Leading scientists and clinical experts in the field of wound care also highlight the important role that microcurrent electrical stimulation therapy (EST) can play in the well established TIMERS wound care assessment and treatment framework.
8/10/2025
A new study finds that bioelectric signalling in older people and those with diabetes is around half that of younger or healthy people – and is a barrier to healing!
A new scientific review supported by world leading experts in the field has found that chronic wounds, especially those in older adults or people with diabetes, may fail to heal properly because a key part of the healing process, namely bioelectric signalling, is weakened by around half.
The study, recently published in Advances in Wound Care, suggest that in healthy skin, tiny natural electrical signals help guide cells to repair injuries. But in certain individuals, these signals may be significantly weakened – this can slow or even halt the healing process.
The essential role of bioelectricity in healing has been known for decades. What’s new in this systematic review is the idea that some wounds may fail to heal because this bioelectric signalling is too weak. It’s like the wound is trying to call for help, but the signal is too weak and the message just doesn’t get through.
The research team carried out a systematic review and identified 12 scientific studies that looked at how aging, diabetes, and inflammation affect the skin’s natural electrical activity. The evidence showed that in these groups of people, the skin’s electrical current at the wound site, known as the “current of injury”, was much lower, roughly halved, compared with younger, or healthy individuals. In other words, patients who are older or diabetic showed a marked weakening of the bioelectric “signal” that normally helps drive healing. Because lower currents of injury are already known to be associated with slower wound healing, the authors proposed that this diminished bioelectric signalling represents a barrier to healing. This may help to explain why wounds in older adults or those with diabetes often heal more slowly and can become chronic despite current best practice treatments. Without a strong enough bioelectrical signal, the cells that provide the body’s repair mechanism may not know where to go or what to do.
What can we do about it? Electrical Stimulation Therapy (EST) can be used to boost bioelectric signalling up to more normal levels
But there is a solution. The authors point to electrical stimulation therapy (EST), which delivers a small external current to the wound area. This “jump-starts” bioelectic signalling and has been shown to stimulate the body’s natural repair process. In particular, microcurrent EST involving very gentle currents, provides a stimulation level similar to what the body produces naturally. It’s designed to give the wound a boost when it can’t generate that healing spark on its own.
To make it easier to incorporate EST into clinical use it should be added to the treatment frameworks such as the well established TIMERS framework.
The authors believe this way of looking at things could change how hard-to-heal wounds are treated, especially in older adults. They recommend updating wound care guidelines, for example the TIMERS framework, to include EST as a potential therapy in cases with a slow healing trajectory. Importantly, EST has also been shown to reduce wound-related pain, which is another important benefit in situations where unresolved wound pain is impacting healing and patient quality of life..
This review presents the idea that what’s preventing the chronic wound to heal is not only factors such as poor circulation, infection, and other local and systemic factors , but also the fundamental bioelectrical current that helps guide healing. This shift in perspective could offer new hope for patients and clinicians facing the challenge of hard-to-heal wounds. Restoring the bioelectrical signalling by adopting EST into clinical protocols may represent a promising advance in wound care and may give new hope to the patients and providers who are battling these stubborn, painful wounds.
The new article can be cited as: Smith J, Nuccitelli R, Zhao M, Atkin L, Dowsett C, Maillard H, Swanson T, Fletcher J, Nair HKR, Carville K, Martin R, Woodmansey E. Is Deficiency in the Electrical Current of Injury a Barrier to Healing in Hard-to-Heal Wounds? A Systematic Review with Implications for the TIMERS Paradigm. Adv Wound Care (New Rochelle). 2025 Sep 16.
For access to the full paper click here