APS Therapy and MS – the story so far

What is Action Potential Simulation? What is an APS Therapy machine?

Action Potential Simulation is sending an electrical copy of a nerve signal along the cells of the body, in between two electrodes. An APS Therapy machine is a machine that does this! APS Therapy comes up in my blogs because it’s my passion, and also, now, my business, because of the results it has had in reducing pain naturally,  and in my working experience with my patients with MS.

 

Background

As an MS specialist nurse, I have always been aware of how much pain can be a problem in MS.  The big one is ‘neuropathic’, or unpleasant burning, tingling or shooting pains that are the result of inflammation, or scarring in the nervous system. ‘Normal’, or ‘nociceptive’ type pain in MS can typically include cramping muscle spasm, pain in stiff or very tired muscles, or the sorts of back or joint pains that can be caused by by being less mobile, or putting a strain on certain joints. Because the medications used, especially for neuropathic pain, can cause very problematic side-effects, including increased fatigue, weight gain, cognitive impairment, co-ordination problems and mood problems, I have always been on the lookout for new, natural, or left-field treatments.

 

I heard about APS Therapy when my friend, manager of the pain team in Hull, called to say that I might be interested – they were having training from a company in Holland in a little known pain relieving device, which had been having big effects on some of their MS patients, and which they were about to start a pilot study in for people with rheumatoid arthritis, and people with MS. Of course I was!

Having had our training from Maurice, from APS HQ in Holland, It actually took a year before the Hull team were able to start their study, and during this time, my workplace, the Beds & Northants MS Therapy centre,  had already allowed us to get started with a clinic machine, running first one, and quite soon, due to popular demand, two machines. Our clinic has now been running for  5 years, now using 4 APS Therapy clinic machines, and one home-use rental machine, and is very busy every weekday, with lots of really happy stories of improved pain and symptoms, and less use of medication.

 

 

Given that the APS has:
  • reduced my fatigue
  • Allowed me to reduce my intake of pregabalin
  • allowed me to come off the voltarol altogether,

I think it is a no-brainer that I should continue!    – Meryl Lovatt, Northamptonshire.

 

 

Because I’m both a clinical nurse specialist in MS, and also have taken on the training and distributorship for APS Therapy in the UK, I’ve been able to train 11 other MS Therapy centres around the country, who now also offer APS Therapy:  Leicestershire, Berkshire, Hertfordshire, Kent, Hampshire, Cardigan, Exeter, Manchester, Sutton and Croydon, Suffolk and the MS-UK Wellness centre in Colchester.

This year, with supervision from the University of Bedfordshire, as part of an MSc by research, I aim to carry out a clinical trial on the effects of APS Therapy in people with MS, with MS Nurse colleagues in the NHS.

 

 

What are action potentials?

 

 

 

APS stands for action potential simulation. Action potentials are the tiny waves of electricity that pass down nerves and other cells, conducting the nerve signal and stimulating cellular functions.  Action potential simulation therapy machines send a copy of this wave, or ‘wave form’ , and also stimulate the body’s own action potentials, between electrodes on to the skin. This results in better communication between cells, improved removal of the waste products of inflammation, and increased production of the hormone melatonin, neuro-transmitter leukine encephalin and the energy carrying molecule, adensoine triphosphate, or ATP.

 

The release of neurotransmitters, including the body’s own pain regulating agents, is stimulated by the electrical discharge of action potentials along nerve cells, and recent research 26 suggests that stimulation of action potentials creates an increase in spontaneous neurotransmitter release that stays elevated well after the stimulation has ended. This may explain why APS can sometimes be so helpful in MS neuropathic pain.

The results to the user, when it works, include reduction in, or sometimes complete relief of pain, enhanced energy/reduced fatigue, enhanced recovery from injury or exercise, and in many cases, improvement to sleep quality and quantity.

So what were the results with our patients?

In Bedford, we have been running our clinic now for over 5 years, but at the 2 year point, we compiled and analysed the outcome measurements, and were able to show the statistical significance in pain relief in a paper and also clinical posters, which were exhibited at a number of international MS conferences in 2016.

Poster Action Potential Simulation Therapy for pain in people with MS, report on a two year pilot study (3) (1) (1)

 

 

In the first 2 years we treated 60 people with a 6 week course of APS Therapy 2-3 x a week, for pain.

(We planned for 3 x a week, but in reality this was often 2) We found that 78% of those people had a reduction in pain; 23% to pain free.

The average reduction in pain was 3.22 for ‘usual’ pain, and 4.78 for ‘worst’ pain on the

10 point ‘Visual Analogue Scale’  (VAS)

In practice, there was a great variety, from no change, to dramatic drops from high pain levels to pain free, as you can see on the following charts.

