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Chronic Refractory Myofascial Pain: Characteristics of Patients who Self-select Long-term Management with Electrical Twitch-Obtaining Intramuscular Stimulation

Jennifer Chu, I Schwartz and S Schwartz

Introduction: Noninvasive Electrical Twitch-Obtaining Intramuscular Stimulation (eToims) is safe and efficacious in long-term management of chronic refractory myofascial pain (CRMP).

Objective: To evaluate factors influencing patient self-selection for long-term eToims management of CRMP.

Methods and materials: Included were 133 consecutive CRMP patients (65 males, 68 females) who opted to pay for eToims treatments between 12/1/09 and 12/31/11. Each session involved treatment to large muscles of C3-C7 and L3-S1 myotomes. Outcome measures include immediate pre&post-treatment session visual analogue scale (VAS), symptomatic (S) and asymptomatic (A) side range-of-motion (ROM) : for neck rotation (NR), shoulder external rotation (ER), shoulder internal rotation (IR), straight leg raising (SLR) and FABERE (FAB). Analysis performed by grouping results as follow: Group0: <=10 treatments and immediate reduction of VAS<2; Group1: ≤ 10 treatments and immediate reduction of VAS ≥ 2; Group2: >10 treatments and immediate reduction of VAS<2; and Group3: >10 treatments and immediate reduction of VAS ≥ 2. Safety precautions include interval history and vital signs before and after treatment.

Results: Groups 0 & 1 comparison showed no measured ROM difference. Group 3 & Group 2 comparison demonstrated shorter interval between treatments (15+47 vs. 138+167 days respectively, p<0.001), longer treatment duration/session (52.0+26.0 vs. 49.0+22.0 minutes, respectively), and immediate improvement in all ROM measured. Group pain relief appears influenced by age, symptom duration, treatment duration/session, pulse reduction and improvement in ROM. No eToims-associated safety issues noted.

Conclusions: Safe and efficacious pain relief with concomitant immediate improvement in ROM and pulse rate reduction correlates with patient satisfaction and self-selection to return for multiple eToims treatments over time.