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Electrical Twitch-Obtaining Intramuscular Stimulation in Lower Back Pain: A Pilot Study

Chu, Jennifer MD; Yuen, Ka-fai MD; Wang, Bo-han MD; Chan, Rai-Chi MD; Schwartz, Ira MD, PhD; Neuhauser, Duncan PhD

American Journal of Physical Medicine & Rehabilitation: February 2004 - Volume 83 - Issue 2 - p 104-111
doi: 10.1097/01.PHM.0000107485.86594.8B
Research Article

Chu J, Yuen K, Wang B, Chan RC, Schwartz I, Neuhauser D: Electrical twitch-obtaining intramuscular stimulation in lower back pain: A pilot study. Am J Phys Med Rehabil 2004;83:104–111.

Objectives To determine if electrical twitch-obtaining intramuscular stimulation (ETOIMS) provides greater myofascial lower back pain relief than muscle stimulation or skin stimulation.

Design In this single-blinded, crossover, pilot trial performed at a university-affiliated outpatient rehabilitation medicine department in Taiwan, 12 acupuncture-naive patients with lower back pain of 3–60 mos duration received one crossover treatment every 2 wks by monopolar needle electrode insertion at bilateral T10-S1 levels to: (1) paraspinal muscles, (2) overlying skin, and (3) paraspinal muscles with ETOIMS applied via the needle electrode at individual treatment sites. A total of 30 manual insertions per side per treatment were performed, with withdrawal after 2 secs. Beginning 1 wk before each trial and continuing until 2 wks after, patients completed a visual analog scale twice daily. In addition, on the day of treatment, patients received a physical examination and completed a visual analog scale both before and after treatment.

Results Significant and immediate reduction in the visual analog scale levels was noted only with ETOIMS. Immediate improvement occurred in one of nine physical tests with muscle stimulation and ETOIMS only. In the 2 wks after treatment, absolute visual analog scale levels for ETOIMS were significantly lower than muscle stimulation and skin stimulation. ETOIMS resulted in a greater percentage of pain relief in the first week after treatment, although it was not statistically significant from muscle stimulation and skin stimulation.

Conclusions ETOIMS provided significantly greater immediate and sustained myofascial lower back pain relief than muscle stimulation and skin stimulation. Although a greater percentage of pain reduction occurred with ETOIMS, it was not statistically significant.

From the Department of Rehabilitation Medicine (JC) and the Department of Surgery, Division of Urology (IS), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; the Department of Rehabilitation Medicine, Veteran’s General Hospital, Tapiei, Taiwan, Republic of China (KY, BW, RCC); and the Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio (DN).

All correspondence and requests for reprints should be addressed to Jennifer Chu, MD, Department of Rehabilitation Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Ground White, Philadelphia, PA 19104-4283.

© 2004 Lippincott Williams & Wilkins, Inc.