Edited and revised September 2016

One talk caught my eye in the COPA brochure last year.  Compared to the gimmicks and hard sell of some of the technologies on exhibit, this sounded like an old-fashioned, modest, and serious research project.  It was presented by a nurse from a Multiple Sclerosis Therapy Centre in Bedford called Miranda Olding.  “Interventions for neuropathic pain” was the title.  There was just something about it that sounded like it would have a bit of substance.   Now neuropathic pain is not something I see all the time, but people do present with it, sometimes as a secondary problem. They have often lived with it and don’t generally expect me to be able to help much.  It has always been something of a mystery to me.  So this was potentially a very useful talk.

Neuropathic Pain is horrible

I got a seat early: luckily, as it was standing room only by the time Miranda began.  She described neuropathic pain as an “unpleasant lesion or disease in the somatosensory nervous system, either central or peripheral”. I immediately warmed to her when she told us the mechanisms behind this pain were “so complex that nobody really understands them”. She seems to have been a diligent and conscientious nurse, administering the recommended drugs to her patients.  However she said that when you’re dealing with MS patients (“who never go away, and never get better”), it is not long before you fall out of love with the pharmaceutical options, which include SSRIs, carbamazepine, anticonvulsants, antidepressants and topical capsicain (the latter so unpleasant to use that not a single one of her patients would continue with it, despite it being in the NICE guidelines).  The side effects of lots of the drugs were worse than the condition.  There are a few other options.  Spinal cord stimulation can work a bit for a couple of years.  Intrathecal opiates can help.  Pain management teams can sometimes offer more, with psychologists, TENS machines, facet injections, and the like,  but these services vary according to where you live.  The suffering of these people really was depressing to hear about.  In a survey she quoted, 17% of neuropathic pain sufferers described the pain as “worse than death”, a description that I found hard to unravel.  How bad is death?  How do they know? I suppose it is a version of “Kill me now”, a kind of pain I am lucky enough only to have had once or twice.

Miranda tried APS at the MS Centre in Bedford

One day a friend of Miranda’s – also a nurse – phoned her up from Hull. Her team had come across some research from Holland which suggested that APS Therapy might help with neuropathic pain.  They had started to use an APS machine and were really excited about the results they were getting.  Miranda went up to see them and got so excited as well that she badgered her boss into investing in a machine for their centre.  They cost a little over £1000.  Very little research had been done, so they decided to assemble some basic numbers themselves.  They had the machine, a room and a desk.  They began with 42 subjects – not just MS sufferers, but anyone with chronic pain, including headache-prone members of staff who wanted a go; mostly, though, it was neuropathic pain of the feet and legs.  Of the 36 that saw the study through, 28 improved.  And they improved quite dramatically.  It seems that it either works for you, or it doesn’t, and if it does work, it works really, really well.  The average level of improvement on a visual analogue scale was 4.7 points.  (This outperforms morphine!)  In addition, there were numerous other benefits such as improved sleep, mood and energy levels (no wonder, if your pain rating drops from 8 to 3.3).Someone’s recurrent urinary tract infections even stopped.  Medication use dropped, something that Miranda and her team had not anticipated.  Now, I hear you ask.  “What is this impressive sounding machine and how does it work?”