We broke the pain types down to study the effects, and our biggest group was ‘neuropathic pain in feet and legs’. Here is the before and after bar graph for that pain at ‘usual’ level from that group; before is dark blue, and after pale blue.

Average VAS (0-10 scale) pre: 6.06                 Average post: 2.65

 

And here is the same pain at ‘worst’ levels:

 

Average VAS Pre: 8.3                                                 Post: 3.6

 

The other pain groups were ‘other neuropathic pain’, ‘joint pain or injury’, ‘back pain’ , ‘headaches’ and ‘other nociceptive pains’; all of these groups had an overall reduction in pain; the greatest was for ‘joint pain and injury’.

We found that whilst joint pain, musculoskeletal pain and injury sometimes needed only a short course of treatment to be resolved, neuropathic pain in MS is very often helped, but if it is long term, is likely to need maintenance after the first 6 weeks, of once a week treatment, which for most people, is enough.

In general, people were extremely happy with the treatment. 33 of these first 60 people reduced or discontinued medication as a direct result, which also added to their wellbeing.

We haven’t stopped keeping data, just haven’t stopped recently to collate it! One of the most enjoyable things about being involved in running an APS Therapy clinic at work, is hearing about people with MS  reporting not just pain relief, but many other benefits, and the positive impact this has had on their quality of life.

We’ve had reports of reduction in spasms, elevation in mood, improvement to sleep quality, cessation of recurrent UTIs when on 3 x week, disappearance of fatty/benign lumps, improvements to constipation, hormonal balance, and have just had some really big breakthroughs with trigeminal neuralgia.

The most common of the ‘other benefits’ have been energy improvement/fatigue reduction, and because of this, our clinic is now open for people who want to try APS for these reasons, or to help after relapse, when recovery seems to have hit a plateau.

APS Therapy is not a cure for, nor does it have an effect on the course of MS, however, it is a very exciting treatment for some of the invisible, but also potentially disabling symptoms of the condition, especially as there is no risk, and is generally free of side-effects.

We are lucky to have had a wonderful team of volunteers in our APS Therapy clinic, led by our clinic manager, Heather, to teach and assist people, and in my private business I hire, sell and allow people to trial APS Therapy, teaching them how to use it over Skype, Facetime or Whatsapp videocalling.

Action Potential Simulation could be thought of as a ‘natural pain treatment’. It’s not just for people with MS, but it makes sense that people with MS respond particularly well to it, as the problems in MS are due to the inability of the body to conduct its action potentials down damaged nerves.

It’s my aim to attract researchers to conduct large scale clinical research so that we can explore the possibilities of APS Therapy and make it more widely known about; in the meantime, I will be conducting a small clinical trial in 2019 with colleagues in the NHS.

 

At www.painfreepotential.co.uk there are lots of words from people with MS, who have successfully used an APS Therapy machine to reduce pain, reduce spasms, come off medication in order to start families, boost themselves back after relapse and improve energy levels.

As well as MS, I also Suffer with Anklosing Spondylitis which gives me quite a lot of back pain. The MS itself was making me feel exceptionally tired & I was struggling with bad head aches & a recurring sinus issue.

A treatment plan was put together for me & within 2 weeks of starting the treatment I was no longer waking up every morning with bad headaches. My energy levels were greatly improved & my backache was reduced.

… using this machine in addition to leading a healthy lifestyle has helped me to stay active & continue to enjoy an active lifestyle. – Kat Miller, Bedfordshire.

 

 

 

 

A recent one that made me smile was from Nina Pearce, from Chelmsford, who said:

For more information on APS Therapy, visit my other site, http://www.painfreepotential.co.uk , email miranda@painfreepotential.co.uk, or call 01908 799870 and I will endeavour to call you back within a few days.
Reference:

26Cho R.W, Buhl L.K, Volfson D. Tran A. Li, F. Akbergenova,Y. Littleton, J.T. Phosphorylation of Complexin by PKA Regulates Activity-Dependent Spontaneous Neurotransmitter Release and Structural Synaptic Plasticity.  Neuron. 2015 Nov 18;88(4):749-61

 

 

 

 

Results of a one year pilot using APS Therapy for pain in MS

It’s out!! So proud of this, the report on our results for the first year of using APS Therapy at the MS Therapy Centre in Bedford.

Action Potential Simulation Therapy ( APS Therapy) for pain in people with MS; Report on a One Year Pilot Study.

Miranda Olding RGN MSCN, Denise Kehoe

 

Abstract

People with MS commonly suffer from both nociceptive and neuropathic pain, and the latter is often resistant to treatment, or hard to resolve due to the unwanted side-effects of most of the appropriate drugs.

