eToims® Twitch Relief Method
Electrical Twitch Obtaining Intramuscular Stimulation (eToims® Twitch Relief Method) searches for trigger points within a set time-frame to provide very brief surface electrical stimulation causing muscles to twitch. That characteristic twitch is followed by muscle relaxation, i.e. cessation of spasm and muscle tightness, with improved blood flow, eliminating or decreasing discomfort and/or pain, which can be long-lasting.
eToims® Twitch Relief Method, is a proprietary, revolutionary method that utilizes surface electrical stimulation with state-of-art, markedly innovative new medical technology, to locate motor points (trigger points/acupuncture points).
The elicitation of strong local muscle contractions, termed twitches result in reduced muscle pain and discomfort in the stimulated areas. These local exercise effects can produce pain relief by increasing blood supply and stretching tight muscle spasms affecting release of nerves and blood vessels entrapped within the muscle spasms.
The eToims® Twitch Relief Method thus aids in the location of neuromuscular junctions (trigger points) and simultaneously takes out pain non-invasively if these points can be located through electrical stimulation.
Unlike many injected or oral medications including narcotics, eToims® Twitch Relief Method does not interfere with family/home responsibilities, social interactions, one’s occupation, and the following activities: recreation, sex, self-care and activities of daily living. Living with chronic pain tends to isolate the sufferer. As the eToims® Twitch Relief Method does not promote mental dullness or drowsiness, impairments associated with narcotics and other medications, it enables patient interaction with others at work, home, and in various social situations. eToims® Twitch Relief Method enables interactions and enables chronic pain patients the opportunity to “really” live. Furthermore, if one requires access to those in the workplace, family, clergy, and therapists, eToims® Twitch Relief Method by enabling interaction, enables these supports.
eToims® Twitch Relief Method is available at the eToims® Soft Tissue Comfort Center which specializes in diagnosis and treatment which ends muscle discomfort and pain from (a) work-related injuries, (b) repetitive strain injuries, (c) sports-related injuries, (d) aches and pains due to aging, (e) trauma due to car accidents, falls, lifting injuries, etc. and (e) Injuries due to activities of daily living.
eToims® Soft Tissue Comfort Center is located within the Science Center at the Avenue of Technology in University City, Philadelphia. Quality, innovative neuromuscular specialty management is provided for individuals with nerve related muscle discomfort and/or pain in a professional healing environment of compassionate, competent, and individualized care. Our goal is to prevent or relieve pain and/or suffering while maintaining or promoting that individual’s productivity, activity, quality of life, relationships, and self-image.
eToims® Twitch Relief Method: Frequently Asked Questions
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What is eToims® (Electrical Twitch Obtaining Intramuscular Stimulation) Twitch Relief Method?
eToims® Twitch Relief Method is a patented method which utilizes surface electrical stimulation to excite nerve-muscle meeting (trigger) points to induce twitches (local muscle contractions) that are characteristically brisk and strong. Such twitch elicitation can be accompanied by substantial reduction in muscle discomfort and/or pain in the areas that were stimulated. The mechanisms for pain/discomfort relief are thought to include stretch effects and twitch movement induced improvement in blood flow due to local muscle exercise effects.
What is Myofascial pain and Fibromyalgia?
Myofascial pain is a pain syndrome limited to skeletal muscles, characterized by trigger points, which when stimulated give rise to pain in characteristic areas and characteristic taut bands that can elicit a local twitch response. Affected muscles have limited range of movement. Fibromyalgia (FMS) is a debilitating disorder with chronic, widespread muscle pain and patients may also exhibit a range of other symptoms, including sleep disturbance, fatigue, irritable bowel/bladder syndrome, headache, skin sensitivity and mood disorders.
Many fibromyalgia patients also have myofascial pain with trigger points. Patients with myofascial pain and fibromyalgia respond to eToims® Twitch Relief Method that uses the non-pharmaceutical, non-surgical approach to relieve pain through electrical stimulation of trigger points.
What is the Mediate Cause of Pain in Nerve Related Muscle Pain Conditions?
The mediate cause of pain in nerve related muscle pain conditions is muscle shortening and/or spasm concentrated at neuromuscular junctions. This muscle shortening and/or spasm results in focal ischemia (lack of blood supply) to intramuscular nerves and blood vessels and also produce a traction effect on pain sensitive structures such as tendons, bones and joints. During eToims® Twitch Relief Method, very brief electrical stimulation is applied to neuromuscular junctions (trigger points) to elicit characteristic twitches which are brisk focal muscle contractions. The twitches produce active local muscle exercise and stretching which, in turn:
- ends traction on selective pain producing structures,
- ends pain producing local muscle anoxia, by increasing intramuscular influx of blood carrying oxygen, and
- ends pain producing accumulation of local muscle tissue wastes, by increasing efflux of fluids carrying these wastes.
