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Low-intensity pulsed ultrasound

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Medical intervention
Low-intensity pulsed ultrasound
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Low-intensity pulsed ultrasound (LIPUS) is a technology that can be used for therapeutic purposes. It exploits low intensity and pulsed mechanical waves in order to induce regenerative and anti-inflammatory effects on biological tissues, such as bone, cartilage, and tendon. Even if the real mechanism underlying its effectiveness has not been understood yet, it is plausible that the treatment relies on non-thermal phenomena, such as microbubbles and microjets induced by cavitation, acoustic streaming, and mechanical stimulation.

Technique

LIPUS uses generally 1.5 MHz frequency pulses, with a pulse width of 200 μs, repeated at 1 kHz, at a spatial average and temporal average intensity of 30 mW/cm.

Medical uses

Starting around the 1950s this technology was being used as a form of physical therapy for ailments such as tendinitis.

As of 2009 research for the use of LIPUS to treat soft tissue injuries were in the early stages. As of 2012 it was being studied for dental problems.

Low intensity pulsed ultrasound has been proposed as a therapy to support bone healing after fractures, osteomies, or delayed healing. A 2017 review, however, found no trustworthy evidence for the use of low intensity pulsed ultrasound for bone healing, mostly based on the large pragmatic randomized controlled trial published in 2016. An associated guideline issued a strong recommendation against its use in bone healing. Evidence as of 2023 was insufficient to justify its use to prevent non healing of bone fractures. Tentative evidence supports better healing with the use of the system in long bones that have not healed after three months. Some reviews suggested inconclusive evidence of benefit. One industry supported meta-analysis suggested it as a potential alternative to surgery for established nonunions. Most studies suggesting benefit were funded by manufacturers of ultrasound devices.

In 2018, a study published in the journal Brain Stimulation, reported that experiments on mice showed that whole-brain LIPUS therapy markedly improved cognitive dysfunctions without serious side effects by enhancing specific cells related to dementia's pathology. Clinical trials are underway.

In vitro experiments have confirmed the LIPUS capability to regulate cell proliferation and differentiation as well as the opening of cell membrane channels.

