See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/361305649

Dexamethasone Iontophoresis Its Effect On Pain And Function In Patients With

Sciatica

Article · June 2022

CITATIONS READS

0 468

6 authors, including:

Rania M Tawfik Eman Fayez

Cairo University Cairo University
12 PUBLICATIONS 2 CITATIONS 30 PUBLICATIONS 56 CITATIONS

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Does mental practice influence execution time of motor task in stroke patients? randomised control study View project

All content following this page was uploaded by Rania M Tawfik on 15 June 2022.

The user has requested enhancement of the downloaded file.

 ISSN: 13412051
Volume 29, Issue 05, May, 2022

Dexamethasone Iontophoresis Its Effect On Pain And

Function In Patients With Sciatica
Rania M. Tawfik1, Nermeen H. Abdel Haleem2, Eman S. Fayez1, Shereen M. Said3*, Maged M. Abdel
Naseer4, Noura A. ELkafrawy1

Department of Physical Therapy for Neurology, Faculty of Physical Therapy, Cairo University, Egypt1
Department of Physical Therapy, Emergency Hospital, Cairo University Hospitals, Egypt2
Department of Basic Science, Faculty of Physical Therapy, Misr University for Science and Technology,
Egypt3
Department of Neurology, Faculty of Medicine, Cairo University, Cairo, Egypt4

Corresponding author: 3*

ABSTRACT— To investigate the effect of dexamethasone iontophoresis on pain and function in patients
with sciatica. This study was conducted on thirty patients from both sexes with unilateral sciatica due to
lumbar disc herniation at L4-L5 and /or L5-S1 level. Their ages ranged from 30 to 45 years. They were
randomly assigned into two equal groups: the study group (GA) and the control group (GB). Group A (study
group): this group received dexamethasone iontophoresis in addition to a selected physical therapy exercise
program. Group B (control group): this group received a placebo dexamethasone iontophoresis in addition
to the same selected physical therapy exercise program. Each patient was evaluated before and after four
weeks of treatment by visual analogue scale (VAS), Straight leg raising test (SLR) and Modified Oswestry
disability index (ODI) to assess the sciatic pain and function. There was a statistically significant decrease of
the mean values of VAS and ODI in the study group compared to the control group post treatment (p=0.001
and p = 0.003 respectively). There was a significant improvement in SLR test results in study group
compared to control group post treatment (p = 0.02). Dexamethasone iontophoresis has a significant effect
on pain and function in patients with sciatica.

KEYWORDS: Sciatica, Dexamethasone Iontophoresis, Exercise program.

1. INTRODUCTION
Sciatica, also known as sciatic neuralgia, is the most common symptom of lumbosacral radiculopathy which
causes low back pain that radiates down the leg, as well as sensory loss, motor weakness, and/or reflex
abnormalities. Sciatica is characterized by acute, well-localized, shooting or burning pain leg pain that
corresponds to the sciatic nerve's dermatomal distribution down the leg's posterolateral side [1].

In around 90% of cases sciatica is caused by a herniated disc causing nerve root compression. Other causes
include lumbar canal stenosis or foraminal stenosis and less frequently tumors or cysts [2]. The most
common symptom of sciatica is lumbosacral radicular leg pain that radiates below the knee and into the foot
and toes in a dermatomal pattern [2], [3]. Coughing aggravates the pain; patients may experience sensory
complaints, limited forward flexion of the lumbar spine, gait deformity, and unilateral paraspinal muscular
spasm. On the other hand, most patients have a less distinct clinical picture [4].

Magnetic Resonance imaging (MRI) is usually the modality of choice when investigating sciatica [5], [6].
The recommended protocol includes sagittal views of the lumbar spine with additional axial views

7827
Tawfik, et.al, 2022 International Medical Journal

dedicated to lower spine disks, all of which are highly accurate in depicting discoradicular impingement [5].