The effects of muscle relaxation, i.e. cessation of spasm and muscle tightness, with improved blood flow, eliminating or decreasing discomfort and/or pain, can be long-lasting. Narcotics and other pharmaceutical medications used in the management of nerve related muscle pain suppress pain signals to and from the brain rather than treat the mediate cause of pain that restores mobility and function. However, narcotics and other medications can often be a complementary co-therapy with eToims® Twitch Relief Method in patients with severe and long-term chronic pain.
What Can Result if Acute and Chronic Nerve Related Pain is Undiagnosed and/or Inadequately Treated?
If nerve related muscle pain is undiagnosed and/or inadequately treated, pain symptoms may increase in severity and spread through the body, resulting in widespread disabling body pain, sometimes known as trauma-related or "reactive" fibromyalgia. Immediate treatment may potentially prevent nerve injuries from progressing, as well as prevent acute myofascial pain from becoming chronic.
Chronic nerve related muscle pain requires ongoing treatments to improve quality of life. eToims® Twitch Relief Method can be used repeatedly throughout the lifetime of the chronic pain patient without significant side effects or decrease in quality of life that can be associated with multiple elective invasive procedures and medications.
When did eToims® Twitch Relief Method first develop?
Jennifer Chu, M.D., began the development of Twitch Relief Method in 1990, and initially used a needle electrode for automated electrical intramuscular stimulation (click here for a link to a WebMD.com video of the legacy needle version of the eToims device: http://www.webmd.com/video/etoims-ease-aches-pains). The current non-invasive, state-of-the-art technology discovered in 2006, thereby has roots in the 5,000 year old tradition of acupuncture. However, instead of rebalancing altered energy that underlies pain production, eToims® Twitch Relief Method rebalances the altered normal muscle state sufficiently by use of a unique combination of anatomical and physiological knowledge to minimize and in some cases fully eliminate neuromuscular pain.
In what conditions can eToims® provide pain relief?
eToims® Twitch Relief Method provides pain relief if you have acute or chronic nerve related muscle discomfort and/or pain from blunt trauma such as auto- accidents, sports and work related injuries, insidious trauma, or repetitive activities of daily living or aging. In the absence of absolute surgical indications eg., a herniated disc or mass effect with progressive pressure on a nerve root or spinal cord, 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. In patients who have more severe chronic pain, (pain lasting longer than three months), including those patients who still remain in pain after interventional procedures or surgeries, eToims® Twitch Relief Method can increase mobility and function with less need for medications. Narcotics and other pharmaceutical medications used in the management of nerve related muscle pain suppress pain signals to and from the brain rather than treat the mediate cause of pain. However, these medicines can often be a complementary co-therapy with eToims® Twitch Relief Method in patients with severe and long-term chronic pain.
What Outcome Should We Expect From eToims®?
Your results will depend on the ease or difficulty in finding trigger points within a given time frame. If trigger points cannot be stimulated and the twitch forces produced are weak, there may be no relief of discomfort and/or pain or the relief will not be as substantial. Muscles become tight and may impair trigger point localization depending on: (1) The extent and duration of nerve root involvement and degeneration, (2) Age of patient, (3) Obesity, and (4) Any other medical conditions that can affect nerve and muscle function.
How Many eToims® Sessions Are Necessary For Discomfort/Pain Relief?
eToims® can produce pain relief when trigger points can be stimulated to produce the characteristic twitches. With mild acute partial nerve root irritation, trigger points are easier to locate for stimulation to produce the essential twitches. This leads to more significant relief of discomfort and/or pain with one or a limited number of eToims® sessions. With chronic nerve root irritation, trigger point localization is difficult due to chronic tightness of the muscles. Ongoing weekly sessions can maintain the pain relief achieved, and to improve mobility and function for a progressive return to moderate activity. Patients with chronic pain have a tendency for re-injury to nerve roots with formation of additional new trigger points even with activities of daily living. These new trigger points are easier to be healed with ongoing eToims® sessions allowing patients to have a stable or progressive improvement in quality of life.
How Soon After an Injury Should We Receive eToims®?
eToims® is best applied before muscles become shortened and tight, which is usually associated with the highest pain levels. Hence, in order to obtain the best results with eToims®, the sessions should begin preferably within 24 hours of an injury and certainly before the pain escalates.
How Does Muscle Shortening and/or Spasm Cause Pain?