References

  1. ^ El-Bialy, Tarek; Tanaka, Eiji; Aizenbud, Dror (June 25, 2018). "Mechanism of LIPUS on Dentofacial Bioengineering". Therapeutic Ultrasound in Dentistry: Applications for Dentofacial Repair, Regeneration, and Tissue Engineering. Springer. ISBN 9783319663234.
  2. ^ Jiang, Xiaoxue; Savchenko, Oleksandra; Li, Yufeng; Qi, Shiang; Yang, Tianlin; Zhang, Wei; Chen, Jie (2018). "A Review of Low-Intensity Pulsed Ultrasound for Therapeutic Applications". IEEE Transactions on Biomedical Engineering. 66 (10): 2704–2718. doi:10.1109/TBME.2018.2889669. ISSN 0018-9294. PMID 30596564. S2CID 58581708.
  3. Lin, Guiting; Reed-Maldonado, Amanda; Lin, Maofan; Xin, Zhongcheng; Lue, Tom (2016). "Effects and Mechanisms of Low-Intensity Pulsed Ultrasound for Chronic Prostatitis and Chronic Pelvic Pain Syndrome". International Journal of Molecular Sciences. 17 (7): 1057. doi:10.3390/ijms17071057. ISSN 1422-0067. PMC 4964433. PMID 27376284.
  4. ^ Khanna, A; Nelmes, RT; Gougoulias, N; Maffulli, N; Gray, J (2009). "The effects of LIPUS on soft-tissue healing: a review of literature". British Medical Bulletin. 89: 169–82. doi:10.1093/bmb/ldn040. PMID 19011263.
  5. Miller, Douglas; Smith, Nadine; Bailey, Michael; Czarnota, Gregory; Hynynen, Kullervo; Makin, Inder (April 2012). "Overview of Therapeutic Ultrasound Applications and Safety Considerations". Journal of Ultrasound in Medicine. 31 (4): 623–634. doi:10.7863/jum.2012.31.4.623. ISSN 0278-4297. PMC 3810427. PMID 22441920.
  6. Rego, E. B. (2012). "Current Status of Low Intensity Pulsed Ultrasound for Dental Purposes". The Open Dentistry Journal. 6: 220–5. doi:10.2174/1874210601206010220. PMC 3547311. PMID 23341848.
  7. ^ Schandelmaier, Stefan; Kaushal, Alka; Lytvyn, Lyubov; Heels-Ansdell, Diane; Siemieniuk, Reed A. C.; Agoritsas, Thomas; Guyatt, Gordon H.; Vandvik, Per O.; Couban, Rachel; Mollon, Brent; Busse, Jason W. (February 22, 2017). "Low intensity pulsed ultrasound for bone healing: systematic review of randomized controlled trials". BMJ. 356: j656. doi:10.1136/bmj.j656. ISSN 1756-1833. PMC 5484179. PMID 28348110.
  8. Group, TRUST Investigators writing; Busse, Jason W.; Bhandari, Mohit; Einhorn, Thomas A.; Schemitsch, Emil; Heckman, James D.; Tornetta, Paul; Leung, Kwok-Sui; Heels-Ansdell, Diane; Makosso-Kallyth, Sun; Rocca, Gregory J. Della (October 25, 2016). "Re-evaluation of low intensity pulsed ultrasound in treatment of tibial fractures (TRUST): randomized clinical trial". BMJ. 355: i5351. doi:10.1136/bmj.i5351. ISSN 1756-1833. PMC 5080447. PMID 27797787. {{cite journal}}: |last1= has generic name (help)
  9. Poolman, RW; Agoritsas, T; Siemieniuk, RA; Harris, IA; Schipper, IB; Mollon, B; Smith, M; Albin, A; Nador, S; Sasges, W; Schandelmaier, S; Lytvyn, L; Kuijpers, T; van Beers, LW; Verhofstad, MH; Vandvik, PO (February 21, 2017). "Low intensity pulsed ultrasound (LIPUS) for bone healing: a clinical practice guideline". BMJ (Clinical Research Ed.). 356: j576. doi:10.1136/bmj.j576. hdl:1765/98256. PMID 28228381.
  10. ^ Searle, Henry Kc; Lewis, Sharon R.; Coyle, Conor; Welch, Matthew; Griffin, Xavier L. (March 3, 2023). "Ultrasound and shockwave therapy for acute fractures in adults". The Cochrane Database of Systematic Reviews. 2023 (3): CD008579. doi:10.1002/14651858.CD008579.pub4. ISSN 1469-493X. PMC 9983300. PMID 36866917.
  11. Higgins, A; Glover, M; Yang, Y; Bayliss, S; Meads, C; Lord, J (October 2014). "EXOGEN ultrasound bone healing system for long bone fractures with non-union or delayed healing: a NICE medical technology guidance". Applied Health Economics and Health Policy. 12 (5): 477–84. doi:10.1007/s40258-014-0117-6. PMC 4175405. PMID 25060830.
  12. Lou, S.; Lv, H.; Li, Z.; Zhang, L.; Tang, P (September 1, 2017). "The effects of low-intensity pulsed ultrasound on fresh fracture: A meta-analysis". Medicine. 96 (39): e8181. doi:10.1097/MD.0000000000008181. PMC 5626319. PMID 28953676.
  13. Leighton, R.; Watson, J.T; Giannoudis, P.; Papakostidis, C.; Harrison, A.; Steen, R.G. (May 2017). "Healing of fracture nonunions treated with low-intensity pulsed ultrasound (LIPUS): A systematic review and meta-analysis". Injury. 48 (7): 1339–1347. doi:10.1016/j.injury.2017.05.016. PMID 28532896.
  14. "Whole-brain LIPUS therapy improves cognitive dysfunction in mice simulating dementia, Alzheimer's". News-Medical.net. July 20, 2018. Retrieved July 20, 2018.
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