You attach some electrodes to your skin, switch it on and sit there for a bit

How it works – on all sorts of pain, not just neuropathic

It stimulates action potentials.  APS stands for Action Potential Stimulation.  It can also be called micro current therapy, but it’s key property is that it has a unique waveform exactly the same as an action potential.  A man in South Africa called Gervase Lubbe, (not a doctor, but of an inventive disposition) was one day leafing through an American medical journal, when he came to an article about pain mechanisms.  He was intrigued by the possibility of inventing a machine which simulated/stimulated action potentials.  And if he could, he thought, it could possibly have some therapeutic benefit.   Presumably many hundreds or thousands of hours later he emerged from his shed with his APS Therapy machine.  This was back in the early 1990s I believe.  Now this machine doesn’t look like much; it looks maybe like an ultrasound machine, or a bit of paraphernalia in the back of the health food shop, used for allergy testing or the like.    From it you connect multiple electrodes to the painful area(s), turn it on till you feel a slight tingle (a bit like a TENS, but it’s not  a TENS) then turn it down till you can’t feel it and sit there for about 20 minutes or so.  It is a very non-invasive, pleasant kind of treatment.  The most uncomfortable part of it is probably trying to find a parking space near the clinic. You do this three times a week for a minimum of 6 weeks.  It can take a while to feel the symptoms improve.  You might then have to keep using it to keep symptoms at bay, but only once a week or fortnight for maintenance. Now how it works exactly is still not fully understood.  By simulating an action potential it seems to increase electrical activity in an area in which electrical activity might be compromised due to congestion/damage?  There is a lot of talk on various APS websites of revitalizing cells, draining lymph, increasing ATP production and healing damaged tissue. It seems to work best on conditions with an inflammatory component.  The hypothesis is simply that the inflammation interferes with nerve transmission, and the APS machine manages to improve this nerve transmission.  But I’m not sure anyone really knows.  Miranda doesn’t think it works on disc prolapse where there is a severely compromised nerve root, nor is it advised for cancer pain or severe osteoarthritis where bone is grinding on bone.  But it worked terrifically well for this MS population and, according to Miranda, for many different kinds of pain, not just neuropathic. It also seems to make a big difference to insomnia and fatigue.  Chronic headaches are much improved by it, but there is a possibility it can trigger migraines.  The next stage is to identify why it works for some and not others, as the results seem remarkably polarized.

This is what it looks like when you are getting the therapy

APS Therapy today

So where are we now?  Gervase Lubbe is, as far as I can tell from the information you find on the internet, in prison for financial fraud.  (The APS crowd keep a bit quiet about him and I had to do some digging to find out about him.  Maybe don’t bring it up if you talk to them.)  Having caused a stir with the initial APS machine, which was given great credibility when it was used by the esteemed Christian Barnard for his rheumatoid arthritis, the inventor had gone on to invent an early warning malaria detector, and I believe he had taken money for orders which never materialized.  Should we hold that against the APS machine?  Not if it works.

In the first wave of its use, back in the 90s, the machine was distributed fairly randomly without too much training, instruction  or advice.  Somehow it has migrated to Holland, where they are now in wide circulation.  You can even have APS Therapy on your medical insurance there.  A New Zealand website claims that 40,000- 50,000 machines are being used worldwide, but they are still concentrated in Holland and South Africa.

Research is happening now

There is some research but not a robust body:  I’m afraid I haven’t read through it yet but here is a list of papers displayed by APS South Africa.  I only found a couple of things on PubMed (my search technique is appalling): one showed APS had no effect on fibromyalgia. There is a slightly more favourable study here showing reduction in the pain from knee osteoarthritis.

Miranda’s own research project is here, with some other small bits of research.

Miranda is into the statistics

She believes it has such potential (pardon the pun) that she is now selling and renting the machines, and trains therapists in its use.  She is doing more research, and is very busy trying to take APS therapy further and understand its indications better.The centre up in Hull is doing a slightly larger trial, of about 100 people with conditions such as RA and MS, having already won the Grunenthal Commissioning Award for their work with the machine thus far.  No results have been released but word on the street is that quite a few of those subjects in the trial have been investing in their own APS machines.  Nobody can afford to do an RCT on APS therapy, but every little bit helps, and as with osteopathy, if people do benefit they will slowly spread the word.

If you want to try it out

If you would like to be involved in using them as part of your practice you can contact Miranda to buy a clinic machine and go for a day’s training (£50) which will teach you how to work it.  Or you can refer people directly to her and they can rent the machines from her.  I have been for the day’s training now myself and am looking forward to trying out a machine on someone I know, so I can see how it works.  If you really take to APS Therapy you can buy your own smaller rental machines from her (£860) and then rent them out yourself.

If anyone does get involved with APS Therapy, please do let me know how you find it.  I was impressed by the presentation, and the stats, and am going to have a go with one on a couple of friends, but I would love to hear more  from anyone on the ground actually using it.