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Extracorporeal Shock Wave Therapy (ESWT) for HD Patients Rehabilitation

The prevalence of pain in Huntington’s disease is unknown. An initial case report describes severe pain in two HD patients (Albin and Young, 1988). In a more recent study in 2010, eleven of nineteen HD patients had pain, with altered pain perception to pinprick, touch and temperature in some subject (Scherder and Statema, 2010). Exercise-induced muscle pain has been described in a marathon runner, who subsequently developed Huntington’s disease (Kosinski et al., 2007), suggesting that it may be an early unrecognized symptom of the disease. Significantly, there is a 10% to 25% prevalence of diabetes in patients with Huntington’s disease worldwide. Diabetes is a relatively common cause of neuropathic pain in a subset of diabetics.

Professor Areerat Suputtitada, M.D. is an expert on the use of extracorporeal shockwaves therapy (ESWT) on patients with pain management problems. She applies radial shock waves to the musculoskeletal system. The process involves producing high speed and high-pressure sound waves. The waves are delivered either in a focused manner, in which targets deeper tissues, or in a radial manner, in which targets a wider area. The energy is released to the tissues whenever there is a ligament to bone surface change.

Figure 1. Dr. Suputtitada Applying ESWT to Patient

Figure 1. Dr. Suputtitada Applying ESWT to Patient

Benefits for patient include

  • Outpatient treatment
  • No medication
  • No anesthesia
  • No surgery
  • No injections
  • Non-invasive treatment
  • Quick results
  • Improved quality of life

Benefits for the physician

  • Short application time
  • High patient acceptance
  • Broad range of indications
  • Outstanding product quality
  • Modular perfection
  • Low maintenance
  • Low cost

How does ESWT promote tissue healing in HD patients?

ESWT produces a strong energy pulse for a short period of time. The energy pulse breaks the sound barrier, which results in a shockwave. The shockwave from ESWT is identical, only on in a smaller scale, to the shockwaves that occur when a plane is flying faster than the speed of sound.

  1. The shockwave exerts pressure on the afflicted tissue. It increases cell membrane permeability and increases microscopic circulation to the tissues and the metabolism within the tissues, both of which promote healing and dissolution of pathological calcific deposits.
  2. “Cavitation bubbles” are small empty cavities created when shockwave is applied. The cavitation bubbles tend to expand to a maximum size, then collapse, much like a bubble popping. As these bubbles burst, a force is created. This force is strong enough to break down the pathological deposits of calcification in soft tissues and therefore reduce pain.
  3. ESWT stimulates osteoblasts or bone cells. These bone cells are responsible for bone healing and new bone production, so stimulating them enhances the healing process of bones.
  4. ESWT stimulates fibroblasts. Fibroblasts are the cells responsible for the healing of connective tissues like tendon or ligaments.

On a molecular and cellular level, ESWT also leads to complex interactions between the removal of neurogenic inflammation and release of growth factors, changes in gene expression, new bone formation and activation of mesenchymal stem cells, in which can differentiate into a variety of cell types like bone cells, cartilage cells, fat cells and muscle cells. All of these interactions then lead to pain relief and healing of patients.

In conclusion, ESWT is a noninvasive, easy to use after training, and cost effective way to improve quality of life within a short time frame. HD patients with pain management problems could consider ESWT. For more information on Dr. Suputtitada, her work on ESWT and her contact information, please refer to our spotlight article link.

References

Durant A, Millis D. Applications of extracorporeal shockwave in small animal rehabilitation. In: Millis DL, Levine D, editors. Canine Rehabilitation and Physical Therapy. 2nd ed. Elsevier; 2014. P. 381 -392

O gden JA, Toth-Kischkat A, Schultheiss R. Principles of shock wave therapy. Clin Orthopo Relat Res 2001; (387): 8-17

Borsook, David. “Medscape: Neurological Diseases and Pain.” Medscape. Medscape, 2012. Web. 22 Oct. 2015.