Electrophysical agents (FS-08)

Evidence based use of electrophysical agents for managing musculoskeletal pain

Jan M Bjordal (Norway), David Baxter (New Zealand), Ernesto Leal Junior (Brazil), Gladys Cheing (China), Liisa Laakso (Australia)

Focused symposium

Saturday 2 May 2015, 13:45-15:15, Hall 404

Evidence based use of electrophysical agents for managing musculoskeletal pain

Bjordal J.M. 1, Baxter D. 2, Leal Junior E. 3, Cheing G. 4, Laakso L. 5

1University of Bergen, Global Public and Primary Health Care, Bergen, Norway, 2Otago University, Health Sciences, Dunedin, New Zealand, 3Nove de Julho University, Rehabilitation Sciences, Sao Paulo, Brazil, 4The Hong Kong Polytechnic University, Department of Rehabilitation Sciences, Hong Kong, China, 5Griffith University, School of Rehabilitation Sciences, Gold Coast, Australia

Learning objectives

  1. Delegates will be able to outline predictive characteristics of progression of knee osteoarthritis and why these may be amenable to electrophysical agents.
  2. Delegates will be able to discuss the pathophysiology of osteoarthritis and why some electrophysical agents are as effective as simple analgesics for pain relief.
  3. Delegates will be able to outline how some electrophysical agents may optimise the management of acute and chronic joint injury.


The primary aim of this focused symposium is to re-visit electrophysical agents (EPA) and to re-assert their value as one of the pillar of physiotherapy. During the past decade we have seen more than a doubling of published EPA trials. According to PEDro, EPA records have risen from 1219 to 2791 RCTs. In addition, the more recent EPA trials score high on methodological quality, with 78 trials receiving scores of 9 or 10 out of 10 in the PEDro database. This new evidence partly overthrows the myth that EPA trials are lacking or of poor quality. A number of EPA now have a strong evidence-base and the symposium will provide examples of where the evidence is powerful and in the context of a degenerative clinical condition that is often refractory to conservative management. Convenor (JMB) will introduce the session and make the case for why EPA are safer than and just as effective as simple analgesia for managing pain symptoms in some acute and chronic musculoskeletal disorders1-5. In a relatively recent systematic review,6 Presenter 1 (GDB) and colleagues found

that there were a few select predictive variables for progression of knee osteoarthritis (OA) for which there was strong evidence and which can be easily evaluated and utilised in clinical practice. One such predictor was generalised or multiple joint OA which may reflect an underlying systemic influence on cartilage. The influence of acute inflammatory cytokines

has recently been associated with the development of cartilage erosion and synovial inflammation in OA. Hence, Presenter 2 (ECLJ) will discuss the pathophysiology of OA7 and examples of how one specific EPA (low level laser therapy) has been shown to have an effect on the inflammatory mediators involved in the acute stages of joint disease8. As another example, Presenter 3 (GLYC) will re-visit TENS and discuss the optimisation of its use for chronic OA pain relief in the clinical setting. Presenter 49 The Chair (LL) will then invite questions from the floor and mediate an interactive discussion with Symposium panel members of matters raised in the presentations. Finally, the Convenor (JMB) will summarise the outcomes of the Symposium and draw some conclusions that will assist delegates to apply EPA for acute and chronic joint disorders using an evidence-based approach; and suggest a likely future for EPA as part of the total management of acute and chronic joint conditions.



  1. Tölle T et al (2008) Pregabalin for relief of neuropathic pain associated with diabetic neuropathy: A randomized, double-blind study. European Journal of Pain 12: 203-213.2
  2. Pessoa et al. 2004 Photomedicine and Laser Surgery, 22(3): 199-204
  3. HTA report no 7( 2004), Norwegian Knowledge Center for Health Services)
  4. Zhang et al (2010) OARSI recommendations for the management of hip and knee osteoarthritis. Osteoarthritis and Cartilage 18:476-499.
  5. Bjordal JM et al (2007) Short-term efficacy of pharmacotherapeutic interventions in osteoarthritic knee pain: A meta-analysis of randomised placebo-controlled trials. European Journal of Pain 11:125-138.
  6. Chapple CM, Nicholson H, Baxter GD and Haxby Abbott J. (2011) Patient characteristics that predict progression of knee osteoarthritis: a systematic review of prognostic studies. Arthritis Care and Research 63(8):1115-1125
  7. Fernandes et al (2002) The role of cytokines in osteoarthritis pathophysiology. Biorheology 39:237-246.
  8. Alves ACA, Vieira RP, Leal-Junior ECP et al (2013) Effect of low level laser therapy on the expression of inflammatory mediators and on neutrophils and macrophages in acute joint inflammation. Arthritis Research and Therapy doi:10.1186/ar4296
  9. Cheing GLY et al (2003) Optimal stimulation duration of TENS in the management of osteoarthritic knee pain. Journal of Rehabilitation Medicine 35:62-68.




Implications / Conclusions

EPAs are now supported by a significant evidence base which continues to develop year by year. The implications for the delegates of the focused symposium, is that they will re-consider what EPAs can contribute to optimising the clinical management of their patients/clients


Pain; Osteoarthritis; Electrophysical agents

Funding acknowledgements


Relevance to WCPT and expected audience

The focused symposium will be hosted by the ISEAPT WCPT sub-group (Electrophysical Agents) and will have an emphasis on acute and chronic joint disease. The topic is congruent with the 2010-2020 Bone and Joint Decade (Global Alliance for Musculoskeletal Health) of which the WCPT is a supporting organisation. The topic will be of relevance to physiotherapists who have an interest in the management of people with joint conditions

Target audience

PTs working with musculoskeletal pain, sports injuries and aged care.