MAGNESIUM SULFATE: ADJUVANT ROLE IN CHRONIC PAIN MANAGEMENT WITH ELECTRICAL TWITCH-OBTAINING INTRAMUSCULAR STIMULATION (ETOIMS)

Chu J.*, Tun T. M. and Bruyninckx F.

ABSTRACT

Introduction: ETOIMS optimally relieves myofascial pain when autonomous muscle twitches can be elicited at other distant muscles without direct electrical stimulation of involved trigger points. Aim: Use of magnesium sulfate (MgSO4) dermal spray is essential to demonstrate dominant sympathetic nervous system maintenance of pain. Methods and Materials: Three patients with chronic pain were treated with ETOIMS for 1 hour every 1-3 days with long-term follow-up. Recorded post and pre-ETOIMS were systolic (SBP), diastolic blood pressure (DBP), and heart-rate (HR). The patients were classified according to the highest grade level of twitch forces (TF) obtainable in any treated muscle. ETOIMS prior to 2018 was performed using plain faucet water for electrical conduction through the skin. In 2018 dermal magnesium sulfate spray was added for ETOIMS. Results: Patient with TF3 (that which produces anti-gravity movements) post and pre-ETOIMS with water for conduction, paired T-test showed significant reduction in SDP and HR but not DBP. TF4 and TF5 (forces produce anti-gravity movements with autonomous spreading of stimulation phenomenon ending with slow muscle fatigue and autonomous twitches with fast fatigue, respectively) demonstrated post-treatment reduction of all parameters except HR which increased in TF5. With MgSO4 spray added to ETOIMS for transcutaneous electrical conduction improvement, post and pre-treatment paired T-test for TF3-T5 showed significant reduction in all tested parameters (paired T-test p=0.000) except DBP for TF5. ETOIMS results between the 2 methods, the MgSO4 method showed post-pretreatment difference for TF3 for DBP and HR had higher difference (p=0.000) but no significant changes noted for SDP (p=0.06). For TF4 SBP and DBP values were higher post-ETOIMS with MgSO4 but HR was lower using MgSO4. TF5 values were increased after MgSO4 treatment for all parameters but HR was slower. Linear regression with ANOVA statistics showed for number of days between treatments, pre and post-treatment differences increased for SDP and DBP but not HR (p>0.05). Conclusions: MgSO4 showed the best capacity to potentiate ETOIMS TF probably through better skin absorption, local vasodilation from skin hydration promoting iontophoresis effects. MgSO4 facilitated autonomous twitching with stronger force twitches that affect SBP, DBP and HR more than with using water only.

Keywords: magnesium sulfate dermal spray; blood pressure; heart-rate; muscle twitch forces.