SCENAR THERAPY: A COMPARISON WITH OTHER METHODS OF ELECTROTHERAPY. 

Based on material from a lecture by Y. Grinberg  

SCENAR therapy is a form of electrotherapy. Other forms include electro-stimulation, therapy with electro-sleep, dia-dynamic current, interference therapy, therapy with sinusoidal modulated current, fluctuation and impulse electro-therapy.

The effects of electrical therapy may be divided into 3 groups, local (regional), segmental and generalised.

Local reactions include:         

• activation of afferent sensory nerves

Electrical impulses stimulate receptors and nerve endings. Afferent impulses travel to the central nervous system and give rise to the various segmental and general reactions.

• influence on local blood flow

Impulses can regulate the micro-circulation by stimulating contraction or relaxation of the smooth muscle of the vascular wall, in particular the arterioles, capillaries and venules with a resultant change in local blood flow. This effect occurs through a combination of axon-reflexes, bioactive substances (kinins, prostaglandins, substance P, cytokines) and mediators (acetylcholine and histamine). These chemical compounds are often filtered from the blood through the endothelium/vessel wall into the interstitial space and may accumulate in the superficial layers of the skin and various tissues.

• release of endogenous regulators of inflammation and the immune response.

It has been found that there is a reduction in secretion of mediators of inflammation from the cell. Components of the complement system are suppressed by synthesis of macrophages and there is a change in the metabolism of the tissues. What this amounts to is a slowing down of the process of inflammation.

Segmental reactions:

These appear at areas where the electrical impulses are applied and are essentially spinal reflexes. Afferent impulses from sensory nervous fibres activate, via interneurones, motor neurones in the anterior horns of the spinal cord. Efferent impulses then pass back to the area receiving the impulses as well as to the organs corresponding to these segments of the spinal cord. The interaction between visceral and somatic afferent impulses takes place at the spinal level, and impulses are then sent to the bulbar and cortical structures.

Generalised reactions:

These occur as a result of transmission of ascending afferent impulses to the higher centres of the brain. Visceral and somatic afferent impulses converge within the central nervous system and are processed and the resultant efferent impulses cause a general response from the whole system. General reactions also occur as a result of direct stimulation of the glands of internal secretion and of the cerebral cortex.

As an example of general mechanisms of electro-therapy, let us look at DDC (Dia-Dynamic Current or

P. Bernard current).

DDC is made up of impulses half-sinusoidal in shape with a frequency of 50 – 100 Hz with delayed exponent background.  DDC excites myelinated cutaneous nerves, which are sensitive to this current. Ascending afferent impulses go towards the substantia gelatinosa in the posterior horns of the spinal cord and then along paleo-spinal-thalamic, neo-spinal-thalamic and spinal-reticular-thalamic tracts and activate opioid and serotonin-ergic systems of the brain stem.

This gives pain relief in three ways. Firstly, a new dominant focus is formed in the cortex, which causes de-localisation of the previously dominant focus of pain and activates the parasympathetic nervous system. Secondly, a change in sensitivity and a decrease in lability occur in the thick A and thinner C nerve fibres. The faster A-fibres depolarise the substantia gelatinosa and pain impulses arriving via the C-fibres are prevented from continuing (Gate theory). Thirdly, activated cortical and sub-cortical centres produce descending efferent impulses, which increase the blood flow and stimulates local humoral mechanisms, viz., the production and release of endorphins, increase in activity of enzymes, such as acetyl cholinesterase, histaminase and kinases.

When impulses are applied to the paravertebral zones, DDC reduces activity of the Renshaw cells and so restores the ability of the nervous system to damp down the transmission of pain impulses.

Direct action on the affected areas results in rhythmical contraction of a large number of the myofibrils of the skeletal muscles and smooth muscles of the blood vessel walls. This subsequently increases blood flow and opens anastomoses and collateral vessels. Metabolism in tissues speeds up and the temperature in the area increases. The improved blood flow allows redistribution of the ions and water in the interstitium, promotes removal of the products of lysis in tissues, permits rehydration of the tissues and helps to reduce oedema. Reduction of the peri-neural oedema improves conductivity and excitability of the nerves. These metabolic processes take place at the areas stimulated by the impulses and also at the tissues and organs that are innervated from the same segment of the spinal cord.

Based on the above, DDC should be an effective therapy. However, practically, there are many restrictions and contra-indications to this method. One of the limitations of the effectiveness of this therapy is the adaptation of treated tissues, mentioned by author P. Bernard himself. Another reason is the essential energetic component in such current. To be non-damaging, the impulse must be a bi-polar, rectangular impulse, where the duration of each phase is not more than 100microseconds. In DDC, one half-period of a 50Hz impulse lasts 10milliseconds, i.e. 50 times longer then that required to be non-damaging. Shortening the time would mean using an impulse of 5kHz, which is obviously unacceptable!

It is generally accepted that the extent of the response of the organism depends on the area which absorbs most of the electromagnetic energy. In modern electro-therapy there is a tendency to attempt to achieve bigger therapeutic effect using lower electro-magnetic energy by increasing the “informational aspect” and reducing the “energy component” of the input. For this reason, the shape (type) of the impulse signal is important.

There are a number of ways of improving the effectiveness of electro-therapy:

• impulses should be physiological;
• there needs to be less habituation to these impulses;
• impulses are more effective if variable;
• they need to be more concentrated in order to reduce the general load and cause more specific changes in the organism;
• if the impulses affect deeper structures in the organism, their effect is more profound.