We carried out a one year pilot using the electrotherapy device APS Therapy to treat pain in people with MS, at the voluntary sector multi-disciplinary MS Therapy Centre, in Bedford, UK.

An 8 week course of the therapy 3 times a week was offered initially, and 38 people used APS Therapy to treat 61 different pains.

Within  8 week periods, 28 people (76%) got beneficial reduction in pain. Of the 58 pains, 50 (86%) had a reduction of at least one point on the Visual analogue Scale (VAS) for pain. Of the pains that improved, 17 (30%) were reduced to pain free. The average reduction in points on the VAS was 4.7 points. 12 people reduced or discontinued medications as a direct result of the effects of APS Therapy;  with more structured review and supervision, we feel that this number could be higher, and have adjusted our practice accordingly.

Many participants reported improved sleep and enhanced energy, and the improved quality of life that this afforded.

Many of the participants who benefitted, especially those with chronic neuropathic pain, felt that they needed long term treatment, but were able to maintain the benefits sustained at a reduced frequency of treatment ( once a week or even fortnightly), and elected to carry on. We were able to offer this as an ongoing service.

Robust research on APS Therapy is scant, but based on the outstanding results of this pilot is a very promising area for further research and clinical treatment.

Introduction

The problem of pain in the UK

Pain is defined as ‘An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage’ (1)

Chronic pain is defined as continuous, long-term pain of more than 12 weeks or after the time that healing would have been thought to have occurred in pain after trauma or surgery.( 2)

Almost eight million people in the UK have chronic pain, or an estimated one in 5 Europeans. (3) As well as the human suffering, it also represents a significant burden to wider society and economies.  Chronic pain accounts for 4.6 million GP appointments every year at a cost of £69 million. Expenditure is on referrals, appointments, prescribing, consequences of ineffective home prescribing and adverse events. (4)

Current medical treatment centres around medication, but drug treatments often cause unwanted side effects or other medical problems, and the costs of drugs for managing pain alone in England in 2009 amounted to £449 million. (5)

Access to pain management services in the UK is inconsistent and available health services for pain differ markedly in the type of care they offer.(6)

Although in some chronic pain clinics, TENs, acupuncture, physical, psychological techniques, invasive treatments, and complementary therapies are offered, availability varies widely, rates of successful pain resolution are low, and 38% of people with chronic pain report  inadequate pain management.(7,8, 9)

 

The problem of pain in MS

Estimates vary as to the proportion of people with MS who suffer from pain, with some reports suggesting that up to 80% of people with MS may suffer from pain at some stage. (10,11,12)

People with MS commonly suffer from both types of pain; both nociceptive (‘normal’ type, after injury or with inflammation) and neuropathic. Neuropathic pain is defined as ‘pain caused by a lesion or disease of the somatosensory nervous system’ (13) is often characterized as burning, severe shooting pains, and/or painful numbness or tingling. It is commonly a long term or chronic pain, and effective treatment is difficult as the classes of drugs to which it responds best are associated with various adverse effects. ( sedation and weight gain most commonly)  (14)

The aim of treatment is to minimise the level of pain and to develop coping strategies so that the individual can carry out normal day-to-day living. Treatment options include drugs and non-drug treatments such as physiotherapy, electrotherapy or a combination.

Electrical therapies

There are many modalities of electrical therapies currently in use within physical therapy for pain relief and injury repair, which have been categorised into 3 broad areas(15)

Electrical stimulation agents, including Transcutaneous Electrical Nerve stimulation (TENS), Action Potential Simulation Therapy (APS Therapy), Interferential Therapy (IFT), Functional Electrical Stimulation (FES), and Microcurrent therapy (MCT),

Thermal modalities,  including Infra red Irradiation (IFR), Therapeutic Ultrasound and Laser Therapy, and

Non Thermal Modalities including Pulsed Ultrasound, Pulsed Electromagnetic Fields (PEMFs) and Microcurrent Therapy (MCT)

The most commonly used form of electrotherapy in healthcare is TENS. This uses an alternating current to affect pain gate mechanisms. A Cochrane review concludes that ‘despite the widespread use of TENS machines, the analgesic effectiveness of TENS still remains uncertain’(16)

There are many studies demonstrating its’ usefulness, however, in my experience with MS it has only occasionally been effective for mild or moderate pain, but has been limited to the duration of treatment with the electrodes, or a one or two hour carryover at best.

We heard about some exceptional case studies carried out in Hull using the electro-therapy Action Potential Stimulation (APS)Therapy showing effectiveness in reducing both pain and fatigue; drastically reducing the medication used, and increasing mobility, independence and quality of life in people with MS(17) and decided to investigate.

