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Iontophoresis is technique using a small electric charge to deliver a medicine or other chemical through the skin. Basically an injection without the needle. The technical description of this process is a non-invasive method of propelling high concentrations of a charged substance, normally medication or bioactive agents, transdermally by repulsive electromotive force using a small electrical charge applied to an iontophoretic chamber containing a similarly charged active agent and its vehicle. To clarify, one or two chambers are filled with a solution containing an active ingredient and its solvent, termed the vehicle. The positively charged chamber, termed the anode will repel a positively charged chemical, while the negatively charged chamber, termed the cathode, will repel a negatively charged chemical into the skin.

Iontophoresis is commonly used by physical therapists for the application of anti-inflammatory medications. Its use has increased dramically in occupational medical clinics - primarily to aid in the reduction of pain and swelling which occurs early following musculoskeletal injuries.

The question we are commonly asked is whether Iontophoresis "makes" an injury OSHA recordable. Paragraph 1904.7(b)(5)(ii)(E) defines first aid as follows: Using hot or cold therapy (e.g., compresses, soaking, whirlpools, non-prescription skin creams/lotions for local relief, etc.).

OSHA does not specifically talk about Iontophoresis. Their first aid list is one of exclusion. If it is not on this list, then it is recordable. If, however, one decides to challenge this notion, the choice of medication that the medical facility uses for Iontophoresis will have to be quite limited. Typically, medications such as Dexamethasone, Hydrocortosone 10%, Diclofenac, Piroxicam are used. These are all prescription medications and would make the case recordable. In addition, even if OTC medications such as ibuprofen or keoprofen are utilized, it is likely the strength used will be at a prescription level.

There is a lot of literature that Iontophoresis works well in reducing pain and swelling when used early in musculoskeletal injuries. However, I feel that it is making the case unnecessarily recordable when OTC anti-inflammatories may achieve the same results - just not as quickly.