Neuroma Pain Dramatically Improved with Shockwave and Electromagnetic Transduction Therapy

Shockwave therapy (pulsed sound waves) can be uncomfortable but should not “hurt” enough that you can’t tolerate a treatment. You try and keep the discomfort under a 6 or 7 on a pain score. But everyone is different. This particular patient had very “sensitive” feet. During the first two treatments of focused and radial shockwave (15-20 minutes) followed by EMTT (pulsed electromagnetic fields; 10 minutes) she was so “jumpy” I thought we would never get a solid treatment session in. I was thinking it might take me a month to get to a full “strength” session completed. With the EMTT treatments patients usually do not feel anything, in fact many patients fall asleep. The EMTT treatments can take 10-20 minutes. She was given five thousand pulses of EMTT treatment directly after the shockwave treatments which was very well tolerated (remember the term “shockwave” does not mean electric shocks!).

The first two complete treatments of all three modalities over the first week did not result in any positive changes in her pain or painful tingling sensation in that left foot. She also did not calm down much with both applications so it was hard to feel like you were getting a complete treatment in. By the third treatment on week two she could tolerate the treatments a little better, but she was still very “squirmy” and there was not much pain reduction in the ball of her left foot. But I had told her at the beginning these treatments were best done on a weekly basis over 6-8 weeks. When she came in for the 4th treatment she very clearly said (after 3 full treatments) that she could walk barefoot and she had no pain in the ball of her left foot and the tingly pain on the top of her foot was significantly reduced. During that fourth treatment she was still very sensitive and fidgety when both the radial and focused shockwave treatments were applied. Usually, as one’s symptoms improve you can increase the power of the treatment energy into the affected area. At her last treatment (5th) before leaving on her Hawaii vacation that weekend she noted she could walk barefoot on the floor or carpet pain-free and almost all the painful tingling sensations on the top of her foot was gone and that 4th toe was less tender and had more flexibility. Also! Finally! I could apply a little more power and lower the frequency of the treatment settings and she did not flinch hardly at all. In fact, we had a lively conversation while I was applying these treatments to her foot. So, you could tell she was definitely improving… and just in time for she and her husband’s annual Hawaii vacation starting that weekend.

At the end of each treatment shockwave treatment, time permitting, I usually massage the treated area with a prescribed combination CBD cream (EB-C4; THC-Free Cannabidiol 3%; Myrcene 3%, Beta Caryophyllene 3%, Arnica 2%, MSM 2% in HRT Heavy Transdermal Cream – by prescription from EBM Medical, Chesterfield, MO). I was a massage therapist 30 years ago so there’s usually a couple of minute massage of the treated body part at the end of the shockwave treatment after applying this cream.

1) Up-regulating anti-inflammatory adenosine receptor A2A and A3.
2) Reducing PGE2 and pro-inflammatory cytokine IL-6 and IL-8 and inhibiting factor NF-kB
    transcription in human chondrocytes and osteoblasts.
3) Increased proliferation and enhanced osteogenic differentiation of mesenchymal stem cells
   (MSCs) isolated from human bone in several in vitro studies.
4) Stimulate activity and differentiation of specific cell cultures of the musculoskeletal system.
5) PEMF devices are approved by the FDA to fuse broken bones, reduce tissue and joint pain
    and support muscle function.
6) PEMP doesn’t have inadequate electromagnetic field power and is missing dynamic oscillations.
7) Electromagnetic transduction therapy (EMTT) is a promising new technology of a treatment
based on PEMF with magnetic field strength between 80 a nd 150 mT and oscillating frequencies
of 120 Hz of each impulse. EMTT acts via electromagnetic transduction. Impulses are emitted by
a high-speed generator to build up a voltage up to 30 kV which is released in nanoseconds and an
impulse release frequency of 3 Hz. The very short duration of each impulse ensures full
electrophysical reaction without any temperature increase in the tissue.
8) Electromagnetic impulses can stimulate osteoblast growth activity; neovasculogenesis; growth
factor release; improve blood supply to the treated area.
9) Studies have shown benefit of EMTT for low back pain , rotator cuff tendinopathy , osteitis pubis
(groin pain) , bone stimulation therapy for scaphoid nonunions and Achilles tendinopathies.

In general there are very few tendon, ligament, muscle or joint problems where these technologies cannot be applied. While people can feel better immediately the full treatment is usually done over 6-8 weeks. Also, the healing response and release of these healing factors can continue for months. I remember at one conference listening to some very successful podiatrists that use these devices. They might do initial treatments of 4-8 weeks then tell the patient to go out and contact them 10 weeks later and the pain is gone. Sometimes the patient doesn’t even realize that all of a sudden there is no more pain. So patience is necessary for these therapies in the long-term. Usually there is enough pain relief or improved function in those first 4 to 8 weeks to get the person functional and get them through the whole treatment program. Point being the healing process that is started during the treatment phase continues for 2-3 months after the treatments end.

Lastly, I always talk about diet with pain patients. Diet can lead directly to pain and inflammation. Being overweight not only puts added stress on your joints, tendons and muscles but fat tissue is releasing inflammatory compounds that are aggravating your pain. You can start very simply by eliminating all dairy products, wheat products and eggs for at least two weeks and also eliminate all processed foods. It would not be a bad idea to be off alcohol during the treatment period as well or the time you are trying to heal. You want to know if and how much diet effects your pain. It sometimes can be dramatic like 80-90% of the patient’s pain disappears with diet change.

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