Archive for January, 2008
eToims®|TENS
January 25, 2008 1:09 amFriday, January 25, 2008
One of the readers has asked about the difference between TENS and eToims®. TENS stands for transcutaneous electrical nerve stimulation and is an effective treatment modality for chronic musculoskeletal pain. Although the indications for use to control neuromuscular pain is similar in both methods, there are major differences between TENS and eToims®.
TENS uses 2-4 surface patch electrodes placed over the areas of pain with very low threshold stimulation usually at high frequencies to control pain. The mechanism behind pain control with TENS is in closing the pain gates in the dorsal horn of the spinal cord so that the pain impulses would not be conveyed to the brain. The electrodes are placed on the skin and an area is stimulated usually for 20 to 30 minutes. If the electrodes are placed over motor points, local twitch impulses can be elicited. This is called motor level TENS and can give pain relief due to the elicitation of the twitches. TENS is usually self-applied by the patient with a unit hooked on to a belt allowing the patient to be mobile. Patient may turn the device on and off and use it several times throughout the day on different body sites of pain.
eToims® standing for Electrical Twitch Obtaining Intramuscular Stimulation is a new anatomical and physiological approach for acute and chronic neuromuscular pain relief. In using the state-of-the-art eToims® Twitch Relief Method, the expert clinician applies the electrical stimulation. Although eToims® stimulation is applied from the skin surface to the motor points as occasionally may occur with TENS, the eToims®stimulus intensity is maximal to supramaximal and lasts only for a fractionth of a second.
Unlike the TENS method, eToims® Twitch Method is targeted to locating and stimulating specifically the motor points within the given timeframe that the patient requests for treatment. All muscles that surround the area of interest as well as muscles supplied by nerve roots (myotomes) above and below the area are treated individually.
The patient is repositioned in many positions to facilitate finding the motor points.The clinician must also position himself/herself to be able to direct the electric current to reach the motor point. Therefore, for all positions of the patient, the clinician literally walks around the treatment table to obtain a good angle for treatment. For example, if the patient is lying on the right side, the clinician may treat the patient from the front of the patient as well as back of the patient with the patient's limbs and spine kept in different positions to relax the muscles needing treatment.
With eToims Twitch Relief Method the patient as well as the clinician are actively participating in the treatment to provide active exercise individually to each and every muscle of interest through motor point stimulation to provide neuromuscular pain relief. eToims® Twitch Relief Method can be used as a stand-alone non-pharmaceutical, non-surgical method in early, mild cases of nerve related muscle pain with chances for complete recovery.
eToims® Twitch Relief Method has been in development since 1990 and in late 2006 became state of the art and noninvasive. Please click on the first HOME button from the left in this blog to visit StopMusclePain.com main site to obtain more detailed information on the new, non-invasive eToims® as well as to view the video which clearly illustrates how eToims is performed.
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Chronic Low Back Pain| Anger| Muscle Tension
January 20, 2008 2:10 amJanuary 20, 2008
In a study on patients with chronic low back pain to determine whether anger-in, anger-out, and hostility predicted symptom-specific muscle tension reactivity found that if anger was kept in with hostility during an anger recall interview, there was increased electromyographic tension in the lumbar paraspinal muscles but not in the trapezius muscle. Increases in systolic blood pressure and diastolic blood pressure changes were also noted with the least changes occurring in those patients with high anger-in/low hostility. These physiological changes did not occur when patients were subjected to a sadness recall interview. The conclusion was that patients with chronic low back pain who tend to suppress anger and are cynically hostile may be more likely to experience high levels of muscle tension near the site of pain and injury during anger, but not during sadness, than other groups1.
On the contrary, a massage can help muscles relax and bring down the blood pressure, at least in healthy subjects. A study that showed that after myofascial trigger-point massage therapy there was a significant decrease in heart rate, systolic blood pressure and diastolic blood pressure. Analysis of heart rate variability revealed a significant increase in parasympathetic activity following myofascial trigger-point massage therapy. Additionally both muscle tension and emotional state, showed significant improvement2.
- Burns JW. Bruehl S. Quartana PJ. Anger management style and hostility among patients with chronic pain: effects on symptom-specific physiological reactivity during anger- and sadness-recall interviews. [Journal Article. Research Support, N.I.H., Extramural] Psychosomatic Medicine. 68(5):786-93, 2006 Sep-Oct
- Delaney JP. Leong KS. Watkins A. Brodie D. The short-term effects of myofascial trigger point massage therapy on cardiac autonomic tone in healthy subjects. Journal of Advanced Nursing. 37(4):364-71, 2002 Feb.
www. stopmusclepain.com Chronic Low Back Pain| Anger| Muscle Tension
Chronic Pain | Complex regional pain syndromes
January 13, 2008 3:01 amSunday, January 13, 2008
Complex regional pain syndromes (CRPS, reflex sympathetic dystrophy, causalgia) are painful neuropathic disorders that develop after trauma affecting a limb with (I) or without (II) nerve injury. Clinical features are pain, impairment of motor function, swelling and autonomic abnormalities (changes in sweating and blood flow). The International Association for the Study of Pain criteria for CRPS I include:
1. The presence of an initiating noxious event, or a cause of immobilization.
2. Continuing pain, allodynia, or hyperalgesia in which the pain is disproportionate to any inciting event.
3. Evidence at some time of edema, changes in skin blood flow, or abnormal sudomotor activity in the region of pain.
4. This diagnosis is excluded by the existence of conditions that would otherwise account for the degree of pain and dysfunction.