 APS Therapy

 APS Therapy ( Action potential simulation therapy) is a type of micro-current therapy.

These therapies involves application of electric currents of similar form and magnitude to those produced naturally by the body and there is evidence that this can promote healing in a variety of damaged tissues. (18)

The APS Therapy device uses an electrical current that supposedly mimics the normal physiological action potential of nerve conduction.  The device is said to produce action potentials that are four times stronger than those naturally occurring in the neuron. When swelling, inflammation, poor circulation and pain occur due to mechanical, chemical or electrical disturbances, by stimulating the body’s natural regenerative processes (as in depolarisation), it is postulated that these conditions are encouraged to resolve. (19) See discussion.

Literature review for micro-current and APS Therapy

A literature review on over 70 papers on micro-current therapy in 2009 concluded that there was evidence for its use with non-uniting fractures, spinal fusions and a skin ulcers, particularly where other forms of treatment had not been successful; that In vitro studies also suggest that there is unexplored potential for its use in musculoskeletal disorders. However, higher quality and more comprehensive research is needed. (20)

An assessment of APS Therapy on 285 Patients with Chronic Pain in 2002 reported  a mean average VAPS was 6.8 before treatment and 3.3 after treatment in the over 50s, and 6.3 and 2.2 respectively in the under 50s.  Out of the 285 patients,44 (15%) ended with a ‘0’ VAPS and 199 (69%) with a score of 5 or less. (21)

A trial of APS Therapy in patients awaiting or having neurosurgery for intractable spinal pain concluded that the number of patients treated was too low to reach a statistical conclusion, but that the trend was very promising and they recommended that  patients waiting for destructive surgery should first be put on a thorough trial of APS Therapy.(22)

In a 1999 randomized, patient blinded, placebo-controlled study, on 76 patients with chronic osteoporotic back pain, reported pretreatment baseline VAPS value average of of 57.79, and post- treatment value after the sixth treatment of 9.7 (p= 0,0001); 6 patients maintained benefits 6 months post treatment.(23)

A study in 1999 on APS Therapy compared with TENS in 99 patients with osteoarthritis of the knee did not find a significant difference between the two treatment groups given just 6 treatments over a 2 week period. The authors did note, however, that the APS group showed a significant improvement in measures of knee flexion and swelling, which persisted even 1 month after the last treatment. (24)

Methods

Sample

People with MS who presented with pain in the MS Nurse’s clinic were screened for suitability and contra-indications, and offered the chance to trial the therapy. Pain due to spasticity/muscle spasm , or pain whose origin was uncertain, where more investigations were needed, were excluded.

Contra-indications include having a Pacemaker, epilepsy, pregnancy, or cancer, or in the past 3 months, stroke, heart attack, deep vein thrombosis or pulmonary embolus. One participant had a baclofen pump; after discussion with the manufacturers of both devices, this was allowed in this case. We also checked that participants felt able to drink the recommended litre and a half of water daily during therapy.

All the participants gave their informed consent to take part in the study; it was made clear that this was optional. 39 had MS, 3 did not. ( 2 were members of staff, and one a volunteer)

An 8 week course of APS Therapy, with 3 x sessions a week, comprising of 4, back to back 8 minute electrode placements, was offered, in a clinic room at the multi-disciplinary, voluntary sector MS Therapy Centre in Bedford, UK. We had first one, and then 2 APS Therapy clinic machines. People who could apply the electrodes themselves had one teaching session and then self-treated, with floating supervision from staff.

During the 8 week course, 6 people dropped out. One had vomiting and headache after 1st treatment, decided not to proceed. Detoxification reactions ( usually headache) are possible, although not common if drinking the recommended amount of water, and are self-limiting.  One experienced flickering in her vision and decided not to proceed. Although there is no documented precendent for this, and the cause was uncertain, electrotherapies can trigger migraine in susceptible people. Three people became unwell, two with existing other conditions and one with an MS relapse since starting treatment and either unable or decided not to proceed. One struggled to travel for treatment and felt discouraged after no benefit felt at 2& ½ weeks.

36 people in this study went on to use APS Therapy to treat 58 different pains.

25 of the pains were neuropathic, including 2 sciatic type pains, and 34 were nociceptive, including headaches, fibromyalgia type tender spots, backache, joint pain and arthritic type pain.

32 were women and 4 were men. The average age was 52 for women and 51 for men. 11 people had relapsing remitting MS, 22 had primary or secondary progressive, and 3 did not have MS.

We measured pain using the visual analogue pain scale (VAS), asking each participant to score for the average, or constant level of pain, and the worst level of pain, and how much of the time the pain was average, how much of the time worse. Medication use was recorded.

