Intramuscular stimulation therapy using localized electrical stimulation

Abstract

A modality of twitch obtaining intramuscular stimulation (IMS) pain relief therapy employs an EMG needle having a Teflon coated shaft and exposed conductive tip to apply micro-electrical stimulation locally and focally to muscle motor end plate zones or regions of adjacent motor end plate zones. The electrical stimulation facilitates the elicitation of strong twitch responses from muscle fibers associated with the stimulated motor end plates, generally without requiring physical needle manipulation following the initial pin insertion. Less skill is required to effectively elicit pain relieving twitch responses, thus facilitating training of medical personnel to carry the procedure. Rapid movement between multiple treatment sites is possible allowing treatment of a larger number of afflicted muscles and muscle areas in a single treatment session. The strength and number of twitches obtained at the treatment sites can provide substantial relief from regional and diffuse myofacsial pain of radiculopathic origin. In addition, since physical manipulation of the pin is generally unnecessary, patients experience less pain and discomfort during the procedure, and the risk of repetitive stress injury to the therapist is reduced.

1. A method of conducting an intramuscular stimulation therapy session, comprising:
 (A) locating a first muscle motor end plate zone or region of adjacent motor end plate zones within an afflicted muscle of a patient; 
 (B) inserting a pin into the patient's flesh such that an exposed conductive tip of said pin is placed within or adjacent one of said motor end plate zones; and 
 (C) providing localized electrical stimulation to said motor end plate zone or region of motor end plate zones by conducting an electrical current through an insulated inserted shaft portion of said pin to said exposed conductive tip, said current flowing from said tip, through said motor end plate zone or region of motor end plate zones and to a reference electrode space from said pin, said electrical stimulation serving to elicit twitch responses of muscle fibers associated with motor end plates within said motor end plate zones, unless said motor end plate zones are or become refractory to electrical stimulation; 
 (D) withdrawing said pin from the patient upon determining that the motor end plate zones are or have become refractory to the electrical stimulation, or, in the event that twitching is evoked by the electrical stimulation, within a time period of said twitching; and 
 (E) repeating steps (A) through (D) to elicit twitches at a total of at least four treatment points within the afflicted muscle. 
 
     
     
       2. A method according to  claim 1 , wherein said pin is held generally stationary while said localized electrical stimulation is provided in step (C). 
     
     
       3. A method according to  claim 1 , wherein steps (A) through (D) are repeated to elicit twitches at 4-10 treatment points within the afflicted muscle. 
     
     
       4. A method according to  claim 1 , wherein steps (A) through (E) are repeated to treat a total of 10-20 afflicted muscles. 
     
     
       5. A method according to  claim 1 , wherein said time period of twitching is in the range of 2-5 seconds. 
     
     
       6. A method according to  claim 5 , wherein between five and ten twitches are elicited in said time period of twitching. 
     
     
       7. A method according to  claim 1 , wherein said pin is a Teflon coated monopolar pin with a shaft diameter of at least 0.013″. 
     
     
       8. A method according to  claim 1 , wherein the motor end plate zone is exposed to a current density of approximately 2.9-3.6 mA/mm 2 . 
     
     
       9. A method according to  claim 1 , wherein said electrical current is alternating current. 
     
     
       10. A method according to  claim 9 , wherein said alternating current is fixed amplitude alternating current. 
     
     
       11. A method according to  claim 9 , wherein the fixed amplitude of the alternating current is 1 mA. 
     
     
       12. A method according to  claim 9 , wherein the alternating current is in the form of a biphasic square wave. 
     
     
       13. A method according to  claim 11 , wherein said exposed conductive tip of the pin has a surface area of approximately 0.28-0.34 mm 2 , thus exposing the motor end plate zone to a current density of approximately 2.9-3.6 mA/mm 2 . 
     
     
       14. A method according to  claim 1 , wherein in step (B) the pin is inserted into the patient's flesh generally radially of a bone underlying the afflicted muscle. 
     
     
       15. A method according to  claim 9 , wherein said alternating current has a frequency of 2 Hz. 
     
     
       16. A method of providing intramuscular stimulation therapy, comprising:
 (A) locating a first muscle motor end plate zone or region of adjacent motor end plate zones within an afflicted muscle of a patient;   (B) inserting a conductor into the patient's flesh such that an exposed conductive region of said conductor is placed within or adjacent one of said motor end plate zones;   (C) providing localized electrical stimulation to said motor end plate zone or region of motor end plate zones by conducting an electrical current through said conductor to said exposed conductive region, said current flowing from said exposed conductive region, through said motor end plate zone or region of motor end plate zones and to a reference electrode spaced from said exposed conductive region, said electrical stimulation serving to elicit twitch responses of muscle fibers associated with motor end plates within said motor end plate zones, unless said motor end plate zones are or become refractory to electrical stimulation; and   (D) carrying out steps (A) through (C) at a total of at least four treatment points within an afflicted muscle region to elicit twitches at said at least four treatment points.   
     
     
       17. A method according to claim 16, wherein steps (A) through (C) are carried out to elicit twitches at 4-10 treatment points within the afflicted muscle region. 
     
     
       18. A method according to claim 16, wherein steps (A) through (D) are repeated to treat a total of 10-20 afflicted muscles. 
     
     
       19. A method according to claim 16, wherein in the event that twitching is evoked by the electrical stimulation, the electrical stimulation is discontinued within a time period of said twitching in the range of 2-5 seconds. 
     
     
       20. A method according to claim 19, wherein between five and ten twitches are elicited in said time period of twitching. 
     
     
       21. A method according to claim 16, wherein the motor end plate zone is exposed to a current density of approximately 2.9-3.6 mA/mm 2 . 
     
     
       22. A method according to claim 16, wherein said electrical current is alternating current. 
     
     
       23. A method according to claim 22, wherein said alternating current is fixed amplitude alternating current. 
     
     
       24. A method according to claim 22, wherein the fixed amplitude of the alternating current is 1 mA. 
     
     
       25. A method according to claim 22, wherein the alternating current is in the form of a biphasic square wave. 
     
     
       26. A method according to claim 24, wherein said exposed conductive region has a surface area of approximately 0.28-0.34 mm 2 , thus exposing the motor end plate zone to a current density of approximately 2.9-3.6 mA/mm 2 . 
     
     
       27. A method according to claim 22, wherein said alternating current has a frequency of 2 Hz.