Iontophoresis and Dexamethasone Patch

Going to physical therapy for your neck or back? If so, you'll likely be given a coordinated set of treatment modalities.

Doctor adjusts a woman's ankle in physical therapy
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The specific therapies are chosen by your P.T. and depend on what's happening with your spine—pain levels, functionality, and the like. Usually, a home exercise program (acronym HEP) is the biggest part of the plan.

But your therapist may add in things like traction, moist heat, and other types of feel-good experiences that have varying degrees of effectiveness as proven via medical studies.

According to a 2018 study published in the journal FP Essentials, such modalities tend to be safe, but not supported by high-quality evidence as being effective in managing typical musculoskeletal problems.

Iontophoresis Patch

One such treatment modality is called iontophoresis, or ionto, for short. This procedure involves a patch that is placed on your skin. It is used most frequently to reduce inflammation and relieve pain.

Attached to the patch is a small pouch of medication. Both patch and pouch are connected to an ionto machine. As the medication is delivered through the pores of your skin, the ionto machine also applies a small electrical current, which further increases your skin's permeability to the medication.

Ionto, Dexamethasone and More

With iontophoresis, it's possible to program the delivery of the medication so that it's distributed over time and/or in varying doses.

Lidocane is a pain reliever and skin numbing agent that also has other medical uses outside the scope of orthopedic treatments.

A dexamethasone patch simulates the corticosteroid cortisol (but is more potent), an important hormone produced naturally by your adrenal glands. Dexamethasone has anti-inflammatory properties, which means it relieves or reduces swelling, heat, redness and pain. And it's used as a treatment for arthritis, bursitis, and tendonitis, as well as other maladies, including cancer.

History of Iontophoresis

As mentioned above, with iontophoresis treatments, the electric current enhances the delivery of the pain-relieving medication as it moves through the barrier of the skin into where it can exert its effect.

In the past, experts believed the action of iontophoresis is to push the medication through the skin. More recently, though, they've updated their understanding of the specific way in which this modality works. In essence, they say, ionto helps open up microscopic pores in the outermost layer of the skin, which in turn allows the medication to flow freely into tissues.

Into the Future with Ionto

Iontophoresis is actively being developed by biomedical researchers in a variety of ways. Experts are trying to increase the ability of the drug to permeate the skin, and also to decrease side effects. And they are interested in improved drug delivery programming.

A variety of technologies are being explored: nanotechnology, which is about working with small amounts of substances and currents, electroporation in which an electrical current is applied to cells to increase permeability of the cell, allowing medication (or things like DNA) to enter—sonophoresis for increasing medication absorption, device miniaturization, and the use of chemical enhancers.

What to Expect When You Get Iontophoresis

When you have an iontophoresis treatment, the physical therapist will likely have you lie down on a treatment table. They will then place two electrodes close to the problem area (where inflammation is present.) One of the electrodes will contain the pain medication—whether dexamethasone, lidocane or something else.

The electrodes will be connected to the iontophoresis machine. The therapist will work the controls on the ionto to raise the amount of current to the point where barriers to drug delivery provided by both your skin and the electrodes are overcome. In this way, the delivery of the medication to your underlying tissue is enhanced. 

An iontophoresis patch is known for enabling a high concentration of medication to reach deeply—all the way to the muscles, with few, if any, side effects. But it also helps distribute the dexamethasone, lidocane, etc to a larger surface area. 

Ionto treatment lasts between 10 and 15 minutes and may be given either before or after the exercise portion of your session.

Ionto is not painful, but the study mentioned above found that it does not offer better outcomes than a course of physical therapy that does not include ionto.

2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Beutler A. Musculoskeletal Therapies: Adjunctive Physical Therapy. FP Essent. 2018.

  2. Roustit M, Blaise S, Cracowski JL. Trials and tribulations of skin iontophoresis in therapeutics. Br J Clin Pharmacol. 2014;77(1):63-71. doi:10.1111/bcp.12128

By Anne Asher, CPT
Anne Asher, ACE-certified personal trainer, health coach, and orthopedic exercise specialist, is a back and neck pain expert.