Electrostimulation an alternative to massage?

[webslave]

Could this tool replace (or supplement) trigger point massage

J Urol. 2003 Oct;170(4 Pt 1):1275-7.

A new high frequency electrostimulation device to treat chronic prostatitis.

John H, Ruedi C, Kotting S, Schmid DM, Fatzer M, Hauri D.
Clinic of Urology, Zurich University Hospital, Switzerland. [email protected]

PURPOSE: We prospectively observed a possible benefit from urethro-anal high frequency electrostimulation in patients with noninflammatory chronic pelvic pain syndrome (Cat IIIB CPPS) as a new treatment option.

MATERIALS AND METHODS: A total of 88 patients with a referral diagnosis of chronic prostatitis underwent fractionated urinary cultures, including expressed prostate secretion and ejaculate analysis twice. Of this group 14 men with Cat IIIB chronic prostatitis / chronic pelvic pain syndrome elected electrostimulation. A urethro-anal stimulation device was applied twice weekly for 30 minutes during 5 weeks at a defined voltage of 6 V, a defined frequency of between 450 and 500 Hz, and a variable self-regulated current of between 1 and 10 mA. National Institutes of Health prostatitis symptom score and quality of life index were determined before and after the treatment.

RESULTS: All patients tolerated stimulation and completed the treatment course. No urethral or anal complications occurred. Generally, the patients reported a distinct perineal feeling and the pain syndrome improved in 83%. The mean total National Institutes of Health prostatitis symptom score significantly decreased from 29 (range 20 to 37) to 14 (range 8 to 24) points (p = 0.002). Mean pain decreased from 15 (range 12 to 20) to 7 (range 4 to 13) points (p = 0.002). Micturition complaints decreased from 2.5 (range 0 to 9) to 1 (range 0 to 8) points (p = 0.007) and quality of life improved from 9.5 (range 8 to 12) to 5.5 (range 3 to 10) (p = 0.003).

CONCLUSIONS: To date the new high frequency urethro-anal afferent electrostimulation device seems to have an important benefit in patients with Cat IIIB CPPS. The device is technically simple and it can be self-administered. Therefore, it may become a new ambulatory treatment option for patients with chronic pelvic pain syndrome.

PMID: 14501740 [PubMed - in process]

(Comment: this study makes a distinction between inflammatory and non-inflammatory CPPS, but other studies, which looked at subtle signs of inflammation and not just at pus cells, have shown that this distinction is invalid, and that all Category III patients have signs of inflammation).

[Richard.N]

it can be self-administered

Anything that empowers the patient is good news . This is wonderful!

[TK]

My therapist did use an electrostimulation device as an adjunct to trigger point therapy and I did rent and use a home unit.

A little background:
As I understand it, PT's have been doing this for quite some time. The more sophisticated professional-office devices may have a broader range of settings, but the home units are switched between:

Stress Incontinence: 50 Hz Frequency (the setting I was instructed to use)
Urge Incontinence: 12.4 Hz

IMPORTANT: note that the setting as described in Webslave's article post refers to 500 Hz. I don't know that much about electricity. It would seem that this research was using a different frequency and that may be critical in terms of results. (Or maybe someone with greater understanding can reconcile the 500 Hz with the 50 Hz)

Here is a link to info about the device that I used.
http://www.utahmed.com/liberty.htm
Note that you need letter from physician to obtain this. (Therapist arranged in my case)

Here is link to general info about the sort of therapy that I received. (Basic frequencies they describe match my home device, but they also discuss use of other frequencies and modulation strategies).
Note: I found this link kinda flakey, Had to print file to read it.
http://www.seekwellness.com/incontinenc ... c_stim.htm

I cannot speak to discrepancies between 500 Hz and 50 Hz Frequency, but here are my experiences. Therapist explained that:

1) The stimulation helped "soothe" the irritated nerves ("soothe is not terribly scientific, but I understood that this was addressing peripheral neuropathy) See seekwellness link for more specifics)

2) It was also a kind of "automated" Kegel/strengthening excercise. At the 50 Hz frequency, (amperage or "strength setting" adjusted to personal comfort) I felt a kind of gentle "gurgling" that as actually the muscles rapidly contracting and releasing. Not to get into issue of Kegels -- a very light regimen of Kegels were OK for me, but not necessarily recommended to others. But relative to Kegels, the electronic stim seemed to have much less potential for harm.

