Surgery: light – thermal – and electrical application – Light – thermal – and electrical application – Electrical therapeutic systems
Patent
1993-12-30
1995-09-12
Kamm, William E.
Surgery: light, thermal, and electrical application
Light, thermal, and electrical application
Electrical therapeutic systems
607115, 607148, 607152, A61N 104
Patent
active
054493781
DESCRIPTION:
BRIEF SUMMARY
The present invention relates to a device and a method for relieving chronic and acute states of pain as well as itch, for affecting the motor activity of disabled people, or for increasing the flow-through of blood in underlying tissue. The device comprises a shapable electrode plate through which extend a plurality of electrodes which are fixed in the electrode plate and terminate, at their respective free ends, in an electrode tip portion for skin penetration. The invention also concerns the use of the device for relieving chronic and acute states of pain as well as itch, for affecting the motor activity of disabled people, or for increasing the flow-through of blood in underlying tissue.
It is well-known that the activation of sensitive mechanoreceptors in the skin may relieve pain as well as itch, and quite a number of theories trying to explain the underlying mechanisms have been launched in the past 25 years. The most well-known theory, the gate theory (Melzack and Wall, Science, 150:971-979, 1965), describes in great detail how the interaction between mechanoreception and pain might work. On the basis of this theory, apparatus for transcutaneous electrical nerve stimulation (TENS) were developed in the 70s and 80s to provide pain relief. These apparatus activate whole nerves (nerve fibre bands) from the skin and the underlying tissue. By using a suitable current intensity, thick myelinated nerve fibres from sensitive mechanoreceptors can be preferentially stimulated, having the lowest threshold for electrical stimulation. This method has been found to have analgetic effects for some states of pain in about 50% of the patients tested.
The majority of nociceptors (injury receptors) have slowly transferring non-myelinated axons, so-called C fibres. These are believed to play a crucial part in chronic states of pain. Previously, one was labouring under the misapprehension that the pain paths activated by these fibres have a diffuse topographic organisation. However, more recent neurophysiological studies have shown that the pain paths have a very detailed organisation with well-defined activating and inhibiting skin areas (Schouenborg, J. Physiol, 356:169-192, 1984; Schouenborg and Kalliomaki, Exp. Brain Res. 83:67-78, 1990). If effective pain relief is to be achieved, local inhibitory skin areas should thus be specifically stimulated. Established TENS technique does not provide this possibility, since whole nerves from the skin as well as the underlying tissue are stimulated. In addition, the different peripheral nerves practically never supply functionally defined areas.
Studies of the organisation of the pain paths have shown that pain-activated nerve cells, as well as other nerve cells receiving information from the body surface, can be maximally activated from very small areas of the skin. Consequently, it is unnecessary, and probably wrong, to stimulate whole nerves supplying large receptor beds. By consecutively stimulating different nearby points at a low frequency for each point, one might obtain high-frequency activation of central nerve cells without tiring individual inward-leading nerve fibres and central synapses.
The knowledge of central nerve paths mediating itch is quite limited. Itch makes one want to scratch the skin, providing a certain relief. Regrettably, scratching often worsens the itch in the long run by injuring the tissue. Thus, it is desirable to activate the central itch-relieving mechanisms without injuring the skin.
Recent research has also revealed that individual muscles can be activated and inhibited from specific skin areas. The areas activating a given muscle correspond to those areas of the skin that the muscle removes upon contraction, and the areas inhibiting a given muscle correspond to those areas of the skin that are moved by the muscle towards a stationary object upon contraction. Muscular activity might be controlled by specifically activating these areas of the skin. This is of importance in order to facilitate motor activity or alter involuntary motor activ
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Information Sheet, Trimix 101H, Nihon Medix Co., Ltd.
Information Sheet, Phyaction 912, Uniphy B.V.
Kamm William E.
Schaetzle Kennedy J.
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