The goal of the primary treatment for sciatica is to keep the pain under control and maintain function while
the compression and/or inflammation decrease, provide patients with information on the natural course of
sciatica and reassure them that their symptoms will fade with time and encourage patients to be active and
avoid bed rest so that their disease doesn't interfere with their daily lives as much as possible [7], [8]

Other treatments for sciatica caused by nerve root irritation as a result of disc herniation include oral
therapies which can be followed by the spinal infiltration of corticoids, which in turn may be followed by
surgery. Percutaneous intradiscal methods (nucleolysis and nucleotomy) can be utilized after conservative
treatment and as an alternative to surgery in specific specialist centres [9].

Patients with lumbar radicular pain who do not improve naturally in a short amount of time should consider
active physiotherapy or exercise therapy. Activities for lumbar strengthening and/or stretching, general
functional exercises, and particular strengthening spinal exercises may be included in exercise programs
[10].

Iontophoresis is a noninvasive technique used to increase transdermal penetration of substances through the
skin layer (epidermis, dermis and hypodermis) [11]. With the help of two electrodes linked to the skin, the
anode (positive electrode) and cathode (negative electrode), an electrolytic solution is infused with
controlled voltage and/or charge [12]. Due to lower production costs, electrotherapy devices built for
iontophoresis application reduced in size and became more economical as microprocessor and
microcontroller technology advanced [13].

The main advantages of iontophoresis are a significant increase in the release of various types of therapeutic
agents, including drugs with high molecular weight, in addition to providing better control of the release of
these agents [12]. The disadvantages are: difficulty stabilizing the therapeutic agent in the application
vehicle, complexity of the drug release system, and prolonged skin exposure to an electric current [14].

Corticosteroid drugs are a class of synthetic steroid hormones that are produced in the adrenal cortex in
healthy individuals. Corticosteroids include glucocorticoids and mineralocorticoids; they are used to treat a
wide range of diseases and symptoms [15]. Dexamethasone is a steroid compound, belonging to the
corticosteroid class (more precisely a glucocorticoid) [16]. They are highly effective anti-inflammatory,
immunosuppressant and decongestant drugs. Since decades they have been applied in a variety of disease
conditions, e.g., auto-immune diseases, allergic reactions and cancer, often improving quality of life and
prognosis immensely [17].

So, this study was designed to determine the effect of dexamethasone iontophoresis on pain and function in
patients with sciatica.

2. Methods
Thirty patients from both sexes with unilateral sciatica due to lumber disc herniation at L4-L5 and /or L5-S1
level were included in a randomized controlled trial (RCT). The duration of illness ranged from six to
twelve months. During the months from May to December 2019, patients were chosen from the physical
therapy department of the Police Academy Hospital. The patients were diagnosed with sciatica after a
thorough clinical examination by a neurologist and radiological studies, including lumbar magnetic
resonance imaging. Patients were divided randomly into two equal groups: the study group (A) and the
7828
 ISSN: 13412051
Volume 29, Issue 05, May, 2022

control group (B).

Group A (study group): This group consisted of 15 patients (7 males and 8 females) who suffered from
sciatica. In this group, patients got dexamethasone iontophoresis as well as a selected physical therapy
exercise program.

Group B (control group): This group consisted of 15 patients (5 males and 10 females) who suffered from
sciatica. In this group, patients were given a placebo dexamethasone iontophoresis in addition to the same
selected physical therapy exercise program.

Inclusion criteria included: The patients with unilateral sciatica due to lumbar disc herniation at L4-L5
and/or L5-S1 level based on careful neurological assessment and radiological investigations, including
magnetic resonance imaging (MRI) of the lumbar spine, patients with positive straight leg raising test
(SLR); their ages ranged from 30-45 years; their illness duration ranged from 6 to 12 months; and their
body mass index (BMI) was less than 30 kg /m2.

