title: The efficacy of automated/electrical twitch obtaining intramuscular stimulation (atoims/etoims) for chronic pain control: evaluation with statistical process control methods.
abstract: BACKGROUND
  Automated and/or electrical twitch-obtaining intramuscular stimulation (ATOIMS & ETOIMS) evoke twitches at/or near motor end plate zones to relieve muscle pain.
  
  
  OBJECTIVE
  To demonstrate that pain levels recorded daily by patients enable statistical process control (SPC) analysis of ATOIMS & ETOIMS effects over time.
  
  
  METHODS
  Four chronic fibromyalgic patients received ATOIMS & ETOIMS treatments to bilateral C3-C8 and L3-S1 myotomes and recorded daily pain on a visual analogue scale. Mechanical stimulation with ATOIMS involved a custom device to insert, oscillate and retract a monopolar needle (MN) at 2 Hz x2s. ETOIMS involved manual insertion of the MN and stimulating with 5 Volts, 0.5 ms pulse duration at 2 Hz for 2s to multiple sites. Positive outcome measures include two pain scales reduction.
  
  
  RESULTS
  Patient 1-4 had 89, 38, 40, 36 treatments during a follow-up time of 625, 1018, 378, 466 days with 5.4 +/- 3.7, 8.0 +/- 4.9, 4.2 +/- 2.4 and 4.6 +/- 2.7 days between treatments (DBT) during the first 6 months and 4.7 +/- 3.0, 21.8 +/- 15.6, 6.2 +/- 4.4 and 4.3 +/- 2.5 DBT respectively in the latter phase of the therapy. The average pain level (APL) in 1st week of treatment for patient 1-4 were 6.4 +/- 1.1, 3.7 +/- 1.1, 6.6 +/- 2.8 and 7.5 +/- 0.4 and in the last week of treatment were 4.5 +/- 0.4, 1.2 +/- 0.1, 4.2 +/- 1.0 and 4.7 +/- 0.7 respectively. APL correlated negatively with time during the first 6 months for patients 2-4 and also after 6 months for patients 4 & 1 who had unchanged and reduced DBT respectively. APL correlated positively with time for patient 2 with no correlation for patient 3 (both had increased DBT) after 6 months.
  
  
  CONCLUSIONS
  Patients will chronically record their pain scales daily enabling analysis by SPC. ATOIMS & ETOIMS applied periodically can be helpful in relieving fibromyalgic pain.
authors.affiliation: Department of Rehabilitation Medicine, Ground Floor, White Building, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA. jechu@mail.med.upenn.edu
authors.forename: J
authors.initials: J
authors.lastname: Chu
authors.forename: D V
authors.initials: DV
authors.lastname: Neuhauser
authors.forename: I
authors.initials: I
authors.lastname: Schwartz
authors.forename: H Htar
authors.initials: HH
authors.lastname: Aye
mesh_terms: D000328:Adult; D002908:Chronic Disease; D004599:Electric Stimulation Therapy / Q000706:statistics & numerical data*; D004576:Electromyography / Q000706:statistics & numerical data; D005260:Female; D005356:Fibromyalgia / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009045:Motor Endplate / Q000503:physiopathology*; D018482:Muscle, Skeletal / Q000503:physiopathology*; D010146:Pain / Q000209:etiology / Q000503:physiopathology*; D059408:Pain Management; D010147:Pain Measurement / Q000706:statistics & numerical data*; D017064:Process Assessment, Health Care / Q000706:statistics & numerical data*; D013997:Time Factors