Treatment of chronic low back pain by electric hyperstimulation analgesia of myofascial trigger points: a retrospective multicenter study

Treatment of chronic low back pain by electric hyperstimulation analgesia of myofascial trigger points: a retrospective multicenter study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Treatment of chronic low back pain by electric hyperstimulation analgesia of myofascial trigger points: a retrospective multicenter study Miguel Gorenberg, Talila Gorenberg, Abed Agbarya This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8068098/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Myofascial trigger points (MTrPs) are associated with chronic nonspecific low back pain (CLBP) in patients presenting musculoskeletal pain. This study evaluated an innovative automated robotic system (Soleve™) that scans patients’ backs to detect MTrPs, by analyzing skin impedance, followed by Electric Hyperstimulation Analgesia (EHA) therapy. The hypothesis is that EHA provides an analgesic effect by altering the biochemical environment of MTrPs, resulting in autonomic reactions that lead to variations in skin resistance. Methods This retrospective multicenter study included 168 consecutive CLBP outpatients (103 females, 65 males; mean age 64.85 ± 14.92 years) treated at two centers in the United States and Germany between January 2014 and September 2015. Patients underwent six Soleve™ treatment sessions at 2–4 day intervals. Each session included 20 minutes of treatment targeting the 10 points with lowest impedance. Inclusion criteria were age ≥ 18 years and baseline pain score ≥ 4 cm on the visual analogue scale (VAS). The primary outcome was change in pain intensity measured on a 10 cm pain VAS. Results The mean ± SD baseline VAS score was 6.51 ± 1.27 cm. Treatment resulted in a significant decrease in VAS scores compared to baseline by 2.0 cm ( P < 0.001). Forty percent of patients achieved VAS improvement of at least 3 cm. Patients with severe initial pain (VAS 7–10) showed greater improvement (2.47 ± 2.19 cm) compared to those with moderate pain (1.49 ± 1.82 cm) (P < 0.005). No adverse events were reported. Conclusions This retrospective analysis provides preliminary evidence that targeted hyperstimulation analgesia using automated MTrP detection is safe and may improve CLBP. The results support further investigation through randomized controlled trials. Chronic Low Back Pain Analgesia Hyperstimulation Myofascial Trigger Point Neurostimulation Background Chronic low back pain (CLBP) is a leading cause of disability in U.S. adults and a major contributor to lost workdays [1,2]. While its etiology is often multifactorial, a subset of patients presents with myofascial pain syndrome, chracterized Myofascial Trigger Points (MTrPs)—hyperirritable nodules located within taut bands of skeletal muscle. These trigger points can generate referred pain, limit range of motion, and cause local tenderness [3]. Other causes of CLBP include discogenic pain, facet joint arthropathy, and central sensitization syndromes [4–6]. The diagnosis of MTrPs relies primarily on clinical palpation, although its reliability has been questioned [7,8]. A 2009 systematic review by Lucas et al. [9] highlighted inconsistencies in physical examination findings, indicating the need for more objective diagnostic tools. Changes in electrodermal conductance at MTrP sites have been documented, where active trigger points often show decreased skin impedance due to localized autonomic and inflammatory changes [10]. Electric Hyperstimulation Analgesia (EHA) delivers focused, low-frequency electrical stimulation to peripheral nerve endings at MTrP locations, aiming to interrupt pain pathways. However, its use has been limited by the complexity of accurately identifying MTrPs. To address this challenge, the Soleve™ system (Nervomatrix Ltd., Israel) was developed as a robotic device equipped with 26 miniature impedance-sensing probes that scan the lower back to generate a topographic map of skin resistance. Prior validation studies [11–14] have shown promising outcomes using this technology for treating nonspecific CLBP. The objective of this retrospective study was to investigate the effectiveness and safety of this automated neurostimulation system in the management of CLBP. Methods Study design and participants This retrospective multicenter study analyzed data from patients with CLBP who underwent Soleve™ treatment at two outpatient centers: Etheredge Chiropractic (The Villages, Florida, USA) and Orthopädische Praxis, (Rottweil, Germany) between January 2014 and September 2015. Inclusion criteria were: age ≥ 18 years, baseline pain score ≥ 4 cm on the visual analogue scale (VAS), and presence of trigger points in the lumbar region. Exclusion criteria