Results:

 

In  8 week periods;

Of the 36 people, 28 (78%) had reduction in pain.

Of the 58 pains, 50 (86%) had reduction.

Of the pains that improved, 17 pains  (30%) went down  to 0/10, or pain free.

pie - people whose pain improved

pie - pains that improved with APS Therapypie - pain free with APS Therapy

 

Reduction’ was quantified as 1 or more whole points on the VAS for pain. Neuropathic pains appeared to respond almost as well as nociceptive pains to the treatment12 people reduced or discontinued medication as a direct result of the results of the APS Therapy, on reflection, with more supervision, we feel that this could have been more.The mean pre-treatment score on the VAS for ‘Average level of pain’ overall was 5.56. Mean reduction in pain was 4.7 points, to a mean post-treatment VAS of 2.3.Average reduction for ‘worst pain’ scores was 4.1 points on the VAS scale.

APS Therapy results chart

Neuropathic pain

nb. in the charts below, a score of 0 or pain free, has been represented by a score of 0.01, in order to show up as a colour.

APS Therapy for neuropathic feet and leg pain

‘Average pain’ in the 14 cases of neuropathic feet and legs had a mean pre-treatment score of 6.3, which reduced by 3.8 points on the VAS on average to 2.5.

2 individual’s pain did not respond at all, 12 people experienced a benefit, and of these, 5 people went to pain free.

APS Therapy for worst pain, neuropathic feet and legs

‘Worst pain’ for neuropathic feet and legs was a pre treatment mean of 8.03, and reduced by 5.17 on the VAS on average, to a post treatment mean of 2.46, with 5 people at pain-free.

Combined ‘average’ and ‘worst’ pain scores gave a mean reduction of  4.5 points on the VAS.

Other neuropathic or nerve pain:

In neuropathic pain of the trunk, arms, hands and face, reduction in ‘average pain’ was a mean of less, at 2.5, but still had a reduction in ‘worst pain’ of 4.9 points on the VAS.

charts - APS Therapy for other neurogenic pains

APS Therapy - charts - Worst pain, other neurogenic

 Joint pain or injury

‘Average pain’ scores for joint pain or injury had a pre treatment mean of 5.1 and fell 2.9 points on the VAS to a mean of 2.2 . Actual results were quite polarised, with 4 people having no response, and 7 going  to pain free.

joint pain or injury results with APS Therapy

‘Worst pain’ for the 16  joint type pains had a pre treatment mean of 7.5 points on the VAS, and  fell by an average 4.9 points on the VAS to a mean of  2.6. 2 people’s worst pain did not respond, and 7 pains went to pain free.

APS Therapy for worst pain - joint pain or injury

 Headaches

People with headaches responded particularly well to APS Therapy; the reduction in ‘average pain’ as scored by the VAS was 4.7, but our data does not catch the reduced incidence in those still experiencing headaches.

APS Therapy for headaches chart

Back pain

‘Average pain’ for back pain had a response of 3.3  points reduction on the VAS on average; 2 people’s pain got worse, one was unchanged, 7 benefitted, and of these, 2 went to pain free.

APS Therapy for back pain in MS patients

Other pains

The remaining pains were 2 cases of muscle fatigue type pain and one pain from metalwork post pin and plate, which did not respond, and 1 psoriasis pain and 1 varicose vein pain, both of which did benefit.

APS therapy charts other pains

‘Other benefits’

For this report, we have not managed to keep accurate data about other benefits reported  during APS Therapy treatment. These have been: 4 cases of significant improvement in energy/reduction in MS fatigue, 2 cases of significant reduction swollen legs and ankles, 1 report of improvement in skin discolouration due to poor circulation, reduction in size of ‘fatty lump’ on hip, swollen gland in neck, and fluid under the skin on the scalp, 2 cases of alleviation of life-long insomnia, and many reports of improvement in sleep quality. 2 people reported no further urinary tract infections, which had been recurrent, and which they attributed to the APS Therapy, and 1; reduction in dizziness and improvement in cognitive function, which again they attributed to the therapy, and reported as a post-treatment effect.

We have identified reliable and valid outcome measures that we will be using for future clinical governance to measure sleep quality and energy levels, and the effect of pain on everyday life and mood.

Discussion

One of our concerns when starting this project was that people might benefit, but need long term therapy, which we would not be able to offer long term. We hoped to be able to use the NHS one-off personal budgets to allow people to purchase their own machine if necessary, but the scheme was only available for people on continuing health funding in our area. In actual fact, we found that although we did have a group of people who needed to maintain therapy to maintain the benefit; but they were able to reduce the frequency of their treatment to once a week, or in one case once fortnightly, and still retain the effect, and a such we have been able to continue to provide a service for these people.

