Development History

Discovery of Non-invasive eToims®
1988: Jennifer Chu, M.D., Associate Professor and Director of Electrodiagnostic Medicine of the Department of Physical Medicine and Rehabilitation at the University of Pennsylvania School of Medicine received a phone call from a patient claiming pain relief after electromyographic (EMG) testing and wanted the EMG test to be repeated. Thinking the pain relief from the EMG testing was an acupuncture effect, Dr. Chu became certified in acupuncture, but soon found that acupuncture was not sufficient to help patients with neuromuscular pain on a consistent basis.

1990: Dr. Chu began using Intramuscular stimulation (IMS) technique for myofascial pain relief using manual oscillation of an acupuncture needle at neuromuscular junctions (motor points or trigger points). This method was first described by C.C. Gunn, M.D., Clinical Professor of Anesthesia at the University of Washington in Seattle. In the IMS method, motor points are treated by oscillating an acupuncture needle through a metal plunger. Since the acupuncture needle was not firm enough to penetrate through thick overlying tissues to adequately reach the deeper layers of muscle, a monopolar EMG needle electrode was substituted. This firmer needle was able to stimulate neuromuscular junctions to elicit twitches. Dr. Chu realized the therapeutic significance of the twitch with its pain relieving effects only after she obtained twitches from a tender area in her own forearm. Dr. Chu taped a monopolar EMG needle electrode to the tip of a syringe to enhance leverage in stimulating neuromuscular junctions (motor points) with manually controlled repetitive oscillatory movements to obtain twitches which relieve myofascial pain due to spondylotic radiculopathy. This technique was termed Twitch Obtaining Intramuscular Stimulation (TOIMS).

After treating many complicated cases of chronic pain using manual oscillation of the monopolar EMG needle electrode to elicit twitches, she sustained repetitive stress injury in her right upper limb. To preclude development of repetitive stress injury in caregivers who treat with TOIMS, Dr. Chu decided to automate the method.

1996: Dr. Chu invented Automated Twitch Obtaining Intramuscular Stimulation (ATOIMS®). In this method muscle twitches were obtained by a hand-held device that mechanically stimulated the neuromuscular junction by automatically: (1) inserting a monopolar needle into it, (2) oscillating it three times in two seconds, and (3) then retracting the needle. Dr. Chu discovered that mechanical stimulation was not a fast or efficient method to evoke twitches.

1998: To increase the yield of twitches for more effective pain relief, Dr. Chu invented the electrical method called NEEDLE ETOIMS®. In this method, a monopolar EMG needle electrode was manually inserted into the motor point of the muscle with electrical stimulation obtained via the EMG machine. Although twitch elicitation became easier, manually inserting the monopolar needle electrode still aggravated Dr. Chu's repetitive stress injury. This led to her inventing an automated needling device for ETOIMS® in which the monopolar needle electrode was automatically inserted and retracted from muscle after 0.5 seconds of electrical stimulation. Although automated needle ETOIMS® was more efficient than mechanical stimulation with ATOIMS®, a more user-friendly, noninvasive method to evoke twitches was sought. The noninvasive method would make ETOIMS® safer through use of a needle free technique, alleviating the potential for any rare complication from use of a needle.

2005: eToims® starts a revolution as a novel, proprietary therapeutic-diagnostic test for detection of acute and chronic denervation. This non-invasive surface electrical testing procedure detects hyper-excitable motor points and these points elicit large force twitches. The detection of these hyper-excitable motor points is essential for diagnosis of presence of nerve irritation and simultaneously provides therapeutic effects that relieve muscle pain. At the hyper- excitable motor points, the twitch forces are strong enough to either shake or move the joint. With chronic muscle tightness due to chronic denervation, the evoked twitches tend to have low forces.

2006: The eToims® Technique for eliciting twitches is facilitated by new developments that have allowed the procedure to become non-invasive, removing the use of the needle electrode. The new non-invasive eToims® retained the acronym eToims®, capitalizing the "T" to signify the importance of the twitch. Dr. Chu also founded eToims® Medical Technology, LLC to research, develop, design, and produce eToims® technology for health care practitioners around the world, and the Soft Tissue Comfort Center® in Philadelphia region for the management of patients with nerve related muscle pain and as center of excellence for training eToims® Specialists.

2008: Dr. Chu published safety and efficacy studies of The eToims® Technique in chronic refractory myofascial pain (Electromyography and Clinical Neurophysiology 48(6-7): 311-420, 2008).

2009: eToims® device (ET127) receives the CE mark for sales in the European Union and Canada. eToims® Medical Technology, LLC develops proprietary noninvasive electrodes for use with the The eToims® Technique for painless and efficacious stimulation of deep muscle tissue.