Exclusion Criteria included: Pregnant females, patients with lumbar canal stenosis, foraminal stenosis,
tumors (spinal tumors), cysts, spinal fracture, polyneuropathy, cauda equina syndrome and cord
compression, previous spinal surgery, degenerative spondylolithesis and patients who are medically or
psychologically unstable.

II. Instrumentations:
A) Instrumentations used for assessment:
Visual analogue scale (VAS):
Pain was quantified using the visual analogue scale (VAS), which is a ten-centimeter horizontal line with no
pain (0) at one end and worst pain (10) at the other end. The length of the line measured from the left side to
the marked point by the patient was regarded a valid means of judging pain intensity [18].

Straight leg raising test (SLR):

The straight leg raising test also called the Lasegue test is a basic neurological procedure used during a
physical examination of a patient with low back pain to detect sciatic impairment caused by lumbosacral
nerve root irritation. The SLR is considered positive when it causes radiating pain along the sciatic nerve
course and below the knee between 30 and 70 degrees of hip flexion [19], [20].

Modified Oswestry low back functional disability questionnaire:

Modified Oswestry Low Back Pain Disability Questionnaire (also known as the Modified Oswestry
Disability Index (ODI)) is a crucial tool used by researchers and disability evaluators to assess a patient's
permanent functional disability. This questionnaire is intended to provide the therapist with information on
how the patient's capacity to engage in daily life has been impacted by back pain [21].

B) Instrumentations used for treatment:

Iontophoresis device:
The Unify Guidance E device was used to give dexamethasone iontophoresis (Made in Bilzen, Belgium and
carry a serial number: 72881).

Medications:
The used medication was 2 cc. of 0.4% (4mg/ml) Dexamethasone phosphate ampoule (8mg/2ml).
7829
Tawfik, et.al, 2022 International Medical Journal

III. Assessment Protocol:

(1) The purpose and methods of the study were communicated to the patients prior to their participation,
and all patients signed a consent form.
(2) All patients underwent a detailed history taking and neurological examination.
(3) To control the diurnal effect, all testing sessions were conducted at the same time of day.
(4) Patients were instructed to dress in light, comfortable clothing and refrain from anxiety and emotional
tension.
(5) Before beginning treatment and after 4 weeks of treatment, evaluation procedures were carried out in the
form of:

A. Visual Analogue Scale (VAS):

Visual Analogue Scale (VAS) was used to assess pain intensity; each patient was instructed to be aware of
the VAS as being a ten cm horizontal line with one end described as (no pain =0), and other end (the worst
pain I ever felt = 10). Patients were asked to mark a point on the line between the extremes that relates to
their level of pain [18].

B. Straight leg raising test (SLR):

The participants laid supine with a normal cushion supporting their head in a neutral position. The examiner
was on the same side of the bed as the elevated limb. The hands of the examiner were placed proximally
above the patella and distally behind the calf/Achilles tendon. The subject's leg was passively elevated
towards 90° with the hip in neutral rotation, knee completely extended, and ankle left loose, and this was
repeated until the patient complained from pain in the back of thigh and leg. The SLR was stopped at 90° if
no responses were elicited [22].

B. Modified Oswestry low back disability questionnaire:

It was used to assess a patient's functional impairment, and the Modified Oswesrty Index was used to
interpret the results. It is divided into ten sections, each of which covers a different aspect of daily living.
The patient was instructed to check one box in each section for the statement that best fit him or her. For
each section the total possible score was 5; if the first statement was marked the section score = 0; if the last
statement was marked, the section score = 5. If all 10 sections were completed and the score was calculated
as following: (total scored) /50 (total possible score) x 100. Minimum detectable change (90% confidence):
10% points (change of less than this may be attributable to error in the measurement) [23].

IV) Treatment Protocol:

Group (A): In addition to the chosen physical therapy program, patients in this group got dexamethasone
iontophoresis. The dexamethasone iontophoresis (2 cubic centimetres solution containing 8 milligramme of
0.4 % dexamethasone injected to the negative electrode) is carried out for 20 minutes. The patients in this
group received 3 sessions /week for 4 weeks.

