Chronic pain (CP) is a worldwide public health problem affecting physiological, psychological and social well-being. There are 1.5 billion chronic pain (CP) sufferers worldwide. In the USA, annual CP care is estimated at $635 billion, more than the cost/year for cancer, heart disease, and diabetes. Low back pain and neck pain respectively has a 9.4% and 4.9% prevalence worldwide. Public health priorities urgently need safe and efficacious innovations for (1) prevention (pre-rehabilitation), (2) simultaneous real-time ability to clinically diagnose, (3) treat (rehabilitation) and (4) provide prognosis in acute and CP management.
Using ETOIMS to stimulate nerve-muscle junctions (myofascial trigger points/MTrPs) provide objective evidence of denervation supersensitivity (DS) in multiple myotomes as cause, aggravation and maintenance of CP.
Grade 1 twitches result from focalized, partial contraction of stimulated muscle(s) at MTrP. A stronger twitch force on the electrode overlying MTrP with DS gives an asymmetrical, bouncy feedback on the bipolar probe with 6 inches (15 cm) separation between two water-wetted surface electrodes. Using magnesium sulfate (MgSO4) dermal spray before and during ETOIMS, reduces tissue impedance facilitating twitch elicitation from the deepest muscles. Grade 2 twitches additionally show rocking/shaking limb and/or trunk movements from stimulation of MTrPs of deep muscles apposed to bone and joints. Grade 3 twitches produce antigravity limb movements with MTrP stimulation. Grade 4 twitches, in addition, has autonomous twitches that take minutes to fatigue whereas Grade 5 autonomous twitches rapidly fatigue within a few seconds.
To obtain nerve-muscle-joint pain relief, minimum grade 2 force is essential. The deeper, more forceful Grades 3–5 twitches produce more pain relief but are difficult to elicit needing MgSO4 spray to help reduce muscle hypertonicity.
Therapies for chronic LBP without high quality evidence for improving pain intensity and function include lumbar supports, traction, superficial heat and cold, ultrasound, transcutaneous electrical nerve stimulation, low level laser therapy, acupuncture, muscle energy techniques, spinal manipulation, chiropractic treatments, massage, epidural injection to facet joints, nerve blocks, radiofrequency lesioning, intradiscal radiofrequency thermocoagulation and minimally invasive discectomy. Systematic reviews do not show clear evidence that long-term antidepressants, non-steroidal anti-inflammatory drugs, muscle relaxants and opioid therapy are effective for CP treatment. Gabapentin at doses of >1200 mg is effective for some neuropathic pain conditions.
A systematic review on stretching suggests that before, after or before-after exercise stretching does not produce clinically important reductions in delayed-onset muscle soreness. ETOIMS stretching is more effective due to summation of twitch-induced stretch forces focused to MTrPs with repetitive 1–3 Hz stimulation.
Exercise therapy appears to be slightly effective at decreasing pain and improving function in adults with chronic LBP. ETOIMS is aerobic exercise therapy improving circulation to individual muscles. Patients can empower themselves performing "Selfie-ETOIMS" and recording twitch-force and blood pressure.
ETOIMS is presently seeking FDA marketing approval as a muscle stimulator for treating pain and can be billed as physical therapy sessions.
In acute MP management, ETOIMS is best applied preferably within 24 hours of injury when muscles/nerves are most viable. MgSO4 spray can be used as a stand-alone treatment in acute pain and to potentiate ETOIMS.
ETOIMS is suitable for use also in developing countries since it is cost-effective and has been used in Myanmar for several years. ETOIMS clinical training can be done using online videos, real-time video-conferencing and inventor’s review of clinicians/patients' short videotapes of ETOIMS treatments.
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