Iontophoresis and phonophoresis are intervention options therapists use to treat several different physical conditions.
Physical agent modalities (PAMs) include superficial modalities such as thermotherapy and cryotherapy, and deep modalities such as ultrasound, electrical stimulation, and the application of topical medications. The two forms of topical medication application include iontophoresis and phonophoresis. Unfortunately, in educational settings and in practice, iontophoresis and phonophoresis are under-discussed and underutilized.
This might be due to the lack of ability to provide hands-on training in educational settings, as students are unable to practice applying medication to each other in labs. It may also be due to lack of understanding of the purpose and proper use of topical medication applications in therapy practice.
Common Practice Areas for Iontophoresis and Phonophoresis Use:
The purpose of this article is to discuss topical medication application, appropriate diagnoses for topical medication, typical protocols, and contraindications for iontophoresis and phonophoresis within occupational therapy practice to better help practitioners in their understanding, confidence, and use of the underutilized topical medication modalities.
Iontophoresis
If you recall from your training and curriculum, iontophoresis is the application of ionized topical medication through the skin to tissues of the body by the continuous and direct electrical current. Research indicates iontophoresis is experimental/investigational in the treatment of physical conditions. Literature exemplifies the use of iontophoresis in clinical applications to assist in treating conditions including, but not limited to (Baskurt, Ozcan, & Algun, 2003; Starsky, 2015):
Iontophoresis uses two electrodes to deliver medication. Many protocols exist, varying in dosage and intensity. However, the following principles are consistent in all iontophoresis applications: the skin should be properly cleaned prior to treatment, positively charged medication should be placed in the positive electrode, and negative medication in the negative electrode. Common medications include (Watson, 2015):
Check with referring doctors and your facility to determine the medication available at your practice. Dosage is expressed in milliamp per minute.
To determine the effectiveness of iontophoresis, remember that a patient receiving iontophoresis should report positive results within one to three treatment sessions. If no signs of improvement are reported, iontophoresis should be discontinued. Contraindications for iontophoresis are pacemakers, pregnancy, cancer, decreased sensation, and over broken/bleeding skin (Hecox, Mehreteab, Welsberg, & Sanko, 2006).
Phonophoresis
Alternatively, phonophoresis is the application of topical medication by skin absorption and deep tissue distribution facilitated by ultrasound waves. Literature suggests phonophoresis is experimental/investigational in use but may be effective in the treatment of several conditions including:
(Ay, Doğan, Evcik, & Başer, 2010; Garcia, Lobo, Lopez, Servan, & Tenias, 2016; Jain et al., 2010; Lake & Wofford, 2011, Starsky, 2013).
Protocols for phonophoresis vary in frequency, duration, time of treatment, and medication being used. The current literature recommends an intensity of 1.5 W/cm2 (Starsky, 2013). Remember that the ultrasound head should be held perpendicular to the treatment area. Medication gels for phonophoresis include local anesthetics and anti-inflammatory drugs (Loyd, 2011):
Once, again, check with referring physicians and your facility to see what medication you may have available to use.
Treatments should be discounted if no signs of improvement are reported after six to eight therapy sessions. Contraindications for phonophoresis are pacemakers, pregnancy, application over the eyes or testes, deep vein thrombosis (DVT), tumor/malignancy, infection, active bleeding, and over epiphyseal growth plates (Loyd, 2011).
Visual learners: Watch this video to help you with phonophoresis application!
https://www.youtube.com/watch?v=_hU1Q5D8vA4
Helpful hint: Remember, multiple states have additional licensure requirements for therapists prior to the use of physical agent modalities, including iontophoresis and phonophoresis, in various settings. The requirements may include additional continuing education as well as proctored practice administering the superficial and deep modalities. Check with your state licensing board prior to using iontophoresis and phonophoresis in your practice.
Prior to application of iontophoresis or phonophoresis, remember the following key points: PAMs are best used as preparatory methods, assess if the patient has any contraindications for treatment, check for topical drug interactions, and be aware of potential adverse reactions to treatment such as rashes or burns.
Looking to get certified?
- First check with your state requirements for certification
- Use continue education resources including MedBridge and get $175 off a yearly subscription using the coupon code COVALENT
- Check for weekend PAMs courses in your area, such as: http://www.pampca.org/info.html
- Ask a certified mentor to help you with proctored treatments
