http://www.doctoroz.com/videos/pulse...-how-they-heal


Maybe this can help with muscle atrophy? I already emailed both doctors....

Debbie

Hi Debbie,
I saw he had a special the other day on natural healing but I did not see this segment. Why not give it a shot but first check it out real good. We should try anything we think may help us as we don't want to give up hope. Everyone is so different so what may work for one may not work for another. Go for it and let us know what you find out.
thanks,
kathy d

Dear Debbie -

Please pardon the late response, but, IMHO, YOU DO NOT WANT TO GO THERE.

I saw my pain management specialist at USC today, and surprise, surprise, you're not the first patient who saw Dr. Pawluk's bit on Dr. Oz. My doctor told me that he went on Pawluck's website and read through his stuff on pulsed electromagnetic fields. He noted that it included everything except any reference to actual studies showing that it worked!

I then asked what a patient with chronic CRPS ["small fiber neuropathy" as it's referred to by some, see, generally, Is Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome Type I a Small-Fiber Neuropathy? Oaklander AL and Fields HL, Ann Neurol. 2009;65:629-638, online text @ http://www.rsds.org/pdfsall/Oaklande...eurol_2009.pdf] can do about atrophy if she is able to exercise as much as recommended by her PT but it still does no good. (I suggested a possible mechanism of ischemic constriction of small blood vessels in the muscles, to which no disagreement was offered, but that might have been a polite way of telling me I didn't know what I was talking about. )

But I got an interesting response to the main question. Turns out that years ago, before steroids and HGH became all the rage, body builders were using the equivalent of locally applied TENS units to provide pulsed neuromuscular electrical stimulation (NMES) to build muscle mass! See, Neuromuscular electrical stimulation. An overview and its application in the treatment of sports injuries, Lake DA, Sports Med. 1992 May;13(5):320-36:

Abstract
In sports medicine, neuromuscular electrical stimulation (NMES) has been used for muscle strengthening, maintenance of muscle mass and strength during prolonged periods of immobilisation, selective muscle retraining, and the control of oedema. A wide variety of stimulators, including the burst-modulated alternating current ('Russian stimulator'), twin-spiked monophasic pulsed current and biphasic pulsed current stimulators, have been used to produce these effects. Several investigators have reported increased isometric muscle strength in both NMES-stimulated and exercise-trained healthy, young adults when compared to unexercised controls, and also no significant differences between the NMES and voluntary exercise groups. It appears that when NMES and voluntary exercise are combined there is no significant difference in muscle strength after training when compared to either NMES or voluntary exercise alone. There is also evidence that NMES can improve functional performance in a variety of strength tasks. Two mechanisms have been suggested to explain the training effects seen with NMES. The first mechanism proposes that augmentation of muscle strength with NMES occurs in a similar manner to augmentation of muscle strength with voluntary exercise. This mechanism would require NMES strengthening protocols to follow standard strengthening protocols which call for a low number of repetitions with high external loads and a high intensity of muscle contraction. The second mechanism proposes that the muscle strengthening seen following NMES training results from a reversal of voluntary recruitment order with a selective augmentation of type II muscle fibres. Because type II fibres have a higher specific force than type I fibres, selective augmentation of type II muscle fibres will increase the overall strength of the muscle. The use of neuromuscular electrical stimulation to prevent muscle atrophy associated with prolonged knee immobilisation following ligament reconstruction surgery or injury has been extensively studied. NMES has been shown to be effective in preventing the decreases in muscle strength, muscle mass and the oxidative capacity of thigh muscles following knee immobilisation. In all but one of the studies, NMES was shown to be superior in preventing the atrophic changes of knee immobilisation when compared to no exercise, isometric exercise of the quadriceps femoris muscle group, isometric co-contraction of both the hamstrings and quadriceps femoris muscle groups, and combined NMES-isometric exercise. It has also been reported that NMES applied to the thigh musculature during knee immobilisation improves the performance on functional tasks. (ABSTRACT TRUNCATED AT 400 WORDS)

PMID: 1565927 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/1565927

I just went on PubMed, and the studies, small as they may be, appear to be generally encouraging and completely in line with what my doctor was saying. Here are some that are available free of charge:

(1) Home based neuromuscular electrical stimulation as a new rehabilitative strategy for severely disabled patients with chronic obstructive pulmonary disease (COPD), Neder JA, Sword D, Ward SA et al, Thorax. 2002 Apr;57(4):333-7, online text @ http://thorax.bmj.com/content/57/4/333.full.pdf;

(2) Randomised controlled trial of transcutaneous electrical muscle stimulation of the lower extremities in patients with chronic obstructive pulmonary disease, Bourjeily-Habr G, Rochester CL et al, Thorax. 2002 Dec;57(12):1045-9, online text @ http://thorax.bmj.com/content/57/12/1045.full.pdf [Yale University School of Medicine];

(3) Neuromuscular electrical stimulation and volitional exercise for individuals with rheumatoid arthritis: a multiple-patient case report, Piva SR, Goodnite EA, Azuma K, Phys Ther. 2007 Aug;87(8):1064-77, Epub 2007 Jun 6, online text @ http://ptjournal.apta.org/content/87/8/1064.full.pdf;

(4) Electrical muscle stimulation preserves the muscle mass of critically ill patients: a randomized study, Gerovasili V, Stefanidis K, Vitzilaios K et al, Crit Care. 2009;13(5):R161, Epub 2009 Oct 8, online text @ http://www.ncbi.nlm.nih.gov/pmc/arti...pdf/cc8123.pdf; and

(5) Electrical muscle stimulation prevents critical illness polyneuromyopathy: a randomized parallel intervention trial, Routsi C, Gerovasili V, Vasileiadis I et al, Crit. Care 2010;14(2):R74, Epub 2010 Apr 28, online text @ http://www.ncbi.nlm.nih.gov/pmc/arti...pdf/cc8987.pdf.