3) This was actually administered by a small "anal probe device" (not particularly uncomfortable). The same device that therapist used for biofeedback and measurement could be hooked to home and office unit.

THE FOLLOWING WAS ADDED TO THIS POST:

This was initially omitted because of 1) length and 2) I didn't want to scare others with my idiosyncratic fears about electricity (I am generally courageous, but a maybe just a little weird about electrodes in my butt)

One downside of my personal experience with electrical stimulation therapy:
(My therapist told me this was also REPORTED BY OTHERS).

On some occasions-- as I eased the amperage (strength) setting up to the point of comfortable effect--the unit would not "kick in" as expected, perhaps because the lubricated probe was not making proper contact. Trying to find the setting sometimes resulted in a MILD "shocking/burning" sensation. I emphasize that this was not terribly painful, but I FEARED that I would react with a sudden, jerking response which would result in a severe muscular contraction that would set me back months.

The experiences of electric shock were few and mild. And my reactions were not severe as feared. But since I was getting better anyway, I decided to stop using the unit at home.

[webslave]

Given the frequency disparities mentioned by TK and the quoted webpage that states that this mode resembles kegels exercises, which Wise discourages, I think we need to discuss this very fully before endorsing it.

[DX]

TK,
First off, thanks for all your posts. I think that it's great that you're not abandoning the people in pain after you get better. Your posts have been invaluable to me as it seems that we have tried many of the same things without even discussing it.
I do have couple of questions for you. I have been undergoing trigger point release (25 sessions so far) with paradoxical relaxation over the past 4 1/2 months and experienced tremendous improvement. The worst symptoms I have now are like the best days I experienced only 6 months ago. I am able to work normally and go out when I want to. Discomfort after sex is rather minimal, whereas before the flareups would last for weeks.
But of course I am looking for anything that would help me alleviate my remaining symptoms and my PT did not mention anything like this. Can you elaborate on your use of this device:
1. How much improvement did you feel you got out of it relative to therapy and relaxation?
2. At what stage did this improvement occur?
3. Which particular symptoms may have been helped the most?
Anything else that you feel is important?
I understand that the precise answer might not be possible.
Thanks again,

Dan

[TK]

Dan,

Precise answer is difficult, because the electrostimulation was always administered at the end of the trigger point therapy. I cannot separate the results.

Your observations as to the "pace" of improvements seem to match my own. It's hard to quantify on a week by week basis, but recognizeable progress seems to occur in 3-4 month increments.

Just a layman's hunch, but I think this has something to do with the neurological component. Dr. Jerome Weiss has written that, if there is a relatively stimulus-free period, Central Sensitization can be progressively reversed. I think these 3-4 month increments correspond to how long it takes for the nervous tissue to make "progress" that we can detect.

Sounds like you're on the track, Dan. Just keep doing what you"ve been doing -- which takes a lot of discipline because, once you reach a certain point, you just don't feel like doing several sets of stretching excercises every day, etc.

Good Luck!

[webslave]

David Wise PhD has responded to this thread as follows:

Dear Mark,

I am responding to your question as to my opinion about surface anorectal electrical stimulation as a treatment that can aid or substitute for intrarectal myofascial trigger point release. I can give you my own opinion based on my experimentation with it when I was symptomatic and my observation of a few dozen patients I have seen who have used it.

Despite the reports of others stating that surface electrical stimulation is effective in ameliorating pelvic pain, I experienced no benefit from it myself after having used a state of the professional art e-stim machine when I was looking for answers to my pain. Furthermore I have not seen one patient derive any lasting benefit from internal or external electrical stimulation. We don't used e-stim in our protocol although I would support its use if I believed it might help. In summary, I see little value in it in the treatment of prostatitis and the pelvic pain syndromes we treat.

My best,
David Wise, Ph.D.

[vertigo3]

I think a lot of people on this thread have the wrong idea about this new treatmen, this is in no way standard estim therapy, all the electrostim units and procedures I've seen, use power levels MANY times higher and the frequency is atleast half of what this new treatment uses, TENS uses 0-100 volts and 0-100 ma and EMS uses even higher power levels while this procedure uses 6 volts at 1-10ma, so the effects would be in no way simular, nor would they cause any sort of muscle contraction. Just thought I would let people know before this therapy is discouraged before it really gets off the ground.