Twitch-obtaining intramuscular stimulation: Observations in the management of radiculopathic chronic low back pain

Objectives: To display the effect of twitch-obtaining intramuscular stimulation [TOIMS] in chronic lower back pain management and to identify characteristics of patients who respond best to TOIMS. Methods: Retrospective analysis included 32 consecutive patients who failed conventional treatment for low back and/or lower extremity pain. All patients referred for TOIMS received such treatment. Analysis included TOIMS patients treated between January, 1992 through June, 1995. Treatments occurred weekly or every two weeks. The controls were patients with similar symptoms referred for electrodiagnosis and received only standard treatment [StdRx, not including TOIMS] for lower back pain management. Assessment of outcomes occurred at a mean of 30.9 +/- 10.8 months. The main outcome measures studied were pain reduction and return to work. Results: Patients who received TOIMS had significantly longer symptom duration, and there were more patients with fibromyalgia, spinal stenosis, and failed lumbar surgeries. At follow-up, 60.7% of the TOIMS patients indicated a perception that TOIMS therapy was very effective for pain control whereas only 10% of the StdRx patients felt that way about conventional care. The two groups exhibited no differences in their pain levels or numbers of working patients at follow-up. However, the TOIMS group had an increase in the number of patients who expressed Lower pain levels and in those patients who could return to work from the pre-treatment assessment. This pattern did not occur in the StdRx patients. Twitch obtaining intramuscular stimulation was more effective in those without evidence of spinal stenosis. Conclusions: Twitch obtaining intramuscular stimulation seems promising in the management of partial radiculopathy related chronic low back pain. With the present manual mode of TOIMS, it is unlikely to benefit those with evidence for bony spinal abnormalities such as stenosis.