Iontophoresis is the process of using electrical current to ‘drive’ ions of medication through the skin to inflamed tendons and ligaments. Similarly, phonophoresis is the process of using ultrasound waves to ‘drive’ medication from the ultrasound gel to those same structures through the skin. Because physicians, physical and occupational therapists, chiropractors, and other medical professionals use electrodes for iontophoresis and ultrasound gel for phonophoresis, and have to apply the medication to the electrode or mix it with ultrasound gel, many of these people have asked about the availability of electrodes or gel that are pre-medicated. There are factors that discourage manufacturers from producing pre-medicated iontophoresis electrodes or ultrasound gel.
Any medical products manufacturer is subject to intense scrutiny by various government and industry agencies during research, development, production, and distribution of any medical device or supply. Were a manufacturer to include an additional component, particularly a medication, which would have to remain stable and clinically effective in an electrode or mixed with ultrasound gel while those products were stored in clinics awaiting use, would mean additional scrutiny and increased costs at every step in the already lengthy and cost-prohibitive process of bringing a medical product to market. Further, a medical products manufacturer is licensed only to produce and distribute medical products, not medications, therefore the manufacturer would have to absorb the costs of additional licensing as a pharmaceutical manufacturer and/or distributor.
Even were a medical products manufacturer able to produce an iontophoresis electrode with a medication in it or an ultrasound gel premixed with medication for phonophoresis, the number of iontophoresis or phonophoresis treatments using any specific medication is relatively small. In addition, what the manufacturer could ultimately charge for a premedicated electrode or ultrasound gel is dependent on the amount insurers are reimbursing medical professionals for administering these types of treatments. Unfortunately, payment by insurers for numerous medical treatment is either going down or being eliminated altogether. This is particularly true of iontophoresis and phonophoresis. As a result, a manufacturer may produce an electrode or gel that insurers no longer pay medical professionals to use. Even in case where payment is still being made the amount may be less the cost of the item or leave so little for the medical professional that alternative treatment methods would most likely be utilized. This means the manufacturer runs the risk of not selling any or enough premedicated electrodes or ultrasound gel to make enough money to remain in business.
Finally, while dexamethasone is the most frequently used medication during iontophoresis or phonophoresis treatments, it is not the only medication that can be used for these types of treatments, so producing a premedicated electrode or gel using dexamethasone limits the type and number of treatments that could be done using a premedicated electrode or gel. In other words, the medical professionals that administer iontophoresis and/or phonophoresis would lose some of the flexibility of having electrodes or ultrasound gel that could be used with any number of appropriate medications.
While the concept of pre-medicated iontophoresis electrodes along with gel lends itself to convenience, the increased costs, decreasing reimbursement, and limited medication discourages these types of electrodes and gel from being produced.
Rob Blair is Vice President of Operations at ProHealthcareProducts.com, where he advises medical experts on purchases of iontophoresis supplies and other products used for physical therapy.