J Korean Med Assoc Search


J Korean Med Assoc > Volume 54(10); 2011 > Article
Lim, Seo, Cho, Ahn, and Park: A systematic review of the effectiveness and safety of intramuscular stimulation therapy


Intramuscular stimulation (IMS) therapy has been used widely ever since Gunn introduced the effect of IMS in his study in 1980. Usually IMS has been based on Cannon's radiculopathic model, known for its effectiveness in chronic pain relief. In this study we systematically review the effectiveness and safety of IMS. In order to accomplish a systematic review, we searched for IMS-related studies through 12 bibliographical databases and 19 studies were included (4 randomized controlled trials (RCTs), 2 non-RCTs and 13 case reports/studies). Study selection was conducted independently by two researchers based on title and abstract. As a result, most included studies of 16 showed significant improvement in range of motion, decrease of drug consumption as well as pain relief after IMS treatment; the other 3 studies reported adverse events. In terms of the effectiveness of IMS, the results of intervention were good, so we concluded that IMS therapy is a useful method of pain treatment; with respect of safety, few adverse events that could have been caused by IMS were observed. However, it is not certain that there was a causal relationship between IMS and the adverse events that were reported due to a lack of evidence. Therefore, clinicians who have sufficient knowledge and experience of IMS will have to perform the procedure after thorough clinical examinations to determine its appropriateness for target patients. This study provided meaningful data on the current state of IMS treatment. We expect that the result of this study will stimulate further more extensive research on IMS.


1. Gunn CC, Milbrandt WE, Little AS, Mason KE. Dry needling of muscle motor points for chronic low-back pain: a randomized clinical trial with long-term follow-up. Spine (Phila Pa 1976) 1980;5:279-291.

2. Cannon WB, Rosenbleuth A. The supersensitivity of denervated structures; a law of denervation 1949;New York: MacMillan.

3. Sharpless SK. In: Jasper HH, Nard AA, Pole A, Isolated and deafferented neurons: disuse supersensitivity. Basic mechanisms of the epilepsies 1969;New York: Little Brown & Company. 329-355.

4. Sharpless SK. In: Riesen AH, Disuse supersensitivity. The developmental neuropsychology of sensory deprivation academic press 1975;New York: Academic Press.

5. Gunn IMS: imtranuscular stimulation [Internet]. Gunn IMS Pain Clinic, Research, and Education c2007;cited 2011 Jul 14. Vancouver, BC: iSTOP. Available from:http://www.istop.org/ims.html.

6. Ga H, Koh HJ, Choi JH, Kim CH. Intramuscular and nerve root stimulation vs lidocaine injection to trigger points in myofascial pain syndrome. J Rehabil Med 2007;39:374-378.

7. Byeon HT, Park SH, Ko MH, Seo JH. Effects of intramuscular stimulation in myofascial pain syndrome of upper trapezius muscle. J Korean Acad Rehabil Med 2003;27:753-756.

8. Ahn SL, Woo JW, Kim JA, Yoon DK, Cho KH, Jang JA, Hong MH, Kim HJ, Park YK. A comparison of NSAID and intramuscular stimulation therapy effectiveness in the female patient with chronic shoulder pain. J Korean Geriatr Soc 2002;6:55-66.

9. Karakurum B, Karaalin O, Coskun O, Dora B, Uçler S, Inan L. The 'dry-needle technique': intramuscular stimulation in tension-type headache. Cephalalgia 2001;21:813-817.

10. Nam SG, Choi KY. Comparison of efficacy on trigger point injection and intramuscular stimulation using visual analogue scale. J Soonchunhyang Med Coll 2006;12:263-267.

11. Chu J. Twitch-obtaining intramuscular stimulation: observations in the management of radiculopathic chronic low back pain. J Musculoskelet Pain 1999;7:131-146.

12. Cho CK, Kim HW, Ahn SW, Kwon HU, Kang PS. Is intramuscular stimulation a safe procedure in unpracticed hands? A case of cervical epidural hematoma resulting in hemiparesis: a case report. Anesth Pain Med 2010;5:118-120.

13. Jung W, Lee BJ, Kim SS, Lee YJ. The effect of Gunn's intramuscular stimulation for postherpetic neuralgia: a report of 4 cases. Korean J Anesthesiol 2010;58:311-317.

14. Kim JI, Choi HJ, Choi CY, Yang HE. A case of intramuscular abscess in the sternocleidomastoid muscle after intramuscular stimulation (IMS). J Korean Soc Plast Reconstr Surg 2010;37:182-186.

15. Ahn K, Jhun HJ, Lee SC. Successful treatment of spasmodic dysphonia using IMS: a case report. Anesth Pain Med 2009;4:218-220.