included: cardiac pacemaker, implanted cardiac defibrillator or other metallic/electronic devices, pregnancy, or postpartum status within one year. Ethical considerations The study was approved by the Bnai Zion Medical Center ethics committee (protocol number 0056-16-BNZ) in accordance with the Declaration of Helsinki. Patient consent for medical record review was waived by the ethics committee due to the retrospective, anonymized nature of the data collection. Intervention protocol The intervention consisted of six treatment sessions scheduled 2–4 days apart. Each session began with patients positioned supine on the treatment table with the lower back exposed and hygienically prepared. The Soleve™ device's 26 probes were positioned over the posterior superior iliac spine. Each session included a 4.5-minute automated back impedance screening to identify MTrPs and select the 10 locations with lowest impedance levels. Each selected MTrP was consecutively treated for 2 minutes according to proprietary algorithms, resulting in a total treatment time of 20 minutes per session. Technical specifications The Soleve™ device (Nervomatrix Ltd., Israel) used 26 miniature probes (0.4 cm diameter) to perform automated screening over a 20 × 30 cm area of the lower back across 15 levels. The system measured impedance at each point and identified the 10 MTrPs with the lowest resistance using data analysis software and image processing algorithms. The electrotherapy parameters included: Asymmetrical two-phase rectangular waveform Maximum voltage output: 320V (± 5%) positive phase, 24V negative phase Output current: 16mA (± 5%) at 500Ω positive phase, maximum 0.125mA negative phase Pulse width: 300 microseconds Frequency: 8 Hz Maximum phase charge: 9.6 µC Stimulus amplitude range: 0.4-16mA The stimulus amplitude was individually determined through a tolerability test, with gradual increases until patients reported a strong but tolerable sensation. Outcome measures The primary outcome was change in pain intensity measured using a 10 cm VAS, where 0 represents no pain and 10 represents worst pain imaginable [15]. VAS scores were recorded at baseline (before first treatment) and before each subsequent treatment session. Secondary outcomes included VAS class reduction (mild: 0–3, moderate: 4–6, severe: 7–10) and the proportion of patients achieving clinically meaningful improvement (≥ 3 cm reduction). Statistical analysis Data were analyzed using SPSS version 20 (IBM, NY, USA). The primary efficacy variable (Delta_VAS) was calculated by subtracting the final VAS score from the baseline VAS score. Patients were stratified by baseline VAS scores into moderate (4–6 cm) and severe (7–10 cm) groups. Statistical comparisons used paired t -tests for continuous variables and chi-square tests for categorical variables. Pearson correlation analysis examined relationships between VAS improvement and patient characteristics. Repeated measures ANOVA analyzed VAS changes over time. Statistical significance was set at p < 0.05. Results Patient characteristics A total of 168 patients completed the study (103 females [61.3%], 65 males [38.7%]) with a mean age of 64.85 ± 14.92 years (range 20–90) (Table 1 ). Patients received an average of 5.4 ± 2.45 treatments (range 2–17). The mean baseline VAS score was 6.51 ± 1.27 cm, with 81 patients (48%) in the moderate pain category and 87 patients (52%) in the severe pain category. Primary outcomes Treatment resulted in a significant reduction in VAS scores compared to baseline (mean reduction 2.0 ± 2.08 cm, p < 0.001). This reduction exceeded the established minimal clinically important difference (MCID) of 1.8–1.9 cm for CLBP. Patients with severe baseline pain showed greater improvement (2.47 ± 2.19 cm) compared to those with moderate baseline pain (1.49 ± 1.82 cm) ( p < 0.005). Gender analysis revealed significant differences in improvement, with males showing slightly greater pain reduction (2.17 ± 0.27 cm) compared to females (1.89 ± 0.19 cm) ( p < 0.05). Secondary outcomes Forty percent of patients ( n = 68) achieved VAS improvement of ≥ 3 cm (Table 2 ). Among patients with moderate baseline pain, 48% ( n = 39) demonstrated one VAS class reduction. In the severe pain group, 68% ( n = 59) showed one class reduction, while 22% (n = 19) achieved two-class reduction to mild pain levels. Table 1 Patient characteristics and treatment outcomes Variable Value Demographics Total patients, n (%) 168 (100) Female, n (%) 103 (61.3) Male, n (%) 65 (38.7) Age, years (mean ± SD) 64.85 ± 14.92 Number of treatments (mean ± SD) 5.4 ± 2.45 Pain scores Baseline VAS, cm (mean ± SD) 6.51 ± 1.27 VAS improvement, cm (mean ± SD) 2.00 ± 2.08 Moderate baseline pain (4–6 cm), n 81 - VAS improvement, cm (mean ± SD) 1.49 ± 1.82 Severe baseline pain (7–10 