Application of dexamethasone iontophoresis:

• Patients were told to lie in a comfortable prone position.
• To achieve optimum contact, clean the skin before inserting the electrodes.
• Electrode placement: Target the stimulation at the proper spinal cord level L3-S1 to gain the most
benefit from the modality. One electrode (active electrode) should be placed paravertebral, while the second
electrode (dispersed electrode) should be placed over the sciatic notch.
• At least the diameter of the active electrode should divide the electrodes
• Low-amperage currents appear to be more effective as a driving force than high-amperage currents.
7830
 ISSN: 13412051
Volume 29, Issue 05, May, 2022

A current intensity of 2-4 mA was recommended.

• A typical iontophoresis medication dose was 40 mA/min.
• The generator was turned on and maintained at (40-45 MA) for the whole 20-minute therapy.

The selected physical therapy program included the following:

A) The flexibility program: Stretching exercises for the hamstring and piriformis muscles, as well as
stretching for the lower back muscles, were included. Each stretching exercise was held for 30 seconds and
repeated three times with a three-second rest in between each stretch.
B) Strengthening exercises for abdominal and back muscles in the form of: Static abdominal exercise,
bridging exercise, and pelvic rocking exercise. Each exercise was performed in two sets/ session. Each set
consists of five repetitions with one minute rest in between and a five-count hold before the patient returns
to the beginning position.

Group (B): Patients in this group got a placebo dexamethasone iontophoresis as well as the selected
physical therapy exercise program. The patients in this group received 3 sessions /week for 4 weeks.

2.1 DATA ANALYSIS

Descriptive statistics and unpaired t-test were conducted for comparison of the mean age, weight, height
and BMI between groups. Chi squared test was conducted for comparison of sex distribution between
groups. Unpaired t-test was conducted for comparison of VAS and ODI between groups; and paired t test
was conducted for comparison between pre and post treatment in each group. Chi- squared (Fisher's exact)
test was used for comparison of SLR test finding between groups; and McNemar test was conducted for
comparison of SLR test finding between pre and post treatment in each group. The level of significance for
all statistical tests was set at p < 0.05. All statistical measures were performed through the statistical
package for social studies (SPSS) version 25 for windows.

3. Results
Subject characteristics:
Table 1 showed the subject characteristics of both groups. There was no significant difference between
groups in the mean age, weight, height and BMI (p < 0.05). Also, there was no significant difference in sex
distribution between groups (p = 0.45)

Table 1. Comparison of the mean age, weight, height, BMI and sex distribution between study and control
groups.
Study group Control group

mean ± SD mean ± SD MD t- value p- value

Age (years) 41.13 ± 2.66 40.86 ± 3.33 0.27 0.24 0.81

Weight (kg) 81.33 ± 6.83 80.53 ± 8.53 0.8 0.28 0.77
Height (cm) 168.33 ± 8.6 166.53 ± 8.3 1.8 0.58 0.56
BMI (kg/m²) 28.72 ± 1.76 29 ± 1.83 -0.28 -0.41 0.68
Females/Males 8/7 10/5 (χ2 = 0.55) 0.45
SD, Standard deviation; MD, mean difference; χ , Chi squared value; p-value, Level of significance.
2

7831
Tawfik, et.al, 2022 International Medical Journal

Effect of treatment on VAS, ODI and SLR:

Within group comparison
There was a significant decrease in VAS and ODI scores post treatment compared with that pretreatment in
both groups (p < 0.001). The percent of change of VAS and ODI of the study group was 49.25 and 34.07%
respectively while that in the control group was 26.11 and 16.08% respectively (Table 2).

There was a significant improvement in SLR test results post treatment in the study group compared with
that pretreatment (p > 0.001), while there was no significant change in the control group (p > 0.05) (Table
3).

