Key Words

I nterfercntial current,
physiology, effectiveness.

The Mystique of Interferential
Currents When Used to
Manage Pain
Summary Physiotherapists frequently use interferential therapy
for the control of patients‘ pain. But there is little consistent
information about the different effects of varying dosages. In fact conditions. DeDomenico (1987) describe
there is scanty proof that it works a t all. the use of IFC for the management of acutc
a n d chronic pain, acute a n d chronic
Introduction oedema, spasticity, stress incontinence
In a survey of 160 Australian physiotherapy muscle re-education, circulatory anc
facilities Robertson and Spurritt (1998) abdominal problems, and to facilitate thc
recently reported that electrophysical healing of injured tissue. Nikolova (1987
agents were used in a t least 50% of all describes the use of IFC in the managemen
physiotherapy treatments. They questioned of children’s diseases, gynaecologica
such widespread use of electrophysical diseases, diseases of the internal organs
agents as there is little objective evidence to diseases of the joints, diseases and injuries o
support clinical effectiveness. Interferential the nervous system, occupational disease
current therapy is an electrophysical agent a n d surgical conditions. Savage (1992
which is commonly used by physiotherapists describes the use of IFC in the treatment o
to manage painful conditions and surveys recent injuries, herpes zos ter, rheumatic
have shown that there is widespread use of conditions, shoulder pain, back and disc
interefential currents (IFC) in clinical lesions, incontinence, a n d thoracic an(
practice (Mantle and Versi, 1991; Pope et al, circulatory conditions.
1995; Robertson a n d Spurritt, 1998). These claims of IFC effectiveness are base(
However, therapists are inconsistent in their o n anecdotal evidence in t h e form Q
use of IFC parameters and it is likely that descriptive studies o r from the persona
therapists administer IFC using protocols experience of experts in the field.
based o n trial and error (‘Johnson and Using clinical observation to judgc
Tabasam, 1998). A number of beliefs about effectiveness can be unreliable, as im
the IFC therapy prevail in the literature: provements in a patient’s condition ma
IFC is clinically effective for the be due to factors unrelated to an activc
management of a variety of ailments. ingredient in the treatment. Sociocultura
The physiological and clinical effects of conditioning and the environment in whicl
IFC are mediated by the amplitude the treatment is administered may marked1
modulated wave (the interference wave). bias a patient’s report of treatment outcome
Different frequencies of this amplitude Patients view IFC (and other electrophysica
modulated wave will produce different agents) as technologically impressive an(
physiological effects. expensive treatments and this may influenci
It is possible to prescribe electrical a patient’s expectation of treatment success.
characteristics of IFC for different medical A qualified physiotherapist, who invests
conditions (DeDomenico, 1987; Nikolova, much time and effort in helping a patient, is
1987; Savage, 1992). required to administer the treatment.
The aim of this commentary is to explore Patients may exaggerate their reports of
potential problems with these beliefs. treatment outcome in order to please the
therapist, as some patients are known to
Johnson, M I (1999).
‘The mvstiaiie of
Is IFC clinically
.
effective
.
an the management report what they think they should rather
, I

interfrrrritial ciirrrrits of’a *amety of’ailments? than what they are really experiencing.
wilerl used to manag:c It is easy to read published material as O t h e r factors such as spontaneous
pair]’, Physioth,era$y, 85, 6, proven fact. Textbooks claim that IFC can be improvement of t h e ailment, natural
291-297. used for the treatment of a variety of clinical fluctuations in the time course of the