In myofascial pain resulting in neck or lower back pain for example, the mediate root of pain is muscle shortening and/or spasm. This pain from muscle shortening results from multiple mechanisms that experimentally have been demonstrated to include: via stimulating stretch and pain receptors, located within muscle and outside the muscle (its sheath, attached ligaments, tendons, periosteum, etc.); and via compression mechanism of blood vessels primarily within the muscle, impairing inflow of oxygen and vital nutrients and impairing outflow of tissue wastes. Tissue lack of oxygen, termed hypoxia, causes pain wherever it occurs, eg. heart tissue hypoxia results in angina. Blood carries oxygen and the Greek root of the term ischemia, refers to keeping blood back, resulting in localized anemia, leading to hypoxia or anoxia of the involved tissue. Impairment of blood flow impairs removal of localized tissue wastes, which in themselves experimentally are understood to cause pain. The eToims® Twitch Relief Method reverses the above enumerated localized causes of pain through the action of the twitch induced exercise.
Should We receive eToims® Only When We have Pain?
No. Often one has heard of or experienced progression from muscle tightness, through spasm, then discomfort, to tenderness and pain. If one has this pattern, early intervention with eToims® is beneficial, even before onset of overt pain. It is common for those with chronic or relapsing pain to recognize that the earlier the intervention at a lower pain level, by eToims®, medications or whatever mechanism that has worked in the past, the more efficacious it seems. Many times with early intervention, pain progression can be halted and/or reversed. Generalizing from common experience, if developing significant muscle tightness, spasm and/or discomfort, intervention with eToims® appears warranted before onset of pain.
When the pain level is high, the eToims® sessions will not be able to locate the trigger points effectively, due to severe muscle tightness. That tightness appears to exert a dampening effect on the involved muscle fibers directly affected by that trigger point, impairing resultant generation of a twitch of sufficient force from those fibers, as well as appears to inhibit spread of applied electrical impulse outward, impairing recruitment of surrounding trigger points, which taken together adversely affect the cumulative force of the generated twitch. Therefore, experience has taught patients undergoing eToims® to schedule weekly sessions when pain free and involved muscle characteristics are commensurate with eToims® ability generate adequate force twitches. This tends to preclude pain escalation over time, which parallels precluding escalation of muscle spasm over time.
When pain levels are above 7/10, pain must first be controlled by medications so that eToims can be more effective. Many of these patients have learned not to depend on pain medications that offer, at best, only pain suppression limited to the duration of action of the medication. When explained, patients with chronic pain prefer to have the mediate root cause of the pain, i.e., the muscle spasm and tightness, removed by eToims®.
By relieving muscle spasm eToims® increases range of motion, which analgesics, such as narcotics, cannot provide. Increasing range of motion increases function. One also functions better if not in pain. Chronic pain patients have multiple reasons for not sleeping. Prime among them are pain and paresthesias (tingling and numbness). Ever talk to someone who was awakened by pain to find their foot in plantar flexion, toes in dorsiflexion, or fingers flexed? Muscle spasm can also be a sleep robber. Insomnia (inability to have adequate sleep) negatively affects function and quality of life. What of treating the mediate cause of such insomnia, rather than just the symptom? In such an instance, even if not experiencing significant daily pain, eToims® sessions have the potential to improve or end this particular mediate root cause of insomnia.
The eToims® Twitch Relief Method provides potential benefit by relieving mediate root causes for muscle pain, discomfort, tenderness, spasm, and insomnia secondary to the above, consequently enhancing function and quality of life. While this approach can work collaboratively with other approaches, such as medications (including narcotics), its duration of action far exceeds medications aimed at symptoms alone. It has potential to actually remedy the situation, depending upon multiple factors. Unlike many narcotics, it does not interfere with family/home responsibilities, social interaction, occupation, recreation, sex, self-care and life-support activities. As the eToims® Twitch Relief Method does not promote becoming mentally dull or drowsy, which can occur with narcotics, it enables and can facilitate the patient's interactions with others at work, at home, and in various social occasions.
Can eToims® Allow Complete Resolution of Acute Myofascial Pain?
To get a permanent resolution of acute myofascial pain, the nerve injury must be of very recent onset, mild and partial and the trigger points must be stimulated as soon as the injury occurred, preferably within 24 hours after injury. If the nerve injury and interval to treatment fit established criteria, potential exists to permanently resolve acute pain, prevent nerve injury from progressing, and prevent acute injury from becoming chronic, all without significant side effect or decrease in quality of life.
Patients must also modify activities to allow progressive healing of nerves to take place. Limitation of activities that bring about the acute pain will also help in preventing additional formation of new trigger points that tend to perpetuate the acute pain to become chronic. If the original injury produced many trigger points leading immediately to significant muscle tightness, chronic pain will still occur. In those situations, starting eToims® early can keep the pain levels low even when chronic pain cannot be averted.
Is eToims® Painful?
In general, no, however the degree of discomfort during a session depends upon one's immediate, preexistent pain level and degree of muscle tightness. If one's pain level is very high in the ranges of 8-10/10, one needs the pain level to be first decreased by appropriate medications.
