Iontophoresis and Dexamethasone Patch

Going to physical therapy for your neck or back? If so, you'll likely be given a coordinated set of treatment modalities.

The specific therapies chosen by your P.T. will depend on your pain level, limitations, functionality, and the like. Usually, a home exercise program, or HEP, is the biggest part of the plan.

But your therapist may add in things like traction, moist heat, and other types of feel-good experiences that have varying degrees of effectiveness as proven via medical studies.

According to a 2018 study published in the journal FP Essentials, such modalities tend to be safe, but not supported by high-quality evidence as being effective in managing typical musculoskeletal problems.

Iontophoresis Patch

One such treatment modality is called iontophoresis, or ionto for short. This procedure involves a patch that is placed on your skin. It is used most frequently to reduce inflammation and relieve pain.

Attached to the patch is a small pouch of medication. Both patch and pouch are connected to an ionto machine. As the medication is delivered through the pores of your skin, the ionto machine also applies a small electrical current, which further increases your skin's permeability to the medication.

Ionto, Dexamethasone and More

With iontophoresis, it's possible to program the delivery of the medication so that it's distributed over time and/or in varying doses.

Lidocaine is a pain reliever and skin numbing agent that also has other medical uses outside the scope of orthopedic treatments.

A dexamethasone patch simulates cortisol, an important hormone produced naturally by your adrenal glands. Dexamethasone has anti-inflammatory properties, which means it relieves or reduces swelling, heat, redness and pain. And it's used as a treatment for arthritis, bursitis, and tendonitis, as well as other maladies, including cancer.

History of Iontophoresis

As mentioned above, with iontophoresis treatments, the electric current enhances the delivery of the pain-relieving medication as it moves through the barrier of the skin into where it can exert its effect.

In the past, experts believed the action of iontophoresis is to push the medication through the skin. More recently, though, they've updated their understanding of the specific way in which this modality works. In essence, they say, ionto helps open up microscopic pores in the outermost layer of the skin, which in turn allows the medication to flow freely into tissues.

Iontophoresis Development

Iontophoresis is actively being developed by biomedical researchers in a variety of ways. Experts are trying to increase the ability of the drug to permeate the skin, and also to decrease side effects. And they are interested in improved drug delivery programming.

A variety of technologies are being explored: nanotechnology, which is about working with small amounts of substances and currents, electroporation in which an electrical current is applied to cells to increase permeability of the cell, allowing medication (or things like DNA) to enter—sonophoresis for increasing medication absorption, device miniaturization, and the use of chemical enhancers.

What to Expect When You Get Iontophoresis

When you have an iontophoresis treatment, the physical therapist will likely have you lie down on a treatment table. They will then place two electrodes close to the area where inflammation is present. One of the electrodes will contain the pain medication—whether dexamethasone, lidocaine or something else.

The electrodes will be connected to the iontophoresis machine. The therapist will then use the machine to deliver an electrical current to the treatment area. In this way, the delivery of the medication to your underlying tissue is enhanced. 

An iontophoresis patch is known for enabling a high concentration of medication to reach deeply—all the way to the muscles, with few, if any, side effects. But it also helps to distribute the dexamethasone, lidocaine, etc. to a larger surface area. 

Ionto treatment lasts between 10 and 15 minutes and may be given either before or after the exercise portion of your session.

Ionto is not painful, but the study mentioned above found that it does not offer better outcomes than a course of physical therapy that does not include ionto.