PhysiotherapyJune lYYY/vol85/no 6

July 30. 1969. Faculty of €Iealth and Environment. such circumstances would be deceiving their An unsuspecting reader might conclude patients that IFC had specific treatment that an amplitude modulated frequency of effects when in fact it did not. t h e therapy will be effective. Clinical activity and the mechanism of pain relief is observations a n d / o r research which has unclear. Placebos modulated wave produce a summation effect Scicnccs. proposed action. 1985). . amplitude modulated wave can produce Therapists should make clinical decisions specific physiological effects as claimed in based on clinical evidence from the findings texts: of randomised controlled clinical trials and ‘A constant frequency in the sedative systematic reviews of randomised controlled range (100-130 Hz) is selected. Calvcrlcy n o known therapeutic ingredient. available’ (Savage. 1987. If IFC effects p a r t assisting i n resolution’ (Savage. page 6). nervous system. 130 Hz trials which have taken placebo effects into b e i n g t h e m o s t e f f e c t i v e i f this i s account. claims with experimental evidence. In a ‘Reduction o f pain’). observation i n d e t e r m i n i n g t r e a t m e n t follows that specific frequencies of the effectiveness. would question the continued use of IFC in ‘Experimental and clinical investiga- clinical practice.eeds Metropolitan therapy under study. This comrrientary was to the active ingredient in the therapeutic However. ’Reduction o f bruising’). observed with a comparable placebo (eg a ‘A constant 100 C IS produces anal- stimulator with n o current o u t p u t ) this gesia’ (Willie. were proven to be no greater than those 1992. based medicine (Sackett et al. 1997). p a g e 58. Author and Address for additional interventions may also mislead T h e mechanism by which this occurs is Publication therapists’ j u d g e m e n t of t r e a t m e n t obscure a n d discussions fail to support Dr Mark I Johnson PhD effectiveness. page 503). 1991). produce sedation a n d analgesia and increase blood flow to tissue. could be effective are likely to produce a component currents within the amplitude School of Health placebo response (Evans. It has BSc is principal lecturer Patients who believe that a treatment b e e n suggested that t h e individual in Human PhysioloAy. page 60. neuronal December I. threshold of excitation is reached and an Street. as it would suggest that tions so far have shown that a constant treatnieiit success was due to factors which frequency of 100 Hz has a suppressing were unrelated to the electrical currents effect o n the sympathetic segment of produced by interferential therapy. are used in clinical research to imitate the whereby the resting membrane potential oE 1. this mechanism of fibre activation received on. 1. 1992. activate the parasympathetic on IFC effectiveness. There is an 100 Hz would suppress the sympathetic urgent need for randomised controlled trials nervous system. Naturally. placebo produce spec@ physiologzcal effects ? to Gharala Tabasam for effects are unpopular with therapists as Even if the amplitude modulated wave is the assistance in the they question t h e reliability of clinical active ingredient of IFC it by n o means preparation of the final manuscript. failed to take placebo effects into account Acknowledgments will exaggerate treatment effects (McQuay Do diflwent electrical charactmstics of IFC I wish LO express thanks a n d Moore. 1998. investigators can separate clinical effects due action potential generated (moth. cost-conscious health service it is becoming ‘Frequencies of 10-1 50 Hz stimulat- increasingly difficult to justify the use of ing t h e p a r a s y m p a t h e t i c nerves treatments which are not underpinned by increase t h e blood flow through t h e good quality clinical evidence.Are physiologtcal and clinical effects mediated Implicit in these claims is the concept that by the amplitude m. Because placebos have the axon is gradually depolarised until the University. 1996). This is the cornerstone of evidence. 1998 a g e n t .ceds I S 1 3HE.patient’s symptoms or treatment effects of excitable tissue in deep-seated structures. Physiotherapists believe Experimental work using animals a n d that the amplitude modulated wave is the humans has shown that the analgesic active ingredient of IFC and they claim that effect of transcutaneous electrical nerve the amplitude modulated wave mediates stimulation (TENS) is mediated by the physiological effects by selectively activating selective activation of large diameter fibres PhysiotherapyJune 1999/vol85/no 6 .odulated -ruai~e? different frequencies of the amplitude The continued use of IFC in clinical practice modulated wave can selectively activate h a s b e e n justified in part by the different populations of nerve fibres or physiological rationale which underpins its initiate differing physiological actions. from clinical effects d u e to t h e has been questioned and the relationship a r i d accepted on investigators’ a n d patients’ belief that between fibre type activated. t h e a u t o n o m i c n e r v o u s system’ Therapists who continued to use IFC under (Nikolova.