Between group comparison

There was no significant difference between the study and control groups pretreatment (p > 0.05). Study
group showed significant decrease in VAS and ODI scores compared with that of the control group post
treatment (p < 0.01) (Table 2).

There was significant improvement in SLR test results of the study group compared with that of the control
group (p > 0.01) (Table 3).

Table 2. Comparison of the mean values of VAS and ODI pre and post treatment of the study and control
groups:
Study group Control group
mean ± SD mean ± SD MD t- value p value

VAS
Pre treatment 8 ± 1.41 7.66 ± 1.11 0.34 0.71 0.47
Post treatment 4.06 ± 0.88 5.66 ± 0.81 -1.6 -5.15 0.001
MD 3.94 2
% of change 49.25 26.11
t- value 14.75 14.49

p = 0.001 p = 0.001

ODI (%)
Pre treatment 42.26 ± 8.18 44.4 ± 8.91 -2.14 -0.68 0.5
Post treatment 27.86 ± 7.47 37.26 ± 8.5 -9.4 -3.21 0.003
MD 14.4 7.14
% of change 34.07 16.08
t- value 12.01 7.31
p = 0.001 p = 0.001
SD, standard deviation; MD, mean difference; p-value, level of significance

Table 3. Comparison of SLR test results pre and post treatment of the study and control groups:

7832
 ISSN: 13412051
Volume 29, Issue 05, May, 2022

Study group Control group

SLR Frequency Frequency χ2- value p value
Pre treatment
Positive 15 (100%) 15 (100%)
0 1
Negative 0 (0%) 0 (0%)
Post treatment
Positive 2 (13.3%) 10 (66.7%)
8.88 0.008
Negative 13 (86.7%) 5 (33.3%)
McNemar’s test value 11.07 3.2
p = 0.001 p = 0.07
χ , Chi squared value; p-value, Level of significance
2

4. Discussion
Sciatica is a debilitating illness that affects about a quarter of the population. Patients frequently complain
of lower limb discomfort that is more severe than low back pain, as well as numbness and motor weakness
[24]. Iontophoresis, commonly known as transdermal delivery, is a technique that uses electrical current to
deliver a drug through the skin. This method improves drug absorption across biological tissue, such as skin
[25].

The current study was conducted to investigate the effect of dexamethasone iontophoresis on pain and
function in patients with sciatica.

In the present study there was a statistically significant decrease of the mean values of VAS and ODI in the
study group compared to the control group post treatment (p = 0.001). Also, there was a significant
improvement in SLR test results of the study group compared with that of the control group (p > 0.05).

These findings are in line with those of [26], who investigated the effects of transdermal steroid application
in radiculitis. The goal of this study was to test if administering an anti-inflammatory medicine via local
iontophoretic administration to patients with tendonitis of the shoulder joint would produce similar
outcomes as administering the drug locally. In 36 patients with cervical and lumbar radiculitis, transdermal
administration of steroids (iontophoresis) was used with medical and physical therapy treatment. The results
showed that the group that utilized iontophoresis in conjunction with medicine and other physical therapy
methods had the highest benefits.

Moreover, [27] evaluated the effectiveness of dexamethasone iontophoresis (DIP) for temporomandibular
joint (TMJ) involvement in juvenile idiopathic arthritis (JIA). The effectiveness of DIP was assessed by
comparing the maximal inter-incisor opening (MIOTMJ) and the maximal lateral excursion (MLETMJ)
before and after treatment. Improvement in TMJ range of motion from DIP is associated with lower
MIOTMJ, lower MLETMJ, and absence of TMJ crepitus at baseline. DIP appeared to be an effective and
safe initial treatment of TMJ involvement in JIA, especially among patients with decreased TMJ
measurements.

The findings of this study corroborate those of [28], who looked at the effects of dexamethasone
iontophoresis on individuals with acute Bell's palsy and divided the patients into two equal groups (A,B).