16. Ahn K, Moon J, Lee SC. Ultrasound-guided cervical facet joint IMS. Anesth Pain Med 2009;4:214-217.

17. Kim SY, Jang WI, Chung S, Choi DE, Na KR, Lee KW, Shin YT. Perirenal hematoma induced by acupuncture and intramuscular stimulation. Korean J Nephrol 2009;28:146-151.

18. Kim SS, Park BS, Lee YJ. The effect of intramuscular stimulation (IMS) in cervicogenic headache. Korean J Anesthesiol 2006;50:355-360.

19. Park JS, Park BS, Lee YJ. The effect of intramuscular stimulation (IMS) in Carpal Tunnel syndrome: a report of 4 cases. Korean J Anesthesiol 2005;48:666-670.

20. Ahn K, Lee Y, Lee S, Lee C, Lee Y. Clinical effect of fluoroscopy guided interventional muscle and nerve stimulation (IMNS) on intractable spinal origin oain. Korean J Anesthesiol 2004;47:96-100.

21. Nam SG, Jeon IS, Heo HM, Hwang KH, Park W. Assessment of intramuscular stimulation in patients with myofascial pain syndrome using thermography. J Korean Pain Soc 2003;16:54-59.

22. Kim JK, Lim KJ, Kim C, Kim HS. Intramuscular stimulation therapy in failed back surgery syndrome patients. J Korean Pain Soc 2003;16:60-67.

23. Kim HK, Kim SH, Kim MJ, Lim JA, Kang PS, Woo NS, Lee YC. Intramuscular stimulation in chronic pain patients. J Korean Pain Soc 2002;15:139-145.

24. Park YK, Woo JW, Ann SL, Kim JA, Youn DK, Park SH, Cho KH. Effectiveness of intramuscular stimulation therapy in patients with osteoarthritis of the knee joint. J Korean Geriatr Soc 2001;5:318-328.

25. Lee YJ, Ahn K, Lee SC. The deep dry needling techniques, and interventional muscle and nerve stimulation (IMS) for the treatment of chronic pain. Korean J Pain 2006;19:1-7.



Bibliographic Database

National Assemly Library (NAL): http://www.nanet.go.kr/main.jsp
The National Library of Korea (NLK): http://www.nl.go.kr/nl/index.jsp
KoreaMed: http://www.koreamed.org/SearchBasic.php - 1997 to present
Korean Library Information System Network (KOLIS): http://www.nl.go.kr/kolisnet/
Researching Information Sharing Service (RISS): http://www.riss.kr/index.do
Koreanstudies Information Service System (KISS): http://kiss.kstudy.com/
Korean Medical Database (Kmbase): http://kmbase.medric.or.kr/
National Discovery for Science Library (NDSL): http://www.ndsl.kr/index.do
Pubmed Central (PMC): http://www.ncbi.nlm.nih.gov/pmc/
The Cochrane Library: http://www.thecochranelibrary.com/
Figure 1
Summary of the database search and the process of study selection. IMS, intramuscular stimulation therapy; SCIE, Science Citation Index Expanded; NRP, National Research Foundation of Korea.
Table 1
Characteristics of included studies

RCT, randomized controled trial; MPS, myofascial pain syndrome; T, treatment group; C, control group; IMS, intramuscular stimulation therapy; TPI, trigger point injection; IMES, intramuscular electrical stimulation; TTH, tension-type headache; TOIMS, twitch-obtaining IMS; StdRx, standard treatment; NA, not available; PHN, postherpetic neuralgia; FBSS, failed back surgery syndrome.

Table 2
Effectiveness of intramuscular stimulation therapy : result of intervention

IMS, intramuscular stimulation therapy; T, treatment group; C, control group; ROM, range of motion; TPI, trigger point injection; VAS, visual analogue scale; IMES, intramuscular electrical stimulation; TOIMS, twitch-obtaining IMS; StdRx, standard treatment; KWOMAC, Korean Western Ontario and Macmaster osteoarthritis index scale.

Table 3
Safety of intramuscular stimulation (IMS) therapy: examples of adverse effect report
Share :
Facebook Twitter Linked In Google+ Line it
METRICS Graph View
  • 3 Crossref
  • 3 Scopus
  • 985 View
  • 6 Download
Related articles in
J Korean Med Assoc


Browse all articles >

Editorial Office
37 Ichon-ro 46-gil, Yongsan-gu, Seoul
Tel: +82-2-6350-6562    Fax: +82-2-792-5208    E-mail: jkmamaster@gmail.com                

Copyright © 2023 by Korean Medical Association.

Developed in M2PI

Close layer
prev next