Targeting deep areas of the skeletal muscles effectively alleviates postoperative pain

July 02, 2020

CHICAGO (July 2, 2020): Postoperative pain can pose a number of challenges for surgical patients and their care providers. A common method to treat pain has been to administer opioids. However, opioids come with a number of different, often intolerable, side effects, and surgeons have been actively looking for other, safer, pain-relieving options. To address postoperative muscle pain in patients undergoing abdominal surgery, researchers from Yonsei University College of Medicine, Seoul, South Korea, developed a new method of effective pain control called needle electrical twitch obtaining intramuscular stimulation (NETOIMS). The research team's findings appear as an "article in press" on the website of the Journal of the American College of Surgeons ahead of print.

According to study authors, surgical manipulation, such as retraction and suture, shortens skeletal muscle fibers, contributing to postoperative pain. The NETOIMS method effectively alleviates this pain by inserting a needle in the muscle and electrically eliciting twitch responses. NETOIMS targets the deep motor endplate zones of the skeletal muscles, targeting strained muscle fibers. This technique results in the stretching of the shortened muscle fiber and improving circulation, relaxing the muscle and alleviating postoperative pain.

The researchers said their study is one of the first to investigate the effects of NETOIMS on postoperative pain, functional indicators, and postoperative complications after open abdominal surgery.

"The major goal of postoperative care is to reduce the postoperative complication and to restore function as soon as possible," said corresponding study author Joon Seong Park, MD, PhD, FACS, of the pancreatobiliary cancer clinic, department of surgery, Gangnam Severance Hospital, Yonsei University. "NETOIMS not only reduced postoperative muscular pain, but also reduced the time it takes for gait speed and peak cough flow to recover to the preoperative state."

To study the NETOIMS method, a double-blind, randomized controlled clinical trial was developed that included 44 patients scheduled for open pylorus-preserving pancreaticoduodenectomy (PPPD), a surgical procedure performed to remove pancreatic tumors where a portion of the duodenum is removed and the pylorus--the part of the stomach that connects to the duodenum--is kept.* The patients were randomly allocated to the NETOIMS group or the control group.

Once the operating surgeon left the operating room after completing the procedure, another surgeon who did not participate in the operation conducted the NETOIMS procedure. The treatment site was covered and markings on the NETOIMS sites were erased, making it impossible to identify the patients who received NETOIMS.

Pain was measured using a visual analog scale (VAS) that utilizes a measure on a scale from 1-10 of how much pain a patient is experiencing. Patients in the NETOIMS group returned to a VAS score of 2--a very tolerable level of pain--in an average of 2.6 fewer days after surgery than the control group. Further, on the third day after surgery, the VAS score of the NETOIMS group was 20 percent lower than that of the control group.

"Not only was the reduction in pain intensity greater, but the rate of pain relief was also faster in the NETOIMS group," study authors write. "Patients are unlikely to require hospitalization for pain management. Thus, NETOIMS is expected to reduce the length of hospital stay after surgery."

Dr. Park said that NETOIMS is a convenient and safe intervention that can be implemented in other medical centers. "Any experienced professional can safely perform the procedure without an image guide such as ultrasound while monitoring the tissue resistance felt at the fingertip during needle insertion and monitoring the regular twitching responses obtained by the intramuscular stimulation," he said.

The researchers report that in this study, NETOIMS was performed only once after the operation. Future studies will address whether there is cumulative effect of this type of treatment.

"NETOIMS helps in rapid reduction of somatic pain resulting from open abdominal surgery," the researchers concluded. "We suggest that NETOIMS is an effective new treatment modality for postoperative pain control and rapid functional restoration following open abdominal surgery such as PPPD."
Dr. Park's coauthors are Jinyoung Park, MD; Hyung Sun Kim, MD; Jung Hyun Park, MD, PhD; Yoon Ghil Park, MD, PhD; Sanghoon Shin, MD; Jae Eun Park, MD; Sangwon Hwang, MD; and So Young Jun, RN.

"FACS" designates that a surgeon is a Fellow of the American College of Surgeons.

Citation: Effectiveness of Intramuscular Electrical Stimulation on Postsurgical Nociceptive Pain for Patients Undergoing Open Pancreaticoduodenectomy: A Randomized Clinical Trial. Journal of the American College of Surgeons. DOI: 10.1016/j.jamcollsurg.2020.06.008

* Whipple's Procedure and Pylorus Preserving Pancreatoduodectomy (PPPD). Pancreatic Cancer Action. Available at: Accessed June 30, 2020.

About the American College of Surgeons

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 82,000 members and is the largest organization of surgeons in the world. For more information, visit

American College of Surgeons

Related Pain Articles from Brightsurf:

Pain researchers get a common language to describe pain
Pain researchers around the world have agreed to classify pain in the mouth, jaw and face according to the same system.

It's not just a pain in the head -- facial pain can be a symptom of headaches too
A new study finds that up to 10% of people with headaches also have facial pain.

New opioid speeds up recovery without increasing pain sensitivity or risk of chronic pain
A new type of non-addictive opioid developed by researchers at Tulane University and the Southeast Louisiana Veterans Health Care System accelerates recovery time from pain compared to morphine without increasing pain sensitivity, according to a new study published in the Journal of Neuroinflammation.

The insular cortex processes pain and drives learning from pain
Neuroscientists at EPFL have discovered an area of the brain, the insular cortex, that processes painful experiences and thereby drives learning from aversive events.

Pain, pain go away: new tools improve students' experience of school-based vaccines
Researchers at the University of Toronto and The Hospital for Sick Children (SickKids) have teamed up with educators, public health practitioners and grade seven students in Ontario to develop and implement a new approach to delivering school-based vaccines that improves student experience.

Pain sensitization increases risk of persistent knee pain
Becoming more sensitive to pain, or pain sensitization, is an important risk factor for developing persistent knee pain in osteoarthritis (OA), according to a new study by researchers from the Université de Montréal (UdeM) School of Rehabilitation and Hôpital Maisonneuve Rosemont Research Centre (CRHMR) in collaboration with researchers at Boston University School of Medicine (BUSM).

Becoming more sensitive to pain increases the risk of knee pain not going away
A new study by researchers in Montreal and Boston looks at the role that pain plays in osteoarthritis, a disease that affects over 300 million adults worldwide.

Pain disruption therapy treats source of chronic back pain
People with treatment-resistant back pain may get significant and lasting relief with dorsal root ganglion (DRG) stimulation therapy, an innovative treatment that short-circuits pain, suggests a study presented at the ANESTHESIOLOGY® 2018 annual meeting.

Sugar pills relieve pain for chronic pain patients
Someday doctors may prescribe sugar pills for certain chronic pain patients based on their brain anatomy and psychology.

Peripheral nerve block provides some with long-lasting pain relief for severe facial pain
A new study has shown that use of peripheral nerve blocks in the treatment of Trigeminal Neuralgia (TGN) may produce long-term pain relief.

Read More: Pain News and Pain Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to