7833
Tawfik, et.al, 2022 International Medical Journal

Oral systemic steroids were given to group (A) together with a placebo effect of iontophoresis, while
Dexamethasone Iontophoresis was given to group (B). There was a considerable difference between group
A and group B, according to the findings. They concluded that dexamethasone iontophorsis is efficient in
treatment of acute Bell's palsy.

The findings of this study are also consistent with those of [29], who conducted a controlled clinical trial
(CCT) to assess the efficacy of a conservative treatment for carpal tunnel syndrome (CTS) using
corticosteroids iontophoresis combined with ultrasound therapy. The study found that physiotherapeutic
treatments are successful in treating non-advanced forms of CTS, but that individuals with advanced CTS
should be referred for surgery.

Moreover, [30] conducted a randomized control trial (RCT) to assess the effects of steroid iontophoresis
(SI) and electrotherapy (ET) on bicipital tendonitis. The ET group showed less immediate improvement and
the advantage was less long-lasting than the SI group. The authors suggested that the application of steroid
iontophoresis (SI) in addition to conventional physical therapy provides a better and more prolonged
clinical and functional improvement in patients with biceps tendonitis.

Also, the findings of this study are consistent with those of [31], who compared the effects of TENS and
sodium salicylate iontophoresis on functional impairment and pain in 20 patients with osteoarthritis of the
knee. Although both groups showed a significant reduction in pain and functional disability, the researchers
determined that group treated with sodium salicylate had a significant higher reduction of pain and
functional disability compared to the other group treated with TENS.

The anti-inflammatory effects of glucocorticoids are mostly attributable to a reduction in the production
and/or release of a range of inflammatory mediators, including prostaglandins, which are also blocked by
NSAIDS, which could explain the improvement. The combination of these actions suppresses the vascular
alterations that cause the cardinal indications of inflammation [32].

Dexamethasone is a synthetic glucocorticoid steroid that is 25 times more effective at reducing

inflammation and has little sodium retention. Overall, dexamethasone's effects have been shown to be
outstanding. The binding of glucocorticoids to particular receptors in the cytoplasm of targeted cells
initiates their anti-inflammatory and metabolic activities. The receptor-steroid complex subsequently
migrates to the nucleus, where it binds to DNA and disrupts protein synthesis. A variety of cellular
functions are influenced as a result, including the production of enzymes that govern metabolic processes
and those that control the synthesis of inflammatory autacoids immune-related cytokines [11].

The findings of this study, however, conflicted with those of [25], who performed a systemic review to
investigate the effectiveness of iontophoresis as a treatment for lateral epicondylitis. The authors concluded
that iontophoresis is not suggested for the management of epicondylitis; however, because it is a dose-
response modality, it should not be ruled out in the treatment of epicondylitis. So, more research and
reviews of research on the use of iontophoresis in the treatment of epicondylitis are needed

Furthermore, the findings of this study contradict those of [33] who looked into the efficacy of
dexamethasone iontophoresis as a noninvasive treatment for carpal tunnel syndrome. The majority of the
outcome indicators showed no meaningful improvement after therapy. Although the treatment group had a
subjective improvement in symptom severity levels, the control group had a similar improvement. They
found that while corticosteroid iontophoresis is possible in clinical settings and well tolerated by patients,
7834
 ISSN: 13412051
Volume 29, Issue 05, May, 2022

dexamethasone iontophoresis was ineffective in treating mild to moderate carpal tunnel syndrome

The possible limitation of our study is the lack of follow-up to determine the long term effects of
dexamethasone iontophpresis on pain and function in patients with sciatica. However, the study may help in
the future research toward better results in patients with sciatica.

Conclusion: On the basis of the present data, it is possible to conclude that: Dexamethasone iontophoresis
has a significant effect in improvement of pain and function in patients with sciatica.

