Electric Muscle Stimulation (EMS) as Treatment for Chronic (Wrist) Pain

Transcription

1 Evidence-Based Practice Group Answers to Clinical Questions Electric Muscle Stimulation (EMS) as Treatment for Chronic (Wrist) Pain A Rapid Systematic Review By WorkSafeBC Evidence-Based Practice Group Dr. Craig Martin Manager, Clinical Services Chair, Evidence-Based Practice Group July 2017 Clinical Services Worker and Employer Services

2 Electric Muscle Stimulation (EMS) as Treatment for Chronic (Wrist) Pain i About this report Electric Muscle Stimulation (EMS) as Treatment for Chronic (Wrist) Pain Published: July 2017 About the Evidence-Based Practice Group The Evidence-Based Practice Group was established to address the many medical and policy issues that WorkSafeBC officers deal with on a regular basis. Members apply established techniques of critical appraisal and evidence-based review of topics solicited from both WorkSafeBC staff and other interested parties such as surgeons, medical specialists, and rehabilitation providers. Suggested Citation WorkSafeBC Evidence-Based Practice Group, Martin CW. Electric Muscle Stimulation (EMS) as Treatment for Chronic (Wrist) Pain. Richmond, BC: WorksafeBC Evidence-Based Practice Group; July Contact Information Evidence-Based Practice Group WorkSafeBC PO Box 5350 Stn Terminal Vancouver BC V6B 5L5 craig.martin@worksafebc.com Phone Toll-free ext 7417

3 Electric Muscle Stimulation (EMS) as Treatment for Chronic (Wrist) Pain 1 Objective To determine whethere there is any evidence to support the efficacy and/or effectiveness of COMPEX SP 8.0, an electric muscle stimulation device, to treat chronic (wrist) pain. Methods A search through the company s website ( revealed that COMPEX SP 8.0 is an electro-stimulation device, claiming to Optimizes your strength and endurance, helps you recover faster, while helping to avoid injury and treating pain. The company website further stated that COMPEX Electrical Muscle Stimulation devices are equipped with unique muscle intelligence technology that adapt to each of user s muscles to provide the most effective electro-stimulation possible. The devices claim to work by scanning the muscle and automatically adjusting stimulator parameters to the user s physiology ( However, there was no published literature listed within the company s website to support the above claims. Based on the above information, systematic literature searches were conducted on July 4, The literature searches were conducted on commercial medical literature databases including: Cochrane Database of Systematic Reviews (2005 to June 29, 2017), ACP Journal Club (1991 to June 2017), UK York University Database of Abstracts of Reviews of Effects (1st Quarter 2016), Cochrane Central Register of Controlled Trials (May 2017), UK NHS Health Technology Assessment database (4th Quarter 2016), UK NHS Economic Evaluation Database (1st Quarter 2016), BIOSIS Previews (1969 to 2008), Embase (1974 to 2017 July 03), Medline Epub Ahead of Print, Medline In-Process & Other Non-Indexed Citations, Medline Daily Update and Medline (1946 to Present) These searches were done by using combinations of keywords, including: o (compex sp) No published study was identified through this search. o ((percutaneous electrical muscle stimulation) OR (electrical muscle stimulation) OR (electric muscle stimulation) OR (electro muscle stimulation)) AND (chronic wrist pain) No published study was identified through this search.

4 Electric Muscle Stimulation (EMS) as Treatment for Chronic (Wrist) Pain 2 o ((percutaneous electrical muscle stimulation) OR (electrical muscle stimulation) OR (electric muscle stimulation) OR (electro muscle stimulation)) AND (chronic pain) Two (1-2) published studies were identified through this search. These two (1-2) studies were thought to be relevant and were retrieved in full for further appraisal upon examination of their titles and abstracts. o ((percutaneous electrical muscle stimulation) OR (electrical muscle stimulation) OR (electric muscle stimulation) OR (electro muscle stimulation)) AND (sprain OR strain) Five (3-7) published studies were identified through this search. Examination of the titles and abstracts of these five (3-7) published studies did not provide any information relevant to the objective of this systematic review. Hence, these five (3-7) studies will not be discussed further. No limitations, such as on language or date of publication, were employed in these searches.

