Neuromodulation via Interferential Electrical Stimulation as a Novel Therapy in Gastrointestinal Motility Disorders

Abstract

The concept of therapeutic percutaneous neuromodulation has, until recently, been limited by the ability to penetrate deeply enough to stimulate internal organs. By utilizing 2 medium frequency, slightly out of phase electrical currents passing diagonally through the abdomen, a third, low frequency current is created at the point of bisection. This interferential current appears to stimulate nerve fibers in the target organs and may have a therapeutic action. The aim of the study is to review the use of transcutaneous interferential electrical stimulation with a focus on its application in gastroenterology, particularly in motility disorders. Studies involving use of interferential current therapy were searched from Medline, PubMed, and Scopus databases, and articles pertaining to history, its application and all those treating abdominal and gastrointestinal disorders were retrieved. Seventeen studies were identified, 13 involved children only. Eleven of these were randomised controlled trials (3 in adults). Four trials were from the one center, where each paper reported on different outcomes such as soiling, defecation frequency, quality of life, and colon transit studies from the one pool of children. All studies found statistically significant improvement in symptom reduction. However, weaknesses in study design were apparent in some. In particular, finding an adequate placebo to interferential current therapy has been difficult. Interferential current therapy shows potential as a novel, non-pharmacological and economical means of treating gastrointestinal dysfunction such as constipation. More studies are needed particularly in the adult population. However, the design of a suitable placebo is challenging. Search MethodA search of Medline, PubMed, and Scopus databases for information on electrical interferential current and its application using search words such as "electrical interferential current," "transcutaneous," "therapeutics or uses," "mechanisms of action," and "gastrointestinal" was performed. Articles that were available in English were included. This review focuses on the use of transcutaneous interferential current therapy in the treatment of gastrointestinal symptoms. The Nature of Interferential Current TherapyInterferential current therapy has been used in a variety of settings including low back pain 11 and neurological disorders such as carpal tunnel syndrome. 12 More recently, interferential current therapy has been found to be effective in small studies in managing conditions such as fecal incontinence and constipation. It has the benefit of being completely non-invasive, cost effective and convenient, as it can be self-administered at home. 13Despite increased convenience to the patient, doctor and payer, the use of transcutaneously-delivered current can be problematic. To stimulate the nerve of interest, the current has to pass through the skin and surrounding muscle to reach its target. This causes resistance to flow, requiring the use of a higher current to achieve the desired resu...

Randomised clinical trial: transabdominal interferential electrical stimulation vs sham stimulation in women with functional constipation

“…A duration of 6 weeks for treatment was chosen with a view to maximising compliance, however, even better responses may occur with longer use as seen in some pilot studies in children . Other observational studies using home‐based treatment had participants using it for a minimum of 3 months . In the present study stimulation was performed for 6 weeks at a daily basis at home.…”

“…16,17 Other observational studies using home-based treatment had participants using it for a minimum of 3 months. 5,8 In the present study stimulation was performed for 6 weeks at a daily basis at home. This was based on previous paediatric studies which found home stimulation to be easy, well tolerated with a larger effect seen compared with studies that used intermittent stimulation (3 × a week).…”

“…Stimulation with an interferential current is thought to increase propagating sequences and colonic activity, perhaps mediated by effects exerted on the excitability of cells such as the interstitial cells of Cajal that produce the slow wave activity in the bowel. Alternatively, as the electrodes are close to the spinal cord, it has been proposed that therapy may directly impact on the autonomic (or intrinsic) nervous system either via the afferent or efferent pathways …”

“…Alternatively, as the electrodes are close to the spinal cord, it has been proposed that therapy may directly impact on the autonomic (or intrinsic) nervous system either via the afferent or efferent pathways. 8 To date, there has been limited study of the effects of interferential therapy in adults with constipation. In a case series of only 11 patients, 7 participants improved after interferential therapy.…”

Electrical Stimulation and Recovery of Gastrointestinal Function Following Surgery: A Systematic Review

“…Effects of GI tract stimulation have been variously attributed to a stimulating effect on the pacemaker ICC, stimulation of the intrinsic/extrinsic autonomic nerves , or modulation of Meissner's and Auerbach's plexi in conjunction with smooth muscle . However, TENS and EA have an established application in pain‐relief and this may inform and/or confound the interpretation of its role in postoperative GI recovery.…”