Percutaneous electrolysis and microelectrolysis for musculoskeletal pain management: milliamps or microamps? An evidence-based comparison through systematic review and meta-analysis

Introduction
Invasive techniques like percutaneous electrolysis have recently surged in popularity for treating musculoskeletal disorders. However, emerging techniques have sparked debates on optimal intensity current, highlighting the need for clarity in their efficacy.

Objective
To assess and compare the effects of electrolysis and microelectrolysis on pain intensity in individuals with musculoskeletal pain.

Methods
This study is a quantitative systematic review with an observational, retrospective, and secondary design. The search included databases such as PubMed, Scopus, Web of Science, EMBSCOhost, Embase, Cochrane Library, PEDro, and Google Scholar (updated on July 1, 2024). Independent reviewers selected eligible studies and assessed their quality using the Cochrane risk of bias 2 tool. Pain intensity was the primary outcome, while secondary outcomes included pain pressure threshold and disability. The meta-analysis calculated pooled effects using mean differences or standardized mean differences for these outcomes.

Results
Twenty-eight studies were included with an overall low risk of bias (21.4%). Randomization and outcome measurement (21.4%), intervention deviations (28.6%), and outcome measurement (53.6%) were all sources of bias. Post-treatment, pain intensity, and disability reduction were statistically significant (p < 0.01) for microelectrolysis (pain: SMD = -0.92; 95% CI: -1.3, -0.5 and disability: SMD = -0.92; 95% CI: -1.3, -0.5) and electrolysis (pain: SMD = -0.3; 95% CI: -0.6, -0.01 and disability: SMD = -1.8; 95% CI: -3.1, -0.6). For the pain pressure threshold, none of the modalities outperformed the controls.

Conclusions
This review highlights the effectiveness of electrolysis modalities in managing musculoskeletal pain and disability, especially microelectrolysis. Further research is needed to understand their analgesic mechanisms, and US-guided decisions should be based on comprehensive risk-benefit assessments.