We did not have research funding for this study, there was no control group, and many variables. Our sample, as typical in MS, often had to cancel appointments due to health problems, transport or general difficulties, but still achieved a remarkable result.

It was interesting to note that effectiveness was similar between the neuropathic and nociceptive type pains when using APS Therapy.

The mode of action is not fully understood, but injury or disease can cause oedema, inflammation, neuronal dysfunction, circulatory disturbance and lack of oxygen supply to the tissues or organ systems. Inflammation in tissue also promotes the build-up of chemicals, known as the “inflammatory soup” which may  interfere with neural transmission.

If there is poor transmission or even cessation of activity along the neurone, as a result of injury, inflammation, or disease process, the system cannot conduct its action potentials, and the homeostatic and regenerative mechanisms are disturbed.

It has been postulated by Papendorp (25) that  introducing external action potentials through the use of APS Therapy may result in the metabolic catabolism  and subsequent excretion from the body of inflammatory substances. As inflammatory metabolites may be a major cause of pain, removing the cause allows for pain reduction. Circulation is also improved  and thus antibodies, enzymes, neurotransmitters and hormones are conveyed at an increased rate to the treated area, stimulating the body’s own healing mechanisms.

Conclusion

APS Therapy seemed to be a safe and effective therapy to try in cases of both neuropathic and nociceptive pain. Participants in this study, most of whom had MS, achieved positive results using APS Therapy in 76% of cases. The therapy was safe, and in the main, people were extremely happy with mode of treatment, preferring it to drug therapy, and in some cases reducing and discontinuing analgesic drugs as a result.

We hope that by presenting our pilot study of an APS Therapy service in the context of available research on the subject, we can stimulate further clinical use and research.

 

 

References

1) H. Merskey and N. Bogduk, Eds,.Classification of Chronic Pain, Second Edition, IASP Task Force on Taxonomy, IASP Press, Seattle, 1994.

2) British Pain society 2014 For media, FAQs http://www.britishpainsociety.org/media_faq.htm ( accessed 3/2/2014)

3) Breivik H, Collett B, et al. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain 2006 10( 4):pp 287-333

4) Belsey J. Primary care workload in the management of chronic pain: A retrospective cohort study using a GP database to identify resource implications for UK primary care. Journal of Medical Economics 2002 . 5, (1-4) pp 39-50

5) NHS Information Centre. Prescription Cost Analysis for England 2009. Available at: http://www.ic.nhs.uk

6) Harris M, Spence A, et al. (2000) Clinical Standards Advisory Group (CSAG): Services for patients with pain

7) Breaking through the Barrier’, Chief Medical Officer 2008 Annual Report, March 2000

8) InSites Consulting. Pain Proposal Patient and PCP Surveys. July – September 2010

9)Collett, B. Betteridge, N., Semmons, I , Trueman, P. Pain Proposal, Improving the current and future management of chronic pain 2010 http://www.arthritiscare.org.uk/…/main…/PainProposalUKSnapshotFinal.pdf

10)  Ehde DM, et al.The scope and nature of pain in persons with multiple sclerosis. Multiple Sclerosis 2006;12(5):pp 629-638.

11) Hirsh AT, et al. Prevalence and impact of pain in multiple sclerosis: physical and psychologic contributors. Archives of Physical Medicine and Rehabilitation 2009;90(4):pp 646-651.

12) Archibald CJ, et al.Pain prevalence, severity and impact in a clinic sample of multiple sclerosis patients. Pain 1994;58(1):89-93.

13) International Association for the Study of Pain,  2011 http://www.iasp-pain.org/AM/Template.cfm?Section=Pain_Definitions (Accessed 3/2/2014)

14) Neuropathic pain – pharmacological management: the pharmacological management of neuropathic pain in adults in non-specialist settings. National Institute for Clinical Excellence November 2013

15) Watson, T. Narrative Review : Key concepts with electrophysical agents Physical Therapy Reviews 2010. 15(4): 351-359.

16) Cochrane Database Syst Rev. 2008 Jul 16;(3)

17) Van der Plaat, L. unpublished case studies using APS Therapy on people with MS in a day hospice setting. 2013

18) Berger P. Electrical pain modulation for the chronic pain patient.  South African Journal of Anaesthesiologyand Analgesia. 1999;5:14-19.

19) Van Papendorp DH, Kruger MC, Maritz C, Dippenaar NG.

Medical Hypotheses- 2002 Elsevier

20) Watson, T. Narrative Review : Key concepts with electrophysical agents Physical Therapy Reviews 2010. 15(4): 351-359.