An the management of differing medical evaluation of the use of IFC treatmenc conditions. Pilot studies suggest that thc d e t e r m i n i n g t h e t y p e o f structure analgesic effects of IFC occur only when tht stimulated (Martin. there. 1994. Savage (1992) suggests IFC treatment protocols for m o r e t h a n 20 medical 2. 296 located in superficial structures such as some therapists may use the information ir the skin (Garrison and Foreman. 1987. For example: protocols is needed. the same way as a medical practitioner woulc Conventional TENS delivers electrical pulses use the British National Formulary wher with a short pulse duration which selectively determining the type and dose of a drug activate large (touch related) but not small T h e uncertainty between the electrica (pain relateed) diameter afferents. i s of l i t t l e or no importance in manage pain. Commentators claim that specific devices are large and non-portable. the evidence to support the role of I question some of the beliefs anc swing patterns in determining differential practices about the clinical use of IFC physiological effects is weak ('Johnson and Inferring IFC effectiveness from anecdota Wilson. stimulator is switched o n . Whether characteristics of IFC and specific physio the amplitude modulated wave of IFC can logical and clinical effects casts doubt o r selectively excite different populations of the value of IFC treatment protocols. At the constraints of the clinical rota? present. 15 t o 20 treatments constitute a 1. The rationale accepted within physiotherapy because oj for such effects is rarely explained. in pain and this may be throughout the The issue of frequency-dependent effects entire day (Johnson et al. a n d t h e r e i: Using the results of TENS studies to infer limited pain relief once the stimulator ha: a relationship between physiological effects been switched off (Tabasam et al. A randomised placebo-controlled clinical therapeutic course' (Nikolova. relieve pain. TEN: of IFC is further confused by the role of patients exhibit no fatigue or adverse effect: swing patterns which allow a therapist from long treatment sessions. IFC treatmeni frequency band of the amplitude modulated has taken place within a clinic because IFC wave. should be questioned when IFC is used tc fore. 1997). A benefits over o t h e r electro-analgesic current o f a rhythmical frequency of techniques such as TENS. A randomised controlled clinical trial tc conditions a n d DeDomenico (1987) compare the analgesic effectiveness of IFC provides 15 tables of possible IFC protocols. trial to investigate the effectiveness of IFC tc page 53). The analgesic modulated wave of IFC is dangerous. PhysiotherapyJunr1999/vol %/no 6 . 1997). This approack amplitude modulated wave]. 1998 and specific frequencies of the amplitude Tabasam and Johnson. as the effects of other electrotherapies such a: electrical characteristics TENS and IFC TENS have also been shown to occur during differ markedly. although as advocates of IFC to conduct these trials. Chronic pair TENS and IFC differ in their mechanism of patients administer TENS whenever they art action or analgesic profile. with TENS. evidence is problematic. Therapists should no1 'Interferential therapy i n treating abandon the clinical use of IFC to manage diabetes mellitus is carried out in order pain as the modality could have potential t o improve pancreatic n u t r i t i o n . twc 0-100 Hz is applied for 10 t o 15 minutes studies are urgently required: daily. Traditionally. provided the) to automatically 'scan' or sweep (swing) monitor the condition of their skin beneatl- across a pre-determined upper and lower the electrodes. although some Many commentators believe t h a t IFC commentators express doubt: should be applied for n o more than 2( 'The beat frequency [ o f t h e minutes as patients may tire. It is not known whether rather than after treatment. 1991). However. page 312). Have 20 swing patterns can be used to achieve minute IFC t r e a t m e n t sessions b e e r specific physiological effects. Commentators emphasise that their IFC It is the responsibility of physiotherapists protocols are not prescriptive. nerve fibres is not known. as observations oj IFC success may be due to placebo effects Are prescriptive treatment repmes of IFC Assumptions that the active component oj justvied ? IFC is the amplitude modulated wave and T h e variety of electrical characteristics that different frequencies of this amplitude available o n IFC devices has encouraged modulated wave will produce a variety o j the development of treatment protocols for physiological effects remain unproven. 1994).

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