BioElectric Medicine Clinician Explainer
Our last post addressed how NuroKor provides medically regulated products, delivering personalised pain relief to patients and in this article, we’ll review what clinicians need to know about our technology and we’ll answer some of NuroKor’s most frequently asked questions.
Bioelectric technology. What is it? How can it help patients?
When we refer to bioelectric technologies, we’re talking about devices at the intersection of electrical engineering and human biology. Bioelectronic technologies deploy electrical current over specific areas in the body, modulating the peripheral and central nervous systems to reduce certain symptoms and/or treat underlying disease. This process is known as neuromodulation and is the therapeutic process behind such devices as deep brain stimulators for Parkinsonian tremors, spinal cord stimulators for chronic pain, and implantable cardiac devices (ICDs) for cardiac arrhythmias.
NuroKor technology use three types of neuromodulation delivered transcutaneously (through the skin) to simulate underlying nervous tissue, leading to outcomes such as analgesia and wound healing*.
1. TPNS—(Transcutaneous Peripheral Nerve Stimulation) — This is the most ‘shallow’ modality and neuromodulates at the level of the skin, affecting surface-level nerve endings.
2. NMS—(Neuromuscular Stimulation) — This works ‘deeper,’ is often applied at a higher amplitude and neuromodulates within muscle tissue, often with the desired effect of relieving pain, although evidence suggests other physiological effects, such as preventing muscle atrophy. Studies have shown that NMS increases blood flow to muscles, and, depending on the study, increased range of motion, increasing muscle strength, and/or enhancing muscle endurance.
3. MCS—(Microcurrent Stimulation)—Microcurrent uses a very low current, usually between 1uA and 1000uA or millionths of an ampere. Whereas TPNS is used to block pain, microcurrent is thought to work at the cellular level. Much like drugs that have been used in anaesthesia for decades, we know microcurrent works, but we don’t yet know exactly how. Many studies point to its efficacy, but the technology is new and the subject of various theories and many ongoing clinical studies.
Is it just TENS?
TENS stands for transcutaneous electrical nerve stimulation. It is a term that simply describes the delivery of electricity across the surface of the skin to stimulate underlying nerves. It is a broad term that has various subcategories depending on the frequency and delivery mode of the electricity, including High Frequency TENS, Low Frequency TENS, Brief Intense TENS, Burst Mode TENS and Modulated TENS.
When it comes to the different formulations of bioelectric medicine, each is unique and describing any one of these simply as TENS is reductive.
Thus, referring to the term ‘TENS’ in clinical studies without further definition of the formulation is misleading, as this gives no indication as to the specific type of bioelectric treatment used.
Specifically, TENS can include frequencies between 2Hz and 100Hz, pulses between 60 and 1000 microseconds and burst or modulated modalities, providing a range of clinical outcomes from parasthesia (numbness) to muscle contraction. At high frequencies, A-Delta fibres are targeted, whereas at low frequencies, beta-endorphines are known to be released, with brief, intense TENS aiming to provide noxious stimulation to active C-fibres; all of which can provide significant analgesic effects for different types of pain, including: myofascial, neuropathic, arthritic and even chronic regional pain syndrome (CRPS). Antiemetic effects and improved blood flow have also been noted.
At present, industry often groups all bioelectric treatments under the term TENS, which causes a great deal of confusion. To complete a clinical study and conclude that ‘TENS’ does or does not produce analgesia, wound healing or another desired effect for a certain condition is meaningless without knowing the frequency and modality, because each type of TENS could produce an entirely different result.
Similarly, without knowing details on the device used in a particular study, it is difficult to draw meaningful conclusions, as a device may use accurate, medically researched and proven proprietary treatments, like NuroKor’s, or may just be a rudimentary device, of which hundreds, old and new, are being sold; the accuracy of which is undetermined.
At NuroKor, we therefore avoid the term TENS. Instead, we talk about ‘bioelectric medicine’ as the overall term and we split this into TPNS, NMS and MCS, as we highlighted at the beginning of this article.
When should clinicians/patients use bioelectric technologies?
Research has shown that bioelectric technologies are an important alternative to medication in either difficult to treat patients, or where patients prefer an alternative to medication. As we’ve discussed throughout this recent series of blogs, they have also been used as an adjunct to existing therapies with little to no side effects. NuroKor devices provide additional treatment choices for clinicians to consider when it comes to conditions such as chronic pain and wound healing and ultimately more choice for patients throughout their treatment journey.
While bioelectrical medicine has potential across the healthcare continuum, existing evidence has highlighted several specific clinical areas in which NuroKor and its underlying bioelectric technologies have particularly strong value propositions. This has relevance now, more than ever, in the context of there being finite, viable treatment options using pharmacological approaches and conservative interventional therapies.
Clinical applications & evidence
Looking at this in more detail - there is a growing body of scientific research to show that bioelectrical therapies are an effective means of reducing postoperative pain intensity and need for analgesic pain relief. For example, one study published in the Journal of Aesthetic Plastic Surgery in 2018 showed that Transcutaneous Peripheral Nerve Stimulation (TPNS) can provide a powerful alternative to conventional treatment. This is just one of 14 studies to date, the majority of which have been RCTs.
Surgical recovery is not the only area in which NuroKor’s novel technology could be of immense value. Chronic wound care is a significant cause of expense to healthcare systems across the world, leading to adverse patient outcomes, unplanned hospital admissions and complex condition management. Bioelectrical therapy has been shown to boost healing rates by promoting the biological processes required for effective treatment of chronic wounds and ulcers at cellular level. As of 2020, there have been 10 studies into this exciting new area of biomedicine including one randomised control trial and it is likely that this area of biomedical research will continue to flourish as we see increasingly significant results.
Chronic pain presents a huge burden to patients, healthcare professionals and healthcare systems. As the field of bioelectric technology has seen unprecedented growth over the course of the last decade, its use as a treatment for this costly condition is becoming increasingly commonplace.
NuroKor also has applications outside pain and wound care. Our technology has, for example, been shown to prevent muscle atrophy and loss of function in ageing populations. In this context, in particular, it is important to remember that devices like NuroKor’s are capable of delivering multiple formulations and as yet, multi-frequency studies are not common-place, so the full potential of this type of technology is yet to be realised through clinical evidence.
If you’re a clinician and interested in using NuroKor’s devices to contribute to the growing evidence base behind PNS, NMS and microcurrent to treat a variety of conditions including pain, non-healing ulcers and muscle atrophy, then please get in touch at firstname.lastname@example.org. Not only do we regularly review recent evidence across bioelectric technologies, we are now conducting our own studies in partnership with universities and healthcare providers, specifically with NuroKor technology. We’re keen to hear from anyone who wishes to learn more, participate or engage in a new or existing study with us.
Founded in 2018, NuroKor is a company committed to the development of bioelectronic technologies. NuroKor develops and formulates programmable bioelectronic software for clinical and therapeutic applications, in a range of easy to use, wearable devices. It provides the highest-quality products, delivering personalised pain relief and recovery support and rehabilitation to patients.