The eToims® Technique FAQs

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®, which uses a non-pharmaceutical, non-surgical approach to relieve pain through electrical stimulation of trigger points.

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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 treatment with eToims®, 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::

  • end traction on selective pain producing structures,
  • end pain producing local muscle anoxia, by increasing intramuscular influx of blood carrying oxygen, and
  • end pain producing accumulation of local muscle tissue wastes, by increasing efflux of fluids carrying these wastes.

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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® 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.

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When did eToims® first develop?

Jennifer Chu, M.D., began the development of eToims® in 1990, and initially used a needle electrode for automated electrical intramuscular stimulation. 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® 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.

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In what conditions can eToims® provide pain relief?

eToims® 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® 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® 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® in patients with severe and long-term chronic pain.

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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.

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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 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.

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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.

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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. eToims® reverses the above enumerated localized causes of pain through the action of the twitch induced exercise.

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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 the ability of eToims® to 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.

eToims® 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® 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.

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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.

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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.

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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.

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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

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We live Outside of the U.S., Can We Still Benefit From The eToims® Technique?

The eToims® Technique will be available to patients world-wide beginning in the fall of 2009. At present, any patient who is willing to travel to get world-class pain care can benefit from The eToims® Technique.
1. International and domestic patients can come for evaluation at the eToims Soft Tissue Comfort Center at Ardmore in the mainline of Philadephia. Patients can easily receive consecutive eToims® sessions on a daily basis. We cater to patients from as far away as California, Europe, and Asia who come to Philadelphia to get the benefits of the eToims®.
2. Patients who can come by land or air travel within 2 hours can return home the same day and return weekly as feasible.


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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.

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Which Procedures Are Covered By Health Insurance?

  • The initial consultation and the electrodiagnostic studies are covered by most health-care plans.
  • eToims® Massage and eToims® Medical options are out-of-pocket expenses.

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What are the contraindications to eToims?

We have avoided use of eToims® in patients with implantable cardioverter defibrillators and recommend that presence of such implanted devices and stimulators, be considered a contraindication for the use of eToims. Other contraindications include patients with pacemakers, seizure disorders, history of cerebrovascular accidents including transient ischemic attacks, bleeding disorders, therapeutically anticoagulated, active infections, active inflammations, fractures, acute illnesses, organ failures, neuroendocrine disorders (e.g. pheochromocytoma), hyperkinetic heart syndrome, coronary artery disease with angina, debilitation, significant profound psychiatric disorder, suicidal or homicidal ideas, inability to follow commands, disruptive or non-cooperative patients and pregnant patients. Those patients with very severe and high levels of pain, pain associated with significant denervation, failed multiple spinal surgeries, need for multiple narcotics for pain control, pain due autoimmune diseases, central pain or sympathetically maintained pain, those with thickened and scarred skin, oedema, and obesity are not candidates for eToims®.

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