Skip to main content

Electrical Stimulation Therapy for Pressure Ulcers: Does it Work?

Mr J is a 67 year-old man with a history of multiple sclerosis complicated by paraplegia, bilateral upper and lower extremity contractures, and multiple pressure ulcers.  He had required multiple hospitalizations for his wounds, and I met him after an extended hospitalization necessitating debridement when he was transferred to a skilled nursing facility for ongoing wound care.  Given the extent of his wounds, he was started on electrical stimulation therapy.  I had never heard of this type of treatment, so I wondered, in patients with pressure ulcers, is electrical stimulation therapy more effective than standard wound care?


Electrical stimulation therapy is the application of a current across a wound.  The theoretical mechanism of this therapy is to replicate the “current of injury” that occurs normally when there is a break in the skin.  This current of injury has been shown in various models to promote angiogenesis, fibroblast migration promoting granulation, and keratinocyte migration promoting epithelialization.

I searched the terms “electrical stimulation treatment pressure ulcers” on PubMed Clinical Queries looking for a meta-analysis.  I found an article that pooled data from 15 different studies, including both randomized control trials and observational studies, for a sample of 909 electrical stimulation patients and 371 controls.  The main outcome was mean percent wound healing, which was coded or calculated independently by 2 authors. 

The results showed that patients who received electrical stimulation to their pressure ulcers had a mean percent wound healing of 13.5 more than the controls, which translates to 144% increase in wound healing.  This effect was the same when analyzing just the randomized control trials, suggesting that the effect is not driven by a placebo effect.

In summary, it seems that electrical stimulation can improve wound healing compared to standard wound care.  Although statistically significant, it is hard to know if this outcome is clinically significant, as the potentially more important outcome is complete closure of the wound.  Further, the analysis included studies that employed different electrical stimulation modalities, which raises the question about what is the best way to deliver electrical stimulation therapy.  For example, what is the optimal positioning of the electrodes relative to the wound?  What is the optimal current (direct or alternating) setting?  How long should the electrical current be applied and at what frequency?

Back to the Patient: Mr J received several treatments with electrical stimulation with some improvement in his wounds.  However, one wound did not heal and was found to be infected necessitating further surgical debridement so he was readmitted to the hospital. 

Take Home Points:
Electrical stimulation can improve wound healing for patients with pressure ulcers.
There are still more questions to be answered about the best way to deliver electrical stimulation therapy to be most effective.

 Reference: Gardner, S. E., Frantz, R. A., & Schmidt, F. L. Effect of electrical stimulation on chronic wound healing: A meta-analysis. Wound Repair Regen. 1999 Nov-Dec;7(6):495-503.
Picture Courtersy: las - initially

by: Natalie Young, MD, MS, Geriatrics and Palliative Medicine fellow at Icahn School of Medicine at Mount Sinai, New York.


This post is part of the #GeriCases series, in which we discuss a clinical case in geriatrics and palliative medicine and the attempt to provide patient-centered care with the use of best available evidence. 
Ravishankar Ramaswamy, MD
@RavRamaswamy
Section Editor, #GeriCases

Comments

Popular posts from this blog

Dying without Dialysis

There is a terrific article in this weeks Journal of Pain and Symptom Management by Fliss Murtagh of King's College in London about the epidemiology of symptoms for patients with advanced renal failure who die without dialysis.  This study is important because while we know that patients with advanced renal failure have a limited life expectancy and the average age of initiation of hemodialysis is increasing, we know little about the alternatives to hemodialysis.  Specifically, we know nothing about symptoms affecting quality of life among patients who elect not to start dialysis (so called "conservative management" - is this the best label?).  This article provides a terrific counterpoint to the article in last years NEJM showing that nursing home residents who initiated hemodialysis tended to die and decline in function (see GeriPal write up here). 

The study authors followed patients with the most advanced form of chronic kidney disease (the new name for renal failu…

The Dangers of Fleet Enemas

The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers.  Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. Despite all this talk of oral preparations, little was mentioned about a sodium phosphate preparation that is still available over-the-counter – the Fleet enema.

Why Oral Sodium Phosphate Preparations Are Dangerous 

Before we go into the risks of Fleet enemas, lets spend just a couple sentences on why oral sodium phosphate preparations carry significant risks. First, oral sodium phosphate preparations can cause significant fluid shifts within the colon …

Language Matters: Podcast with Brian Block and Anna DeForest

One of our first GeriPal posts was titled "Rant on Terminology," by Patrice Villars, NP.  In the spirit of looking back over our first 10 years, here is the opening paragraph to that post:

News Headlines read: Sen. Edward Kennedy loses battle with cancer. Really, he lost? I thought he died from a malignant brain tumor, an “aggressive” brain tumor. The median survival is less than a year for people for his particular tumor. Kennedy was diagnosed in May of 2008. He lived over 15 months after diagnosis. What a loser. He must not have fought hard enough. Huh? I thought he spent most of his life battling for social and health care reform in America. In this week's GeriPal podcast we take a deeper dive into this issue of language and medicine.  We are joined by guests Anna DeForest, MD, MFA, a resident in Neurology at Yale, and Brian Block, MD, a pulmonary critical care fellow at UCSF.  

Anna recently published a paper in the NEJM describing her reaction to hearing terms like, &…