On the other hand, another recent study found that four weeks of NMES delivered to women with mild and moderate osteoarthritis and mild strength deficits was insufficient to induce gains in quadriceps muscle strength or activation:

A clinical trial of neuromuscular electrical stimulation in improving quadriceps muscle strength and activation among women with mild and moderate osteoarthritis, Palmieri-Smith RM, Thomas AC, Karvonen-Gutierrez C, Sowers M, Phys. Ther. 2010 Oct;90(10):1441-52. Epub 2010 Jul 29, online text @ http://ptjournal.apta.org/content/90/10/1441.full.pdf

I would urge you to print these out and discuss them with either your neurologist or a good physical medicine specialist, also known as a physiatrist. And forget about Drs. Pawluck et al.

Good luck!

Mike

Thanks for your response. I do have an appt with Dr Dillard next Thursday- He does not sell the devices or may not recommend them. But according to him he is a world renound pain specialist. He wants me to have my C-reactive protien checked and vitamin D level- Not sure how this is going to go..

If you mainly want to work the muscles with a stim device, there are ones you can buy online like Amazon or many health/medical supply sites.

I have an older EMS (electric muscle stim) and just got a new digital IF stim (Inferential) I use them to help with muscle discomfort/pain.

The digital ones are nicer , you don't accidentally bump the dial on the manual ones and give yourself a jolt. done that..
The IF is less likely to produce the stinging zaps when turned up also.

The IF stim & just bought was 90.00 on Amazon.

If you want to try the various types to see if they work for you, calling various local PT places or chiropractors would be a good way to find out who has & uses them, and to see if you can just get a session or 2 to see if they help or not.

Dear Debbie -

In speaking of Dr. Dillard, you say that " according to him he is a world renound pain specialist." Perhaps it's just me, but I've had nothing but bad luck with doctors who are "legends in their own minds."

Then too, and for what it's worth, I searched the directory of the American Board of Pain Medicine http://persweb.connect2amc.com/abpm/...aspx?tabid=250 for anyone holding board certification under the last name of "Dillard," and came up empty.

Mike

Here is a link to his website. Let me know what u think...

http://drdillard.com/

Debbie

Debbie -

Frankly, the gentleman comes across as someone who tells people what they want to hear (consider his pop-psychology essay on "Toxic People") and provides the services they want, as in aroma therapy. That he doesn't attempt - albeit on a website for the general public - to differentiate between different pain conditions is unusual for a pain clinic's website; but he also sounds as though he may in fact approach chronic pain as though it was some sort of an amorphous unitary phenomena, where each case is handled through a process of trial and error (see his "Green Journal Interview"). This doesn't exactly come across as a worldview that's informed by keeping abreast of recent scientific developments. That, and we know that chronic pain isn't all the same, different types map differently in the brain, and so on.

Then his bio offers this:

Dr. Dillard served as an Assistant Clinical Professor at Columbia University College of Physicians and Surgeons for 14 years, and was on the medical staff at the New York-Presbyterian Hospitals Columbia Medical Center. He was also an Attending Physician at Beth Israel Medical Center, in the Department of Pain Medicine and Palliative Care. Dr. Dillard served as the Medical Director of Columbia’s widely-respected Rosenthal Center for Complementary and Alternative Medicine, a National Institutes of Health NCCAM Center-granted research and education center at Columbia University College of Physicians and Surgeons under the direction of Fredi Kronenberg, Ph.D. , during his years employed at Columbia University Medical Center.

Dr. Dillard was the originator and course co-director with Dr. Kronenberg of Columbia’s ground-breaking and highly successful Continuing Medical Education conference, Integrative Pain Medicine, which educated physicians, nurses and psychologists from all over the world for six years. He resigned from employment at Columbia in 2006, to go exclusively into private practice in Manhattan, and in East Hampton, NY.

But a search of PubMed under "Dillard JN," provides only these listings:

Results: 2
1. Complementary and alternative pain therapy in the emergency department. Dillard JN, Knapp S., Emerg Med Clin North Am. 2005 May;23(2):529-49. Review.
PMID: 15829396
[PubMed - indexed for MEDLINE]

2. Should the FDA regulate alternative medicines?, Renner JH, Dillard JN, Edelberg D., Hosp Health Netw. 1999 Oct;73(10):24. No abstract available.
PMID:10576870
[PubMed - indexed for MEDLINE]

Two published articles in 14 years at Columbia. Hardly the way to make tenure. In fact, I'm surprised he lasted as long as he did. That said, his "bedside manner" is probably very good to excellent, not that it has any effect, one way or another, on long-run patient outcomes. Which is to say, he no doubt comes across - and may well be - compassionate and caring.

Sorry I can't offer more of a ringing endorsement. But if it was me, I would take a pass on Dr. Dillard and seek out a bona fide physiatrist or other doctor who could set you up with a good physical therapist: preferably someone with one of the new 4-year graduate DPT degrees (their knowledge of neuro-anatomy is amazing) and hopefully hook you up with a trial of neuromuscular electrical stimulation (NMES). That, or just follow Jo's very sound advice.

Mike


PS I would have gotten back to you sooner but our Internet service went out in fierce "Santa Ana" winds, blowing in from the Great Basin (think: Utah) with gusts up to 80 mph, and am only connected now through a miracle hot-spot device in my wife's purse, which pulls in a signal from another carrier.