5. Funding
This work was not funded.

6. Conflict of Interest
The authors declare no conflict of interest.

7. References
[1] Fjeld O, Grotle M, Siewers V, Pedersen LM, Nilsen KB and Zwart JA (2017): Prognostic Factors for
Persistent Leg-Pain in Patients Hospitalized with Acute Sciatica .Spine, 42 (5), pp. E272-E279.

[2] Valat JP, Genevay S, Marty M, Rozenberg S, Koes B (2010): Sciatica. Best Pract Res Clin Rheumatol,
24:241 7 –252.

[3] Tulder M, Peul W, Koes B (2010): Sciatica: what the rheumatologist needs to know. Nat Rev
Rheumatol., 6:139-145.

[4] Kumar M, Garg G, Singh LR, Singh T, Tyagi LK (2011): Epidemiology, Pathophysiology and
Symptomatic Treatment of Sciatica: A Review .International Journal of Pharmaceutical & Biological
Archives, 2(4):1050-1061.

[5] Jarvik JG and Deyo RA.(2002): Diagnostic evaluation of low back pain with emphasis on imaging. Ann
Intern Med ,137:586–597.

[6] Wassenaar M, van Rijn RM, van Tulder MW, et al. (2012): Magnetic resonance imaging for diagnosing
lumbar spinal pathology in adult patients with low back pain or sciatica: a diagnostic systematic review. Eur
Spine J, 21:220–227

[7] Stochkendahl MJ, Kjaer P, Hartvigsen J, Kongsted A, Aaboe J, Andersen M, et al. (2018): National
Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar
radiculopathy. Eur spine J ; 27(1):60-75.

[8] National Institute for Health and Care Excellence (2016): Low back pain and sciatica in over 16s:
assessment and management (NICE guideline NG59). Full guideline .www.nice.
org.uk/guidance/ng59/evidence.

[9] De Sèze M, Saliba L and Mazaux JM (2013): Percutaneous treatment of sciatica caused by a herniated
disc: an exploratory study on the use of gaseous discography and Discoge. j.rehab; 56(2):143-54.

7835
Tawfik, et.al, 2022 International Medical Journal

[10] McKenzie RA and May S.(2006): The Cervical and Thoracic Spine: Mechanical Diagnosis and
Therapy: New Zealand; 2nd edition. Spinal Publications; Vol.1, 150

[11] Krueger E, Claudino Junior JL, Scheeren EM, Neves EB, Mulinari E, Nohama P (2014):
Iontophoresis: principles and applications. Fisioter Mov ; 27(3):469-81.

[12] Esteves Junior I, Masson IB, Ferreira LM, Liebano RE, Baldan C, Gomes AC. (2005): Topical
administration of hydralazine hydrochloride on the viability of randon skin flaps in rats. Acta Cirur Bras;
20(2):164-167.

[13] Gratieri T, Gel fuso G, Lopez R.(2008): Basic principles and applications of iontophoresis for
cutaneous penetration of drugs. Quím Nova; 31(6):1490-8.

[14] Chorilli M, Brizante AC, Ro drigues CA, Salgado HRN, Pombo-Nascimento E, Ventura DM, et
al.(2007): Aspectos gerais em sistemas transdérmicos de liberação de fármacos. Rev Bras Farm.;88(1):7-13.

[15] Ramamoorthy S and Cidlowski JA.(2016): Corticosteroids-mechanisms of action in health and disease.
Rheum Dis Clin N Am. ; 42(1):15–31.

[16] Ahmed MH and Hassan A.(2020): Dexamethasone for the Treatment of Coronavirus Disease (COVID-
19): a Review. SN Compr Clin Med.; 31:1-10.

[17] Bordag N, Klie S, Jürchott K, Vierheller J, Schiewe H, Albrecht V, Tonn JC, Schwartz C, Schichor C,
Selbig J. (2015): Glucocorticoid (dexamethasone)-induced metabolome changes in healthy males suggest
prediction of response and side effects. Sci Rep ;5:15954.

