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Section XVIII: Physical Agents

Interactions Between Drugs and Commonly Used Modalities

TABLE 18.1Interactions Between Drugs and Commonly Used Physical Modalities
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TABLE 18.1 Interactions Between Drugs and Commonly Used Physical Modalities
Modality Desired Therapeutic Effect Drugs With Complementary/ Synergistic Effects Drugs With Antagonistic Effects Other Drug–Modality Interactions

Cryotherapy

Cold/ice packs, ice massage, cold baths, vapocoolant sprays

  • Decreased pain, edema, and inflammation

  • Muscle relaxation and decreased spasticity

  • Anti-inflammatory steroids (glucocorticoids); non-steroidal anti-inflammatory analgesics (aspirin and similar NSAIDs)

  • Skeletal muscle relaxants

  • Peripheral vasodilators may exacerbate acute local edema.

  • Nonselective cholinergic agonists may stimulate the neuromuscular junction.

  • Some forms of cryotherapy may produce local vasoconstriction that temporarily impedes diffusion of drugs to the site of inflammation.

Thermotherapy

Hot packs

Paraffin

Infrared

Fluidotherapy

Diathermy

Ultrasound

  • Decreased muscle/joint pain and stiffness

  • Decreased muscle spasms

  • Increased blood flow to improve tissue healing

  • NSAIDs; opioid analgesics; local anesthetics

  • Skeletal muscle relaxants

  • Peripheral vasodilators

  • Nonselective cholinergic agonists may stimulate the neuromuscular junction.

  • Systemic vasoconstric tors (e.g., α-1 agonists) may decrease perfusion of peripheral tissues.

  

Systemic Heat

Large whirlpool Hubbard tank

  • Decreased muscle/ joint stiffness in large areas of the body

  • Opioid and nonopioid analgesics; skeletal muscle relaxants

  

  • Severe hypotension may occur if systemic hot whirlpool is administered to patients taking peripheral vasodilators and some antihypertensive drugs (e.g., α-1 antagonists, nitrates, direct-acting vasodilators, calcium channel blockers).
Ultraviolet radiation

  • Increased wound healing

  • Management of skin disorders (acne, rashes)

  • Various systemic and topical antibiotics

  • Systemic and topical antibiotics and anti-inflammatory steroids (glucocorticoids)

  • Many drugs may cause hypersensitivity reactions that result in skin rashes, itching.

  • Antibacterial drugs generally increase cutaneous sensitivity to ultraviolet light (i.e., photosensitivity).

  • Photosensitivity with antibacterial drugs.
Transcutaneous electrical nerve stimulation (TENS)

  • Decreased pain

  • Opioid and nonopioid analgesics

  • Opioid antagonists (naloxone).

  
Functional electrical stimulation (FES)

  • Increased skeletal muscle strength and endurance

  • Decreased spasticity and muscle spasms

  • Skeletal muscle relaxants

  • Skeletal muscle relaxants.

  • Nonselective cholinergic agonists may stimulate the neuromuscular junction.

  

From Ciccone, CD: Pharmacology in Rehabilitation, ed. 3. FA Davis, Philadelphia, 1996, inside front cover, with permission.

Thermal Agents

Thermal agents are modalities that produce a therapeutic transfer of energy to a patient to increase or decrease tissue temperature. Cryotherapy is the term used to describe the use of agents that lower tissue temperature, whereas thermotherapy is the term used for agents that raise tissue temperature. Temperature changes may be superficial or deep depending on the specific modality used, the body part treated, and the ability of the body to provide thermoregulation.

Note: Ultrasound and hydrotherapy may also be classified as thermal agents; however, because they utilize mechanical forms of energy to produce thermal as well as other therapeutic effects, they are listed as mechanical agents in this section.

Physical Laws

Thermal agents transfer heat by the following five modes of heat transfer:

conduction: Heating or cooling that results from ...

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