Intramuscular Stimulation (IMS)
What is IMS?
Dr. Chan Gunn MD describes IMS as “a total system for the diagnosis and treatment of myofascial pain syndromes”. IMS is based on the premise that myofascial pain syndromes result from a functional disturbance or pathological change in peripheral nerves. Hence the identification of signs of peripheral neuropathy is of paramount importance. The objective of treatment is to release shortened muscles through the insertion of fine needles.
How is IMS different from traditional acupuncture?
IMS differs from traditional acupuncture in that it operates on a western medical model. It requires a medical examination and an accepted medical diagnosis. Treatment is based on the findings of the physical examination (ex: tightened muscle bands, autonomic signs etc.). Medically acceptable objective changes are anticipated with treatment.
Is IMS complementary or alternative to traditional western medicine?
Professor Patrick Wall FRS, DM, FRCP cites three reasons to recognise the place of IMS in western medicine:
1) the description of disorders, examination findings and treatments are based entirely on widely accepted terminology in anatomy, physiology and pathology 2) similar to western medical and surgical therapies, IMS is based on hypotheses that are testable by accepted methods of investigation 3) the therapeutic effect is open to scientific observation, analysis and testing.
How does IMS work?
Insertion of a needle into a muscle causes a burst of electrical activity that has even been observed on electromyography. This electrical activity causes a contraction of the muscle that is typically described by the patient as a “cramp”. A spinal cord mediated reflex relaxation of the muscle occurs in a few seconds to minutes.
Who benefits from IMS?
Patients with diagnostic labels such as Fibrositis, Fibromyalgia, Myofascial pain syndrome, Radiculopathy, Degenerative disc disease, Chronic whiplash, Chronic pain, cervicogenic headaches, Occipital neuralgia and Sciatica to name a few can potentially benefit from IMS.
What are some common elements in these conditions?
Sensory: Hyperalgesia ex: increased sensitivity to pin prick, Allodynia ex: acute tenderness in muscles over motor points
Motor: Muscle shortening, enthesopathy
Autonomic: Vasoconstriction resulting in colder extremities, Sudomotor hyperactivity resulting in excessive sweating following painful stimuli, Trophedema which commonly manifests as an orange peel skin appearance and trophic changes which manifests as brittle nail or dermatomal hair loss.
Isn't it necessary to have conduction loss to establish a diagnosis of peripheral neuropathy?
Signs of conduction loss such as weakened reflexes and frank myotomal weakness are often absent. Routine nerve conduction studies are normal and electromyography is of little assistance. The diagnosis is therefore based on detection of subtle sensory, motor and autonomic changes. Hence, the focus of the clinical examination is on detection of nerve dysfunction rather than loss of function.
Does a patient need laboratory testing or diagnostic imaging prior to referral to IMS?
Laboratory testing and Diagnostic imaging are useful to the extent that they can rule out other medically treatable causes of chronic pain such as Rheumatoid arthritis, carcinomas etc. In the absence of clinical signs of such conditions, DI and laboratory testing are of little value as IMS treatment is primarily based on physical examination findings.