5 Electric Muscle Stimulation (EMS) as Treatment for Chronic (Wrist) Pain 3 Results Electrotherapeutic modalities involve the use of electricity and include therapies such as transcutaneous electrical nerve stimulation (TENS), electrical muscle stimulation (EMS), and interferential current (IFC). EMS induces muscle contractions in the applied region, which is thought to promote blood flow and circulation, act as a counter-irritant stimulus, reduce muscle spasms, and increase strength and endurance of the stimulated muscle (2). No published study was found to support the efficacy and/or effectiveness of the COMPEX SP device or EMS devices in general to treat chronic wrist pain. With regard to the efficacy and/or effectiveness of EMS in treating chronic pain in general, a recent Cochrane review (level of evidence 1. Appendix 1) investigating the efficacy and/or effectiveness of electrotherapy to treat neck pain concluded that there is low quality evidence suggesting that EMS was not more effective than placebo, and application of EMS did not reduce pain or disability in patients with neck pain. Summary At present, there is no published study reporting on the efficacy and/or effectiveness of the COMPEX SP device in treating any kind of injuries, including chronic wrist pain. At present, there is no published study investigating the application of EMS as treatment for chronic wrist pain. At present, there is no data to support the efficacy and/or effectiveness of the COMPEX SP device or EMS in general in treating muscle sprain/strain. With regard to the efficacy and/or effectiveness of EMS in treating chronic pain, a high quality Cochrane review concluded that EMS was not more effective than placebo in reducing pain or disability among patients with neck pain.

6 Electric Muscle Stimulation (EMS) as Treatment for Chronic (Wrist) Pain 4 References 1. Kroeling Peter; Gross Anita; Graham Nadine; Burnie, Stephen J.; Szeto Grace; Goldsmith, Charles H.; Haines, T. e. d., and Forget Mario. Electrotherapy for neck pain [Systematic Review]. Cochrane. 2013; (8). 2. Poitras, S. and Brosseau, L. Evidence-informed management of chronic low back pain with transcutaneous electrical nerve stimulation, interferential current, electrical muscle stimulation, ultrasound, and thermotherapy. Spine. Journal. 8 (1) (pp ), Balldin, U.; Annicelli, L.; Gibbons, J., and Kisner, J. An electrical muscle stimulation suit for increasing blood pressure. Aviation. Space and Environmental Medicine. 79 (9) (pp ), Fleming B.C.; Renstrom P.A.; Ohlen, G.; Johnson R.J.; Peura G.D.; Beynnon B.D., and Badger G.J. The gastrocnemius muscle is an antagonist of the anterior cruciate ligament. Journal. of Orthopaedic Research. 19 (6) (pp ), McQuain M.T.; Sinaki, M.; Shibley L.D.; Wahner H.W., and Ilstrup D.M. Effect of electrical stimulation on lumbar paraspinal muscles. Spine. 18 (13) (pp ), Xu, B.; Akhtar, A.; Liu, Y.; Chen, H.; Yeo, W. H.; Park, S. I.; Boyce, B.; Kim, H.; Yu, J.; Lai, H. Y.; Jung, S.; Zhou, Y.; Kim, J.; Cho, S.; Huang, Y.; Bretl, T., and Rogers, J. A. Flexible Electronics: An Epidermal Stimulation and Sensing Platform for Sensorimotor Prosthetic Control, Management of Lower Back Exertion, and Electrical Muscle Activation (Adv. Mater. 22/2016). Advanced. Materials. 28(22):4563, 2016 Jun. 7. Zakaria, D. and Hartsell H.D. Efficacy of electrical muscle stimulation during protected immobilization following anterior cruciate ligament surgery. Physiotherapy. Canada. 45 (2) (pp 89-93), 1993.

7 Electric Muscle Stimulation (EMS) as Treatment for Chronic (Wrist) Pain 5 Appendix 1 WorkSafeBC - Evidence-Based Practice Group Levels of Evidence (adapted from 1,2,3,4) Evidence from at least 1 properly randomized controlled trial (RCT) or systematic review of RCTs. Evidence from well-designed controlled trials without randomization or systematic reviews of observational studies. Evidence from well-designed cohort or case-control analytic studies, preferably from more than 1 centre or research group. Evidence from comparisons between times or places with or without the intervention. Dramatic results in uncontrolled Opinions of respected authorities, based on clinical experience, descriptive studies or reports of expert committees. References 1. Canadian Task Force on the Periodic Health Examination: The periodic health examination. CMAJ. 1979;121: Houston TP, Elster AB, Davis RM et al. The US Preventive Services Task Force Guide to Clinical Preventive Services, Second Edition. AMA Council on Scientific Affairs. American Journal of Preventive Medicine. May 1998;14(4): Scottish Intercollegiate Guidelines Network (2001). SIGN 50: a guideline developers' handbook. SIGN. Edinburgh. 4. Canadian Task Force on Preventive Health Care. New grades for recommendations from the Canadian Task Force on Preventive Health Care. CMAJ. Aug 5, 2003;169(3):