Please advise if I'm using high voltage currents for pain and swelling relief (acute episode), is there a polarity to be set- and how to choose it as well as choice of HVPC over interferrential for the same effect .

Hello, Monika. I agree with Dr. Rennie that there is not a lot of research specifically assessing the effects of HVPC on pain. What little has been done appears to suggest that either would be effective.

I agree with Professor Hoens regarding the effect of cathodal HVPC on edema. The elegant series of papers by Fish & Mendel and colleagues demonstrated that cathodal HVPC was more effective than anodal, albeit using rat and frog models (there has been little work published on humans, and it is equivocal). Based on aspects of their research designs over their research series, Fish & Mendel believed that the polarity effect was not due to the cathode repelling negatively charged serum proteins. There is not a demonstrated, established mechanism for the effect. However, they showed that the cathode must be placed over the site of tissue damage (not necessarily where the fluid has extravasated).

Since there appears to be no differential effect of polarity on pain relief, HVPC could be used for a pain relief effect in a similar manner as with other types of current/waveforms (i.e., those that are biphasic and balanced). I, respectfully, disagree with the hypothesis expressed by Dinesh Varma regarding inability for HVPC to modulate pain relief via neural activation. One can use HVPC to produce a sensory response (the patient will feel tingling) as well as a motor response, depending on the amplitude of the stimulation, even though the pulse duration on such devices are fixed and relatively low. These responses would occur, necessarily, via neural stimulation; supporting the similarity among various current types for the more classical, neural mechanism of pain relief. Regarding circulatory effects of ES, biphasic balanced currents have also been reported to be beneficial.

Hi

I believe Pain relief effects are relatively happening with HPVC - indirectly due to its Circulatory effects on tissues rather then Pain MODULATION effects those are typically achieved by TENS / IFC . The classical TWIN Peak HVPC has very short duration and charge in total. this may not be sufficient for Neural activation for Pain Modulation - classical theory on which - we apply with TENS/ IFC.

Hello Monika Polarity is most relevant when using HVPC for wound healing (in order to attract or repel the desired charged molecules specific to the stage of healing) - this is less of an issue for pain management (as stated by Dr Rennie). However, it is important to address the cause of the pain (you specifically mentioned swelling - but it is important to distinguish between inflammation, edema and swelling). So, if the pain is suspected to be associated with exudate (i.e. edema), which includes protein (which is positively charged), it is relevant to trial negative polarity to repulse the serum proteins Taylor et al, 1997; Bettany et al, 1990. I look forward to further discussion from our colleagues.

Hello Monika Polarity is most relevant when using HVPC for wound healing (in order to attract or repel the desired charged molecules specific to the stage of healing) - this is less of an issue for pain management (as stated by Dr Rennie). However, it is important to address the cause of the pain (you specifically mentioned swelling - but it is important to distinguish between inflammation, edema and swelling). So, if the pain is suspected to be associated with exudate (i.e. edema), which includes protein (which is positively charged), it is relevant to trial negative polarity to repulse the serum proteins Taylor et al, 1997; Bettany et al, 1990. I look forward to further discussion from our colleagues.

Hello Monika Polarity is most relevant when using HVPC for wound healing (in order to attract or repel the desired charged molecules specific to the stage of healing) - this is less of an issue for pain management (as stated by Dr Rennie). However, it is important to address the cause of the pain (you specifically mentioned swelling - but it is important to distinguish between inflammation, edema and swelling). So, if the pain is suspected to be associated with exudate (i.e. edema), which includes protein (which is positively charged), it is relevant to trial negative polarity to repulse the serum proteins Taylor et al, 1997; Bettany et al, 1990. I look forward to further discussion from our colleagues.

Hello Monika. There is not very much research that I could find on the use of HVPC for pain relief. In the studies I found most used the cathode over the painful area. One study (Sandoval, 2010) compared HVPC positive to HVPC negative and found negative worked better. Perhaps you might try using the cathode and see how it works for you. If you are looking for pain relief only, I would suggest interferential as then you would not need to worry about electrolyte build-up as you might with HVPC. Gomes N et al: Revista Brasileira Fisioterapia. 2012;16:10-15 Mendel FC et al: Journal of Sport Rehabilitation. 2010;19:399-410. Sandoval MC et al: Brazilian J of Physiotherapy. 2010;14:193-199.

Hope this helps. Sandy