21) Papendorp DH van. (2002). Assessment of Pain Relief on 285 patients with chronic pain. Biomedical Research 2002; 26: 249-253.

22) Du Preez, J. Neurosurgical Pain Conditions University of Pretoria

23) Odendaal & Joubert APS Therapy- a new way of teating chronic backabacke, a pilot study South African Journal of Anaesthesiology and Analgesia.1999; 5 1

24) Berger, P. Matzner, L Study on 99 patients with osteoarthritis (OA) of the knee to investigate the effectiveness of low frequency electrical currents on mobility and pain: Action Potential Simulation therapy (APS) current compared with transcutaneous electrical nerve stimulation (TENS) and placebo.South Africa Journal of Anaesthesiology and Analgesia

1999 5: 2

25) ) Papendorp DH van. (2002). Assessment of Pain Relief on 285 patients with chronic pain. Biomedical Research 2002; 26: 249-253.

 HOPE YOU LIKE IT!

Article published as of now. Thanks to the guys from the MS Therapy Centre in Bedford who’ve been game to share their stories. We’ve had lots of new stories generated even since this too! APS Therapy article New Pathways magazinenp80FINAL (1)  Here’s the PDF to the full article. Going to try to get just my bit, as this file is huge.

Groundbreaking results for significant pain relief with APS Therapy

APS Therapy update; our first results for people with pain

APS effective for pain chart

At the MS Therapy Centre, we are trialling a new electrical treatment for pain, called APS Therapy (See previous issues for an explanation!)

Here’s a round-up of our results so far.
Some people have completed a course of treatment, some are ongoing, and some have only just started and had a few sessions. We are working hard to make sure we collect better data in future so we can answer more questions. We used the ‘Visual analogue pain scale’ which measures pain out of 10, with 0 being ‘no pain’ and 10 being ‘the worst possible pain’

Neuropathic pain in limb:  7/10 down to pain free; complete pain relief which lasts 4-5 days, but appears to need long term treatment as comes back after this time.

Neuropathic pain in the feet  and feeling  ‘like walking on hot sand’, constant, 6-7/10 down to 3-4/10 in 3 weeks, hot sand feeling down to ‘not very often’ and improvement in blue-ish discolouration due to poor circulation..

Hip pain 6/10 constantly, complete relief since the first week, has not returned, and a decrease in neuropathic pain in the leg from 4/10 to 2/10 in 3 weeks.

Back pain, 8-9/10, worse on exercise, down to pain-free, 2-3/10 on exercise. Treated x 2 weekly for 6 weeks. Has not returned, 1 month after end of treatment. Leg pain, ‘pounding, throbbing’, 8/10, down to pain-free, has started to creep back since recent sensory relapse.

Long term shoulder pain, 2-7/10 to ‘much better’ but has since had to stop treatment for personal reasons.

Hip pain 10/10 plus, no benefit. This could be because there’s a serious problem that needs attending to underlying the pain, or because high doses of opiate painkillers make the treatment less effective. We’ll be helping this person get the right investigations and treatment, and maybe try again later.

Arm pain, possibly radiating from shoulder, no cause detected by GP, 2-3/10 with episodes of stabbing pain 5-6 x a week at 10/10; down to 1& half/10, no episodes of stabbing pain after 2 weeks of treatment

Headaches, constant, 7/10 down to pain-free, and back pain 7/10, down to 1/10, plus complete relief from insomnia.

Chronic pelvic pain, 2-4/10 normally, 7-8/10 when bad, happening less frequently, tramadol usage has dropped from daily to 2-3 x a week, now reducing Amitryptilline also.

Hip pain, 8&1/2 /10, very severe, ‘sickening’, no change, although improvements in sleep pattern. We are helping this person get investigations carried out.

Hip pain, 7/10, 8/10 when worst, down to 4/10 after 3 treatments, but also had deep physio manipulation prior to starting!

Severe muscle spasm and spasticity, no change after 12 weeks +

MS fatigue; no change

MS fatigue; no change

Headaches, 4-6/10, 9/10 when worst, 2-3 x a week, for most of life, worse since starting Rebif, down to pain-free; has had one headache since starting therapy, when had not drunk enough water. Has not taken regular painkillers for weeks. Back pain, 4-6/10, 7-8/10 when bad, down to 3/10. Stopped Naproxen and Co-codamol use. Knee pain (which was unreported, as forgot about it) has disappeared. Much more energy, staying up past bedtime, cleaning.

People who’ve just started:

‘Squeezing’ altered sensation feeling, 7/10, 9/10 when worst, no change yet after 4 sessions; muscular pain in shoulder blade area, 4/10, 8/10 when worst, down to 2/10 after 4 sessions.

