Chu J, McNally S, Bruyninckx F, Neuhauser D
Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Ardmore, Pennsylvania, USA.
Manchester United, Manchester, UK.
BMJ Innov. 2017 Apr;3(2):104-114. doi: 10.1136/bmjinnov-2016-000151. Epub 2017 Mar 24.
Autonomous twitch elicitation at myofascial trigger points from spondylotic radiculopathies-induced denervation supersensitivity can provide favourable pain relief using electrical twitch-obtaining intramuscular stimulation (ETOIMS).
To provide objective evidence that ETOIMS is safe and efficacious in migraine and persistent pain management due to decades-old injuries to head and spine from paediatric American football.
An 83-year-old mildly hypertensive patient with 25-year history of refractory migraine and persistent pain self-selected to regularly receive fee-for-service ETOIMS 2/week over 20 months. He had 180 sessions of ETOIMS. Pain levels, blood pressure (BP) and heart rate/pulse were recorded before and immediately after each treatment alongside highest level of clinically elicitable twitch forces/session, session duration and intervals between treatments. Twitch force grades recorded were from 1 to 5, grade 5 twitch force being strongest.
Initially, there was hypersensitivity to electrical stimulation with low stimulus parameters (500 µs pulse-width, 30 mA stimulus intensity, frequency 1.3 Hz). This resolved with gradual stimulus increments as tolerated during successive treatments. By treatment 27, autonomous twitches were noted. Spearman's correlation coefficients showed that pain levels are negatively related to twitch force, number of treatments, treatment session duration and directly related to BP and heart rate/pulse. Treatment numbers and session durations directly influence twitch force. At end of study, headaches and quality of life improved, hypertension resolved and antihypertensive medication had been discontinued.
Using statistical process control methodology in an individual patient, we showed long-term safety and effectiveness of ETOIMS in simultaneous diagnosis, treatment, prognosis and prevention of migraine and persistent pain in real time obviating necessity for randomised controlled studies.
因神经根型颈椎病导致的失神经超敏反应所引起的肌筋膜触发点自主抽搐激发，可通过肌内电刺激获取抽搐（ETOIMS）来实现有效的疼痛缓解。
提供客观证据，证明ETOIMS在治疗偏头痛以及因儿童美式橄榄球运动导致的头部和脊柱数十年陈旧性损伤所引起的持续性疼痛方面是安全有效的。
一名83岁的轻度高血压患者，有25年难治性偏头痛和持续性疼痛病史，自行选择每周接受2次收费的ETOIMS治疗，持续20个月。他共接受了180次ETOIMS治疗。每次治疗前及治疗后即刻记录疼痛程度、血压（BP）和心率/脉搏，同时记录每次治疗中临床上可诱发的最高抽搐力水平、治疗时长以及治疗间隔。记录的抽搐力等级为1至5级，5级抽搐力最强。
最初，在低刺激参数（500微秒脉冲宽度、30毫安刺激强度、频率1.3赫兹）下对电刺激过敏。随着后续治疗中逐渐增加可耐受的刺激，这种过敏情况得到缓解。到第27次治疗时，出现了自主抽搐。斯皮尔曼相关系数表明，疼痛程度与抽搐力、治疗次数、治疗时长呈负相关，与血压和心率/脉搏呈正相关。治疗次数和治疗时长直接影响抽搐力。研究结束时，头痛症状和生活质量得到改善，高血压得到缓解，抗高血压药物已停用。
在个体患者中采用统计过程控制方法，我们证明了ETOIMS在实时同步诊断、治疗、预后和预防偏头痛及持续性疼痛方面的长期安全性和有效性，从而无需进行随机对照研究。
