Low-intensity pulsed ultrasound

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,[1] cartilage, and tendon.[2] 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.[3][2]

Low-intensity pulsed ultrasound

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/cm2.[4]

Medical uses

Starting around the 1950s this technology was being used as a form of physical therapy for ailments such as tendinitis.[5]

As of 2009 research for the use of LIPUS to treat soft tissue injuries were in the early stages.[4] As of 2012 it was being studied for dental problems.[6]

Low intensity pulsed ultrasound has been proposed as a therapy to support bone healing after fractures,[1] 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.[7][8] An associated guideline issued a strong recommendation against its use in bone healing.[9] Evidence as of 2023 was insufficient to justify its use to prevent non healing of bone fractures.[10] Tentative evidence supports better healing with the use of the system in long bones that have not healed after three months.[11] Some reviews suggested inconclusive evidence of benefit.[12][10] One industry supported meta-analysis suggested it as a potential alternative to surgery for established nonunions.[13] Most studies suggesting benefit were funded by manufacturers of ultrasound devices.[7]

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.[14]

In vitro experiments have confirmed the LIPUS capability to regulate cell proliferation and differentiation as well as the opening of cell membrane channels.[2]


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.
  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. 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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