Shooting, stabbing, intermittent pain in knees, 5-10 -11/10 down to 4/10 max after approx 2 weeks

Tennis elbow, 8/10, worst 10/10, now 6/10, worst 8/10, significantly improved range of motion and no sleep disturbance due to pain, after one week’s treatment ( and also carrying on with Bowen treatment)

So in summary, in our study so far, 18 people have used the APS Therapy at the Centre, 17 with MS and one member of staff. 2 tried APS for fatigue, and 1 for spasticity, and disappointingly, these conditions have not experienced a significant benefit to date.

15 people used APS Therapy for pain. Of these, 13 have felt a significant reduction in pain, and 2 have not. 2 also report a significant increase in energy. Of the people with pain, 5 have achieved pain-free. Of these, 2 people’s pain has not come back since completing the course, one needs to maintain therapy once a week, and 2 are still completing their course of treatment.

We’re delighted that Denise, who many of you will know already from the Gym, has now been employed 3 days a week to also help run this project and help people to use the APS machines at the Beds and Northants MS Therapy Centre. If you are having a problem with pain, you can come and see me (Miranda) for a full pain assessment. If APS Therapy seems like an appropriate course of action and you:

a) Can get in 3 x a week ideally; twice if necessary, and

b) Can drink 1&1/2 litres of water a day, and

c) Have none of the following: heart attack, deep vein thrombosis, stroke or pulmonary embolus in the past 3 months, cancer, epilepsy, or pregnancy.

I will refer you on to Denise, to start a 6 week treatment plan. For some pain, APS Therapy may be able to completely and permanently resolve the problem. For some people it may not help at all, and for others, it may significantly reduce or resolve the pain, but need to be continued to keep getting the effect. In those cases we can help you to purchase your own machine direct from the manufacturers if you wish, and also to apply for charitable funding if money is a problem.

It’s very exciting to be working with such a new, drug-free treatment. We intend to start helping people to review their medication once they get a good result, with a view to reducing pain medication.

APS chart, pain, fatigue, spasticity

APS chart, percentage pain-free

Hello world!

This blog has grown from my work as an MS Specialist Nurse, 3 days a week at the MS Therapy Centre, Bedford, UK. I love my job, especially as I’m allowed the freedom to continuously explore ways you can optimise your health and life when you have MS, from both a ‘conventional’ and a more natural perspective.

Specifically, the blog is an expansion of my regular feature in our MS Therapy Centre newsletter. I’m going to upload all my old ‘posts’ so you can see what I’ve been thinking/learning about over the last few years; the new stuff will go in both places.

This last month has been an exciting one for me, new things that have happened are:

  •  Learning about APS Therapy ( Action Potential Simulation therapy)
  • Doing a teaching session on MS & the bowel on a Peristeen course;  I’ll try to upload it here.
  • Also I am still rounding up the feedback from those people who tried the natural detox product; more on that later!
 I should stick to one topic at a time.  So – APS Therapy
Recently met up with a friend, a nurse,who is now the leader of a fantastic pain management team in Hull.
She told me about the very very good results – people coming off medications completely – that a doctor working in a hospice in Hull had been getting with people with MS who had severe neuropathic pain, and severe muscle spasm, using APS machines. Their team had organised for  someone from the Dutch company who manufacture and supply the machines and training, to come and do a training day in Hull – which I managed to attend.

Basically this therapy looks a bit like TENS, but it’s a different type of electrical current. You put sticky pads on your skin, which are connected to the machine via wires, and then a direct current of micro-amps is directed to travel through the cells of your body, from one pad to the other.

APS machine for the MS Therapy Centre

The current simulates – ie is just like, Action Potential – which is the name for the way that electrical signals pass along a nerve. This apparently stimulates the release of more ATP, which is needed to create energy in the body, and also speeds up the detoxification from cells, and the result, after a period of treatment, is said to be reduced pain and increased energy.  So obviously I am excited!!

In Hull, a proper clinical trial is going to go ahead with a rehab team, pain management team and university in collaboration. In Bedford (!!) the doctor with the hospice experience has been kind enough to offer to come down and share her experiences of using this in clinical practice, so that we can find out

  1. how to use it
  2. how it works
  3. how we can use it effectively
  4. how we can use it fairly
  5. whether we can help people who benefit from it to fund ongoing treatment (?personal health budgets)
  6. whether we can add to the body of knowledge being gathered about it.
So this is happening on July 27th – can’t wait!
I will definatley post again on our experiences, and on everything else I think might be interesting to you!  All the best, Miranda