one or two palliative treatments per month, and for patients who have progressive pathologies. When used at home, after an initial series of one or two weeks of daily treatments, treatment every other day usually provides better results than daily treatment. Tips for Limited or Poor Results While a good MET device will be at least somewhat efficacious on more than 90% of the population when used correctly, MET will not work for everyone. In cases where there are no results at all, there are a few things to consider. Dehydrated patients may not respond well. Patients should be advised to drink at least eight to ten glasses of water daily. Nutrition is certainly a factor. A poor diet does not provide the necessary building blocks to reinstate homeostasis. Also preliminary observations suggest that people who have had a significant exposure to strong electrical current may be poor candidates for MET. This means that they have either been held by electrical current at some time in their life, or that they have been treated with milliampere TENS or similar modalities for a prolonged period of time, usually years. There have even been a few reports of failures in patients that were struck by lightning. Brief exposure to very high levels of electricity is not as bad as longer exposure to any level of electricity. Such patients need to be treated for a longer period of time. Aside from hydration and nutrition and electrical shock, the primary reversible reason patients fail to respond to treatment is that they have some sort of a blockage somewhere on or in their body that is resisting endogenous electrical flow. This is usually something superficial, like a scar or old injury. It need not be anywhere near the patient’s primary problem. Identify all scars by taking a very thorough, persistent history, and examining the patient completely. All scars are important no matter how old or how far they are from the chief complaint. Scar tissue impedes the systemic flow of endogenous bioelectricity because it is a poor conductor of electricity. Accordingly, scar tissue may interfere with the patient's entire bioelectrical system. If scars are present they should be treated with silver electrodes for ten minutes per scar, at least four times. Simply cover the scars with the electrodes, or for large scars, place the electrodes on the ends of the scars. This may be done four days in a row or there can be a short interval of up to a few days between the treatments. Some people report that it helps to repeat this procedure after a month or so. When treating scars the person may experience a significant surge of energy. This can be viewed as if an electrical “bioresistor” has broken down, reestablishing the normal flow of bioelectricity. After scar therapy, patients will often report feeling half their age. Since people have nothing with which to compare their life experience, they usually attribute the subtle effects of scars on their electrical system as normal aging. Be aware that this treatment will often also increase pain, because the whole body and mind "wakes up", including the painful part. However, in nearly all cases, when this happens the painful area can then be successfully treated. Always schedule enough time to treat the pain after a scar treatment, so the patient will not need to endure even a temporary increase in pain. If all the scars are treated and there are still no results, or if there are poor results, there are still a few other options. Question the patient about old injuries that may not have healed properly. These could also be electrical blocks and should be approached in the same way as scars. Consider treating the primary complaint at a lower current setting of 100 µA with silver electrodes for 60 minutes or more. Slightly higher pulse repetition rates (e.g., 1.5 Hz) may produce results in some people when the 0.5 Hz fails, but this is rare. For more information about treating scars, or how to determine which scars to treat, physicians and dentists may contact the American Academy of Neural Therapy through their web site at www.neuraltherapy.com.
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