Iontophoresis with Dexamethasone

Pain Medication through Your Skin — Iontophoroesis

Physical therapy treatment
Physical therapy treatment. sylv1rob1

When you go to physical therapy, you'll likely be given a coordinated set of treatment modalities. The specific modalities are chosen by your therapist and depend on what's happening with your back (or other area.) Usually, the home exercise program (acronym HEP) is the biggest part of the plan, but your therapist may add in things like traction, moist heat, and other types of feel good experiences (with  varying degrees of effectiveness as proven via medical studies.) Usually, the purpose of these modalities is to help relax and/or stimulate muscle associated with the troubled area.

One such treatment modality is called iontophoresis, or ionto, for short. This procedure involves a patch that is placed on your skin. Attached to the patch is a small pouch of medication. Both patch and pouch are connected to the ionto machine. As the medication is delivered through the pores of your skin, the ionto machine also applies a small electrical current. The low voltage current further increases your skin's permeability to the medication.

Ionto Medications Dexamethasone and More

With iontophoresis, it's possible to program the delivery of the medication (instead of releasing it all at once and/or at full force.)

The ionto can deliver a number of different medications including lidocane, peptides, and dexamethasone, according to a 2006 study published in the journal Expert Opinion on Drug Safety, 

Lidocane is a pain reliever and skin numbing agent that also has other medical uses outside the scope of orthopedic treatments.

Dexamethasone is a corticosteroid that simulates an important hormone made naturally by your adrenal glands. Dexamethasone has anti-inflammatory properties, which means it relieves or reduces swelling, heat, redness and pain. It's also used as a treatment for arthritis, bursitis and tendonitis, as well as other maladies, including cancer.

History of Iontophoresis

As mentioned above, with iontophoresis treatments, the electric current enhances the delivery of the pain-relieving medication as it moves through the barrier of the skin (and also the hair follicles.)

In the past, experts believed the effect of iontophoresis was to push the medication through the skin. But more recently, they have updated their understanding of the specific way in which this modality works. In essence, they say ionto helps open up microscopic pores in the outermost layer of the skin, which in turn allows the medication to flow freely into your tissues.

Into the Future with Ionto

Iontophoresis is actively being developed by biomedical researchers in a variety of ways. Experts are trying to increase the ability of the drug to permeate the skin, and also to decrease side effects. And they are interested in improved drug delivery programming. A variety of technologies are being explored: Nanotechnology (working with small amounts of substances and currents,) device miniaturization, electroporation (introducing DNA via electrical pulse to help open up the pores,) sonophoresis (for increasing medication absorption) and the use of chemical enhancers.

The goal in all this exploration, of course, is a more sophisticated ionto machine. As an example of progress being made, authors of the Expert Opinion on Drug Safety study say the fentanyl E-TRANS iontophoretic system was redesigned with "encouraging results."

What to Expect When You Get Iontophoresis

When you have an iontophoresis treatment, the physical therapist will likely have you lie down on a treatment table. He will then place two electrodes close to the problem area (where inflammation is present.) One of the electrodes will contain the pain medication — whether dexamethasone, lidocane or something else.

The electrodes will be connected to the iontophoresis machine. The therapist will work the controls on the ionto to raise the amount of current to the point where barriers to drug delivery provided by both your skin and the electrodes are overcome. In this way, delivery of the medication to your underlying tissue is enhanced. 

Iontophoresis is known for enabling a high concentration of medication to reach deeply — all the way to the muscles, with few, if any, side effects. But it also helps distribute the dexamethasone, lidocane, etc to a larger surface area. 

An ionto treatment lasts between 10 and 15 minutes, and may be given either before or after the exercise portion of your session. Ionto is not painful, so why not use this as a time to kick back and relax before heading home —  or before your therapist puts you to work!

Source:

Batheja P. Transdermal iontophoresis. Expert Opin Drug Deliv. Jan 2006. https://www.ncbi.nlm.nih.gov/pubmed/16370945

Dexamethasone Oral. Medline Plus website. April 2017 https://medlineplus.gov/druginfo/meds/a682792.html

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