The scientific publications relating to Twitch Obtaining Intramuscular Stimulation (TOIMS, ATOIMS®, ETOIMS® and eToims®) are listed below:

Chu J: Dry needling (intramuscular stimulation) in myofascial pain related to lumbosacral radiculopathy. European Journal of Physical Medicine and Rehabilitation 5(4):106-121, 1995.

Chu J: Myofascial pain syndrome - trigger points. J Musculoske Pain 5(1):133-135, 1997.

Chu J: Does EMG (intramuscular stimulation) reduce myofascial pain due to cervical radiculopathy. Electromyogr Clin Neurophysiol 37:259-272, 1997.

Chu J: Twitch response in myofascial trigger points. J Musculoske Pain 6(4): 99-110, 1998.

Chu J: Twitch-Obtaining Intramuscular Stimulation (TOIMS) in acute partial radial nerve palsy. Electromyogr Clin Neurophysiol 39:221-226, 1999

Chu J: The role of the monopolar electromyographic pin in myofascial pain therapy: automated twitch-obtaining intramuscular stimulation (ATOIMS) and electrical twitch-obtaining intramuscular stimulation (ETOIMS)- Electromyogr Clin Neurophysiol 39: 503-511, 1999.

Chu J: Twitch-Obtaining Intramuscular Stimulation: Observations in the management of radiculopathic chronic low back pain. J Musculoske Pain 7(4): 131-146, 1999.

Chu J: Early observations in radiculopathic pain control using Electrodiagnostically derived new treatment techniques:automated twitch- obtaining intramuscular stimulation (ATOIMS)and electrical twitch-obtaining intramuscular stimulation (ETOIMS)- Electromyogr Clin Neurophysiol 40:195-204, 2000.

Chu J: Twitch obtaining intramuscular stimulation (TOIMS): Long-term observations in the management of chronic partial cervical radiculopathy. Electromyogr Clin Neurophysiol 40:503-510, 2000.

Gozon B, Chu J, Schwartz I: Lumbosacral radiculopathic pain presenting as groin and scrotal pain: Pain management with twitch-obtaining intramuscular stimulation. A case report and review of literature. Electromyogr Clin Neurophysiol 41:315-318, 2001.

Chu J, Gozon B, Schwartz I: Twitch-Obtaining Intramuscular Stimulation in Reflex Sympathetic Dystrophy. Electromyogr Clin Neurophysiol 42:259-22, 2002.

Chu J: The muscle twitch in myofascial pain relief: effects of acupuncture and other needling methods. Electromyogr Clin Neurophysiol 42:307-311, 2002.

Chu J: The local mechanism of Acupuncture. Chinese Medical Journal (Taipei) 65:299-302 2002.

Chu J, Neuhauser D, Schwartz I, Aye HH: The efficacy of automated/electrical twitch obtaining intramuscular stimulation (ATOIMS/ETOIMS) for chronic pain control : Evaluation with statistical process control methods. Electromyogr Clin Neurophysiol 42:393-401, 2002.

Chu J, Takehara I, Li T-C, Schwartz I: Skill and selection bias has least influence on motor unit action potential firing rate/frequency. Electromyogr Clin Neurophysiol 43:387-392, 2003

Chu J, Schwartz I: The point of Acupuncture. Journal of Musculoskeletal Pain 12(1): 5-7, 2004

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

Chu J, Takehara I, Li T-C, Schwartz I: Electrical twitch obtaining intramuscular stimulation (ETOIMS) for myofascial pain syndrome in a football player. Br J Sports Med 38(5):E25, 2004. 33. Takehara I, Chu J, Li T-C, Schwartz I: Reliability of quantitative motor unit action potential (MUAP) parameters. Muscle Nerve 30: 111-113, 2004.

Chu J, Eun SS, Schwartz I: Quantitative motor unit action potentials (QMUAP) in whiplash patients with neck and upper-limb pain. Electromyogr Clin Neurophysiol 45:323-328, 2005

Chu J, Schwartz I: eToims Twitch Relief Method in Chronic Refractory Myofascial Pain (CRMP). Electromyogr Clin Neurophysiol 48: 311-320, 2008

Chu J, Schwartz I, Schwartz S: Chronic refractory myofascial pain: Characteristics of patients who self-select long-term management with Electrical Twitch-Obtaining Intramuscular Stimulation Int J Phys Med Rehabil 2013, 1:4 38.

Chu J,Bruyninckx F, Neuhauser DV. Chronic refractory myofascial pain and denervation supersensitivity as global public health disease. BMJ Case Rep doi:10.1136/bcr-2015- 211816. http://casereports.bmj.com/cgi/content/full/bcr-2015-211816?ijkey=TFlyCCTz1g85rzB&keytype=ref