For those with pain levels between 4-7/10, i.e. pain can transiently increase during sessions and, although extremely rare, may remain at elevated levels for up to 1-2 days. This rare occurrence, post-session pain, is mainly noted in people with chronic pain levels that are usually higher than most, suffering longer than most, and usually after unsuccessfully trying many other treatments that failed to help the pain.
While individuals with such entrenched, severe chronic pain can be helped by eToims®, a tremendous amount of educating about chronic pain is entailed, along with recruiting other disciplines to assist these individuals for management of their pain. If the person in this situation is made aware of these points and wishes to continue eToims®, if no other cure is available and eToims® decreases that individual's pain more days in a week than it enhances the pain, then these patients will self-select to continue eToims®. These patients have understood that adding eToims® allows them to use lesser strength or lower dosage, or shorter acting narcotics, with less toxicity, i.e. "balanced pain relief."
In eToims® sessions for those with pain levels 4-7/10, analgesic pretreatment, varying in drug class depending upon patient pain tolerance, may be required. More often than not, narcotic pretreatment is required and, if so, someone must accompany the individual undergoing eToims®, to afterwards drive them home. Therefore, it is up to the person coming for eToims® to accordingly arrange for their transportation.
During eToims® sessions, the underlying pain and during session pain decreases as the method induces effective muscle twitches. When the muscle is soft, trigger point stimulation, inducing muscle twitches, is reported to feel good, pleasant, relaxing and soothing. Actually, patients with chronic pain levels less than or equal to 3/10 are good candidates for Level 2 eToims® and the sessions may be pain-free. After the session, individuals who respond well to treatment feel immediate pain relief, with immediate improvement in range of motion.
What Are the Side Effects of eToims®?
Depending upon the degree of muscle spasm and muscle tightness present, if strong force twitches are not elicited, significant pain relief may not result. Sometimes, even if elicited, twitches can be accompanied by a transient increase in pain, not only during, but to 1-2 days after the session.
What Conditions Can Benefit From Application of eToims®?
Neck, mid-back, lower back and limb muscle discomfort (spasms, stiffness, soreness, aches,
tenderness, tightness, tiredness, etc)
- Neck, mid-back, lower back and limb muscle pain
- Tension headaches
- Myofascial pain syndrome
- Fibromyalgia
- Whiplash of the spine
- Repetitive strain injuries
- Tendonitis and bursitis
- Rotator cuff injuries
- Tennis elbow
- Early carpal tunnel syndrome
- Musculoskeletal pain/discomfort from sports injuries
- Degenerative/bulging/herniated disc disease
- Spinal stenosis
We live in Asia/Europe/Australia/South America, Can We Still Benefit From eToims®?
Any patient who is willing to travel to get world-class muscle pain care can benefit from eToims®.
- International patients can come for evaluation and management staying in University City, Philadelphia within the University of Pennsylvania’s international community. We are conveniently located within walking distance or a moment’s taxi-ride from the luxurious Inn at Penn (A Hilton Hotel, http://www.theinnatpenn.com/). Patients can easily receive consecutive eToims® sessions on a daily basis. We cater to patients from as far away as Europe and Asia who come to Philadelphia to get the benefits of the eToims® Twitch Relief Method.
- West Coast and Canadian patients can come on a monthly basis staying in Philadelphia for consecutive eToims® sessions as feasible and return for further sessions as needed. We recommend patients stay at the luxurious Inn at Penn (A Hilton Hotel) in Philadelphia’s University City neighborhood, http://www.theinnatpenn.com/
- Patients who can come by land or air travel within 2 hours can return home the same day and return weekly as feasible.
- University City http://www.ucityphila.org/ is a vibrant intellectual and international community combining the excellence of the University of Pennsylvania, Drexel University, and many of the business community's biotechnological companies. We are easily accessible via a 20 minute taxicab/train ride from Philadelphia International Airport, four blocks away from the main Penn Train Station at 30th and Market Street and immediately adjacent to 34th and Market Street subway station stop.
What Steps May Be Required Before Receiving eToims®?
Schedule an initial consultation that includes a thorough history and physical examination.
Nerve and muscle tests (electrodiagnostic testing): One may need to undergo a quantitative electromyogram (QEMG) and nerve conduction studies (NCS). QEMG uses a monopolar needle electrode to measure muscle electrical activity. NCS measures the conductivity of nerves using surface electrical stimulation.
Which Procedures Are Covered By Health Insurance?
- The initial consultation and the electrodiagnostic studies are covered by most health-care plans.
- eToims® is an out-of-pocket expense.
Charges for eToimes® are time based:
- 20min: $200
- 40min: $375
- 60min: $500
- 90min: $750