Although sympathetic influences are still viewed as the most likely mechanism underlying the development and/or perpetuation of CRPS, these influences are no longer ascribed to an increase in sympathetic tone. Rather, the most likely mechanism may be increased sensitivity to catecholamines due to sympathetic denervation with an increase in the number and/or sensitivity of peripheral axonal adrenoceptors. Several other pathophysiological mechanisms have been suggested, including neurogenic inflammation with the release of neuropeptides by primary nociceptive afferents and sympathetic efferents. These neuromediators, particularly substance P, calcitonin gene-related peptide, and neuropeptide Y (NPY), induce an inflammatory response (cutaneous erythema and edema) and lower the pain threshold. Neurogenic inflammation at the site of the lesion with neuromediator accumulation or depletion probably contributes to the pathophysiology of CRPS1.
Treatment regimens for CRPS I vary widely and may include physical therapy, sympathetic nerve blocks, tricyclic antidepressants (TCAs), opiates, anticonvulsives, and psychologic treatment. In CRPS I, a prolonged regional inflammation may induce sensitization of primary and secondary somatosensory afferents (peripheral and central sensitization). These aspects of neuropathic pain may be present in each patient in a unique individual mix and with different time profiles and efforts should be made in aiming treatment at the dominant mechanisms underlying the regional inflammation and peripheral and/or central sensitization in an individual patient at a specific moment in time2.
1. Pham T. Lafforgue P. Reflex sympathetic dystrophy syndrome and neuromediators. Joint, Bone, Spine: Revue du Rhumatisme. 2003: 70(1):12-7.
2. Ribbers GM, Geurts AC, Stam HJ, Mulder T.Pharmacologic treatment of complex regional pain syndrome I: a conceptual framework. Arch Phys Med Rehabil 2003;84:141-6.
www. stopmusclepain.com Chronic Pain | Complex regional pain syndromes
Chronic Fatigue| Fibromyalgia| Pre-morbid Life-Styles
January 5, 2008 4:39 pmSaturday, January 05, 2008
Patients with Chronic Fatigue and Fibromyalgia, whom I have treated seemed to have special common traits and a literature search showed the following findings:
Generally considered a “precursor” of Chronic Fatigue Syndrome and Fibromyalgia is overwork since such patients have been described in these terms: “overactive, unable to set limits to the demands of others, high achievement motivation, obsessive–compulsive traits, perfectionism, type-A (like) behavior, workaholism, self-sacrificing tendencies, inability to express one's feelings”.
A study showed that indeed, 80–90% of the significant others of these patients agree with statements that the patients do focus on activity, drive, achievement, impatience and “to know how to set about work.” This quasiunanimous agreement consistently strengthens the image of Chronic Fatigue Syndrome and Fibromyalgia to be premorbidly passionate, strong-willed, energetic and driven, i.e., high “action-prone” individual.
There is even a higher tendency for significant others who showed a negative attitude to the patient’s illness to appraise the patients “action-proneness” than for those who are supporting and solicitous. This ruled out the possibility of influence of personal bias that significant others may have on the results.
These results do not support the hypothesis that Chronic Fatigue Syndrome and Fibromyalgia patients retrospectively idealise their premorbid lifestyle or attitude towards activity.
High “action-proneness,” by promoting an “overactive” lifestyle, may be one of the factors that makes people more vulnerable to Chronic Fatigue Syndrome and Fibromyalgia, and also contributes to the onset and perpetuation of the illness.
People who engage in an “overactive” lifestyle may run a greater risk of acute or chronic physical overburdening by a negligent attitude towards the body, musculoskeletal overuse or sleep deprivation. Particularly those with childhood victimization experiences often show a tendency to exceed physical limits (in work or sports) as a way of coping, i.e., to maintain self-esteem, stabilise the affective equilibrium and prevent anxiety and depression.
Long-lasting physical or mental stress may, in susceptible individuals, eventually lead to neuroendocrine (mainly HPA axis) and immunological dysfunctioning, paving the way for various stress-related disorders and contribute to the neuronal sensitization of central pain mechanisms, resulting in the typical “general pain hypersensitivity” of fibromyalgia patients.
When illness deprives these patients from being able to use “overactivity” as their favourite coping strategy, fatigue and pain may be reinforced by chronic sympathetic arousal, hyperventilation and disturbances of the sleep-wake cycle.
Lifestyle adjustment and psychological counselling and support should always be central goals in cognitive–behavioral programs for these patients. These patients are still prone to outbursts of over-activity when they may feel better perpetuating the chronic pain and suffering.
Reference: Van Houdenhove B. Neerinckx E. Onghena P. Lysens R. Vertommen H. Premorbid "overactive" lifestyle in chronic fatigue syndrome and fibromyalgia. An etiological factor or proof of good citizenship?. Journal of Psychosomatic Research. 51(4):571-6, 2001.
www.stopmusclepain.com Chronic Fatigue| Fibromyalgia| Pre-morbid Life-Styles
