Evaluation of Tissue Oxygenation using Near Infra-red Spectroscopy Following Pulsed Radiofrequency Energy

Introduction: Near infra-red spectroscopy (NIRS) has been used to evaluate tissue oxygen saturation and perfusion Pulsed Radio Frequency Energy (PRFE) is a noninvasive therapy promoted to decrease tissue inflammation and edema, while enhancing tissue perfusion.  This case presentation demonstrates the effect of PRFE on enhancement of tissue oxygenation and perfusion using NIRS.Methods:  NIRS (SnapshotNIR, Kent Imaging LLC, Calgary, Canada) is a non-invasive imaging device that can measure oxygenated and de-oxygenated levels of hemoglobin in the wound and periwound tissues to calculate and create an image of tissue oxygen saturation. PRFE (Provant Therapy, Regenesis Biomedical Inc,  Scottsdale, AZ, USA) is a non-invasive device that delivers pulsed electromagnetic energy to superficial soft tissue in the radio frequency range, typically 27.12 MHz.   A series of cases is presented to demonstrate the effectiveness of Provant Therapy in increasing tissue perfusion oxygenation using SnapshotNIR. Results:  Three subjects received PRFE therapy to one lower extremity.  Provant therapy was administered using the manufacturer’s recommend use guidelines.  Each subject was treated for 30min in a seated position with both extremities elevated to the level of the heart.  SnapshotNIR imaging was accomplished before and after therapy.  Increases in tissue oxygenation was measured in the treated extremity using NIRS in all three subjects, while imaging of the non-treated extremity showed no increase in tissue oxygenation.Discussion:  One of the top priorities in the field of wound care is reducing inflammation and tissue edema, both of which have been correlated with increased tissue oxygenation and perfusion as well as a reduction in associated pain. Pain management in patients with chronic wounds is typically achieved by using medications such as opioids and NSAIDS, both of which have negative side effects and cannot be used without close supervision. Therapies that activate the endogenous anti-inflammatory and anti-nociceptive pathways are being pursued as alternatives to the use of oral medications, due to their lack of systematic load and limited side effects.  This study is the first to demonstrate enhancement of tissue oxygenation and perfusion using NIRS imaging following PRFE therapy.  Additional research is suggested to further define the clinical ramifications of this finding.   References:1. Niezgoda JA, Hardin ST, Kubat N, Acompanado JA. The Management of Intractable Pain with Adjuvant Pulsed Electromagnetic Field Therapy. PUBLISHED, May 2014, ADVANCES IN SKIN AND WOUND CARE (Adv Skin Wound Care. 2014 May: 27(5), 205-209). 2. Foley-Nolan D, Barry C, Coughlan RJ, O'Connor P, Roden D. Pulsed high frequency (27MHz) electromagnetic therapy for persistent neck pain. A double blind, placebo-controlled study of 20 patients. Orthopedics Apr 1990;13(4):445-451. 3. Moffett J, Griffin NE, Ritz MC, George FR. Pulsed radio frequency energy field treatment of cells in culture results in increased expression of genes involved in the inflammation phase of lower extremity diabetic wound healing. J Diabetic Foot Complications 2010;2(3):57-64. 4. Moffett J, Kubat NJ, Griffin NE, Ritz MC, George FR. Pulsed radio frequency energy field treatment of cells in culture results in increased expression of genes involved in angiogenesis and tissue remodeling during wound healing. J Diabetic Foot Complications 2011;3(2):30-39.