In order to achieve greater therapeutic effect, the action should be applied by means of electro-magnetic fields and current. To be non-damaging to nerves, the impulses should last not more then 200microseconds. The time of the relative and absolute refraction phase determines the frequency of repetition of these impulses. In pathological states, these values can differ considerably from values in normal states. For skeletal muscles, the absolute refractory phase is 2.5 milliseconds and for motor neurones the time is <1millisecond. Consequently the time between impulses needs to be longer than these times. As mentioned, the times may vary with the pathology and the frequency of the impulses may need to be varied from single units to hundreds of hertz to accommodate this. In order to excite the nerves, the duration of the impulses and amplitude must be varied considerably.

Practically, these parameters are similar to Short-impulse Electro-Analgesia (SEA) where mono- and bi-polar impulses are used, often formed in bundles and  lasting  20-500 microsecs at frequencies  2-400Hz

As in DDC, SEA causes rhythmical excitement of the myelinated nerves. These afferent impulses go towards the substantia gelatinosa of the spinal cord. Inhibitory interneurones in the lateral horns of the spinal cord reduce the amount of substance P produced. This also reduces the possibility for the transmission of impulses from afferent sensory conductors of the lateral horns (A and C-fibres) to neurones of the reticular formation and supra-spinal structures.  Excitement of the interneurones of the posterior horns of the spinal cord causes a release of opioid substances.  Serotonin is released from the lateral nucleus of the mes-encephalon and from the peptide-ergic ventral nucleus of the hypothalamus. As in DDC, fibrillation of the smooth muscles in the arterioles and superficial skin muscles stimulates the utilisation of the allogenic substances and mediators, which are released in response to pain. Increase in local blood flow stimulates local metabolic processes and defensive reactions in the tissues. Reduction of the peri-neural oedema improves excitability and conductivity of the skin conductors and promotes restoration of suppressed tactile sensitivity.

Why does SEA therapy, which seems to be optimal when we look at its mechanism, work mainly for analgesia and not have wider applications?

1.                  This method has a strict specific administration. Because of the type of current, it has effects on the symptoms rather than a physiological action.

2.                  Habituation of the organism to the impulses. Adaptation is an active response of the organism to changes in the environment. When using electrotherapy, in order to reduce adaptation to electrical impulses, various types of modulation, frequency and wave forms are used. However, it is known that the nervous system builds up a model of the external stimuli by modifying its own elements. As a result, the nervous system blocks all signals, which are within fixed parameters of intensity, time, and space. Only those signals that are outside these parameters will cause a dynamic reaction.

3.                  In SEA therapy, the choice of amplitude of the current is determined by the patient’s sensations (as with other methods of electrotherapy). So excitement of some of the fibres can be a coincidence. With some devices, because of the patient’s subjective sensation, the impulses applied were only sufficient to stimulate sensitive fibres and this determined the extent of the action on the organism.

4.                  Insufficient theory exists to support this modality and the methods used were restricted to studying pain relief.

SCENAR is close to SEA. What determines its significant effectiveness?

1.                  The “force-duration” curve and strength of the acting stimuli differ from previous therapies.  The difference between SCENAR and  DDC and SEA lies in the quality of action :  SCENAR action causes obvious physiological effects. In particular, it excites motor and sensory fibres, increases the speed of blood flow, activates local humoral mechanisms, promotes the removal of the products of lysis from the cell, etc.

2.                  Almost complete absence of adaptation of the organism to SCENAR action. Due to bio-feedback, each subsequent impulse is different from the previous one. For example, towards the end of the session, the power of action may be felt to be increasing by the patient, but not usually decreasing.

3.                  Non-damaging regime of action, technically (short excitatory impulses, bio-feedback, SCENAR-expertise) and methodology (individually-dosing regime of action, therapy based on rules).

4.                  High level of methodology. Various methods for treatment of certain diseases have been developed as well as combination with general zones (including the three pathways on the back, six points of the face etc.). Specific methods of action are used for individually-dosed regimes and according to various rules.

5.                  SCENAR can be used as a diagnostic and therapeutic tool at the same time, because there are different reactions from healthy and pathological tissue. Using the techniques now available we can assess the effectiveness of the procedures.

6.                  The successful construction of the family of SCENAR devices makes it possible in one session to combine the various effects of electro-analgesia, DDC, SEA and so on. The size of the active electrode is about 1cm², which is quite small. Therefore during the treatment we can achieve effects which are similar to the effects of electro-acupuncture. Acupuncture points and reflective zones are at areas of higher innervation (close proximity to nervous trunks, above nervous plexus, lymphatic and blood vessels, at places where a nerve exits/enters the bones). With the high conductivity of these areas, the main energy of action can be applied to them, even though the size of the electrode is bigger than the zones. We can suggest that SCENAR-therapy smoothes away the differences between physiotherapy (electrotherapy) and acupuncture, where general mechanisms and actions are similar to each other.

With all this in mind, wherever other electrotherapies are effective,  SCENAR therapy will also be useful and, indeed, it has been found to be very useful when other electrotherapies have failed. The peculiarities of SCENAR-therapy mean that there are few contra-indications.

The table below shows the indications and contra-indications for electrotherapy. The recommendations for SCENAR-therapy are based on the experience of the founders of SCENAR therapy in Russia: Dr Y.Gorfinkel and Dr. A. Revenko.

Abbreviation used in the table 1/2

DDC – Dia-Dynamic Current;
TE – Trans-cranium Electro-Analgesia;
EST – Electro-Sleep Therapy;
SEA – Short impulse Electro-Analgesia;
ES – Electro Stimulation;
EP – Electro-Puncture;
AT – Ampli-pulse Therapy;
IT – Interference Therapy;
F – Fluctuorisation;
Sc – SCENAR therapy.

Table 1          Indication to Electro-therapy