[18] Mohan H, Ryan J, Whelan B, Wakai A. (2010): The Visual Analogue Scale and Verbal Numerical
Rating Scale as pain assessment tools in the emergency department. Emergency Medical J; 27(5):372-375.

[19] M Das J, Nadi M. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Mar 31, 2021.
Lasegue Sign.
.
[20] Ropper AH and Zafonte RD.(2015): Sciatica. N Engl J Med ; 372(13):1240–1248.

[21] Fritz JM and Irrgang JJ (2001): A comparison of a Modified Oswestry Low Back Pain Disability
Questionnaire and the Quebec Back Pain Disability Scale. Physical Therapy; 81:776-788.

[22] Pesonen J, Shacklock M, Rantanen P, Mäki J, Karttunen L, Kankaanpää M, Airaksinen O, Rade

M.(2021): Extending the straight leg raise test for improved clinical evaluation of sciatica: reliability of hip
internal rotation or ankle dorsiflexion. BMC Musculoskeletal Disorders: 22(1):303

[23] Fairbank JCT and Pynsent, PB (2000): The Oswestry Disability Index. Spine, 25(22):2940-2953.

[24] Ferreira ML. and McLachlan A. (2016): The Challenges of Treating Sciatica Pain in Older Adults
Drugs and Aging, 33 (11): 779-785.

[25] McKivigan J., Yamashita B. and Smith D. (2017): A Systematic Review on the Efficacy of
7836
 ISSN: 13412051
Volume 29, Issue 05, May, 2022

Iontophoresis as a Treatment for Lateral Epicondylitis. Research and Investigations in Sports Medicine;
1(3),[Article RISM.000512].

[26] Gour S, Narkeesh A, and Raghuveer (2011): Effects of Transdermal Application of Steroids in
Radiculitis. Journal of Exercise Science and Physiotherapy; 7(1): 34-41.

[27] Mina R, Melson P, Powell S, Rao M, Hinze C, Passo M, Graham TB and Brunner HI (2011):
Effectiveness of Dexamethasone Iontophoresis for Temporomandibular Joint Involvement in Juvenile
Idiopathic Arthritis. Arthritis care and research J.; 63(11);1511–1516.

[28] EL-Bahrawy M.N., Abd EL-Aleem H.H., Mansour W.T. and Ibrahim M.R. (2019): Effect of
Dexamethasone Iontophoresis on Acute Bell's Palsy Patients: Medical journal of Cairo university; 87(1):
827-834.

[29] Dakowicz A. and Latosiewicz R. (2005): The value of iontophoresis combined with ultrasound in
patients with the carpal tunnel syndrome. Roczniki Akademii Medycznej w bialymstoku; 50 (1):196-8.

[30] Taskaynatan M. A., Ozgul A., Ozdemir A., Tan A. K. and Kalyon T. A. (2007): Effects of steroid
iontophoresis and electrotherapy on bicipital tendonitis. Journal of Musculoskeletal Pain ;15(4) :47-54.

[31] Aiyejusunle C. B., Kola-Korolo T. A. and Ajiboye O. A. (2007): Comparison of the effects of tens and
sodium salicylate iontophoresis in the management of osteoarthritis of the knee. Nig QJ Hosp Med; 17(1):
30-34.

[32] Schimmer BP, Funder JW., Brunton LL, Chabner BA and Knollmann BC (2011): Adrenal steroids and
pharmacology of the adrenal cortex. ThePharmacological Basis of Therapeutics. 12th edition; Chapter 42.

[33] Amirjani N., Ashworth N.L., Watt M.J, Gordon T and Chan KM. (2009): Corticosteroid iontophoresis
to treat carpal tunnel syndrome: A double-blind randomized controlled trial. Muscle Nerve. Wiley Inter.
Science; 39 (5): 627-633.

This work is licensed under a Creative Commons Attribution Non-Commercial 4.0

International License.

7837

View publication stats