Surgery – Diagnostic testing – Sensitivity to electric stimulus
Reexamination Certificate
2000-06-14
2002-08-13
Getzow, Scott M. (Department: 3762)
Surgery
Diagnostic testing
Sensitivity to electric stimulus
C607S046000
Reexamination Certificate
active
06432063
ABSTRACT:
TABLE OF CONTENTS
1. CROSS-REFERENCE TO RELATED APPLICATION . . . 2
2. BACKGROUND OF THE INVENTION . . . 2
2.1. Field of the Invention . . . 2
2.2. Description of the Background Art . . . 3
3. SUMMARY OF THE INVENTION . . . 4
4. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS . . . 5
4.1 Description . . . 5
4.2. Example . . . 8
5. CLAIMS . . . 11
6. ABSTRACT . . . 12
2. BACKGROUND OF THE INVENTION
2.1. Field of the Invention
The present invention relates to a method of determining the cause of pain in a patient and then provide a specific treatment for such pain. More particularly, the present invention relates to a method of determining whether the pain is originated from the muscles of the patient and provide a specific treatment for such pain. More particularly, the present invention relates to a method of electrical stimulation which can accurately pinpoint the specific area of a muscle producing a patient's pain complaint.
2.2. Description of the Background Art
Myofascial pain syndrome can be literally interpreted to describe pain coming from muscles and connective tissue. Despite its liberal meaning in various literature, myofascial pain syndrome normally refers to a wide variety of supposed clinical entities, such as tension, weakness, stiffness, trigger points and tender points. In addition, myofascial pain syndrome can be part of the syndrome referred to as fibromyalgia.
Among the most common causes of pain seen in clinical practice, myofascial pain syndrome is characterized by myofascial trigger points. Trigger points are only one of the many causes that have been equated with myofascial pain. Even though there is no clinical procedure/criteria as to examining patients with muscle pain, many clinicians consider myofascial trigger points as tender areas of muscle that have associated point tenderness on a taught muscle band, local twitch response, referred pain, reproduction of usual pain, restricted range of motion, weakness without atrophy, and autonomic symptoms. Other clinicians believe that pain on palpation reproducing the usual pain is enough to make the diagnosis of a trigger point.
Satellite myofascial trigger points often develop in the zone of referred pain. Secondary myofascial trigger points are found in muscles in the functional motor unit affected. Once these satellite or secondary myofascial trigger points develop, they may persist, eventually referring pain to their own pain reference zones. In this way, the areas of the body involved with myofascial pain syndrome increases, eventually affecting multiple regions.
It is essential for the proper diagnosis and treatment of myofascial pain syndrome that all of the etiologies associated with pain caused by muscle and connective tissue be identified. The prior art has required skill by the clinician in the physical examination of muscle in finding the specific point in the muscle causing the pain in order to identify myofascial trigger points. Since criteria vary for the diagnosis of trigger points, interrater reliability in locating myofascial trigger points is frequently low
Accuracy, consistency, stability and reproducibility of the examination technique is referred to as reliability. The agreement between two or more examiners is referred to as interrater reliability. Interrater reliability is poor when palpation is used as the identifying technique, in part due to the lack of standards as to the amount of pressure to exert when palpating a muscle.
The prior art attempts to locate or confirm myofascial trigger points using techniques more objective than palpation. Such techniques include a palpation index, handheld pressure threshold meter, electronic pressure meter attached to the fingers, thermographic measurement of heat emission and electromyographic identification.
However, these techniques are difficult to learn and use on routine patients in a limited period of time. A simple method is desired that can accurately define, diagnose and lead to the treatment of all of the causes of muscle pain, including trigger points associated with the patient's pain complaint.
Accordingly, it is an object of the present invention to provide a method for diagnosing myofascial pain syndrome with precision to enable more effective treatment of the condition.
Another object of the invention is to provide a technique for examining a patient having myofascial pain syndrome with better accuracy, consistency, stability and reproducibility of the procedure.
Yet another object is to provide a method of examining a patient having myofascial pain syndrome with a high degree of interrater reliability in locating trigger points.
Yet another object is to provide a technique for diagnosing myofascial pain syndrome in the specific area of the muscle producing pain complaint within a limited period of time.
Yet another object is to provide a diagnosis that offers a possible explanation for pain which without such diagnosis would automatically be attributed to the spine and nervous system, possibly leading to utilization of expensive and unnecessary tests and treatments including surgery.
These and other objects of the invention as well as other advantages thereof can be apprehended by reference to the following description and claims.
3. SUMMARY OF THE INVENTION
The foregoing objects are achieved according to the present invention which provides a simple method by which the physician can accurately define, diagnose, and treat specific muscle causes of a patient's pain complaint. In a preferred embodiment, electrical stimulation is used to find muscle pain emanating from trigger points.
According to a preferred embodiment of the present invention, the method comprises: (a) applying an electric stimulus to a muscle through a neuromuscular stimulator and recording the patient's response; (b) repeating step (a) in a different location with resultant decrease in discomfort; and (c) effectively treating the points of maximum sensitivity.
The method of the present invention is useful for all patients whose muscles may be the underlying cause of the pain complaint. It is particularly useful when trigger points are considered in very muscular and/or obese patients since manual palpation of these patients will frequently produce a low pressure in deep muscles. Such a low pressure is insufficient to excite a painful area in order to produce discomfort and thus prove the muscles to be causes of the patient's pain.
The present invention is useful in the treatment of pain for a variety of conditions, and in particular back pain, neck pain, shoulder pain, extremity pain, headaches, and abdominal pain.
4. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
4.1 Description
A. Initial Evaluation
The process begins with an initial evaluation. The initial evaluation should produce details of a patient's activities and habits that may cause the pain. The initial evaluation is an important part of the entire diagnosis, since the ultimate goal is to eliminate factors that cause the pain. After a successful treatment is conducted, these factors would be eliminated from the patient's repertoire.
Types of such factors would be all activities involved in over-use or inappropriate use of musculature. Such inappropriate use would include the following situations: (1) engaging in athletic activities with insufficient warm-up or exercising machines that produce non-physiological positioning, (2) exercising with machines that produce unbalanced exercise routines or abrupt changes in the intensity of an exercise machine, such as changes in the use of an exercise equipment like a re-stringed a tennis racquet, (3) engaging in work position that could lead to strain of muscle groups, such as typing on a computer keyboard placed on the top of a desk rather than in a tray under the desk, looking at a computer monitor improperly positioned so that it is not directly in front of the patient and at eye level or slightly below, holding a telephone handset to the user's ear, or reading and watching television in bed. Hence, no matt
Getzow Scott M.
Norman Marcus Pain Institute
Pennie & Edmonds LLP
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