cm), n 87 - VAS improvement, cm (mean ± SD) 2.47 ± 2.19 Table 2 Distribution of VAS improvement. VAS improvement (cm) < 3 3 4 5 6 7 ≥ 3 Patients, n 100 25 23 13 5 2 68 Percent of total 60 15 14 8 3 1 40 Repeated measures ANOVA demonstrated a statistically significant time effect for VAS scores across all treatment sessions (P < 0.001). No significant correlations were found between VAS improvement and age (r = -0.028, p = 0.772) or number of treatments (r = 0.042, p = 0.586). Safety outcomes No side effects or adverse events were reported during the study period. Discussion This retrospective multicenter study demonstrates that automated neurostimulation targeting MTrPs using the Soleve™ system resulted in clinically meaningful pain reduction in patients with CLBP. The mean VAS reduction of 2.0 cm exceeded established MCID thresholds [16,17], supporting the clinical relevance of these findings. Mechanism and rationale MTrPs are increasingly recognized as a common source of musculoskeletal pain in CLBP patients [18–20]. The underlying pathophysiology remains incompletely understood [21], but Simons' integrated hypothesis suggests that decreased adenosine triphosphate levels caused by reduced blood flow render muscle fibers with insufficient energy to return calcium to the sarcoplasmic reticulum [22–25]. This results in sustained sarcomere contracture, leading to local hypoxia and release of pain-producing biochemicals. These physiological differences may account for the observed decrease in skin resistance at pathological sites compared to surrounding areas [ 26,27]. Comparison with existing treatments Traditional MTrP treatments include manual therapies, pharmacological agents, dry needling, and injection therapy [ 28–30]. Dry needling and trigger point injections have consistently shown effectiveness in MTrP inactivation [ 31] but carry risks of adverse events. Brady et al. [32] reported minor adverse events in 36.7% of dry needling treatments, including bleeding (16.0%), bruising (7.7%), and treatment-related pain (5.9%). EHA offers a non-invasive alternative that avoids needling complications while providing targeted therapy. Previous controlled studies have shown positive responses to EHA in 87% of patients [9, 33]. The automated nature of the Soleve™ system addresses limitations of manual point-finding devices, which can be time-consuming and subject to operator variability. Clinical significance The observed pain reduction patterns showed that patients with severe baseline pain achieved greater absolute improvements than those with moderate pain, suggesting that the treatment may be particularly beneficial for patients with higher pain levels. The 40% of patients achieving ≥ 3 cm improvement represents a substantial clinical response that exceeds many conventional treatments for CLBP. Study limitations Several limitations should be acknowledged. The retrospective design limits causal inference and prevents randomization or blinding. The absence of a control group makes it difficult to separate treatment effects from natural history or regression to the mean. Long-term follow-up data were not available to assess durability of treatment effects. Additionally, the study population was predominantly older adults, potentially limiting generalizability to younger patients with CLBP. The lack of systematic impedance monitoring post-treatment represents a missed opportunity to document physiological changes at MTrPs. Future studies should incorporate longitudinal impedance assessments to better understand treatment mechanisms. Future directions These preliminary findings support the need for randomized controlled trials to establish efficacy compared to standard care or placebo treatments. Future studies should include longer follow-up periods, standardized outcome measures, and direct comparison with established treatments such as physical therapy or pharmacotherapy. Investigation of optimal treatment protocols, including session frequency and duration, would help refine clinical applications. Additionally, studies examining cost-effectiveness and patient-reported outcomes beyond pain intensity would provide valuable insights for clinical decision-making. Conclusions This retrospective multicenter analysis demonstrates that automated neurostimulation targeting MTrPs using the Soleve™ system resulted in clinically meaningful pain reduction in patients with CLBP. The treatment appeared safe with no reported adverse events. These findings support further investigation through randomized controlled trials to establish the efficacy of this novel non-pharmacological approach for CLBP management. Abbreviations • CLBP Chronic low back pain • EHA Electric hyperstimulation analgesia • MCID Minimal clinically important difference • MTrP Myofascial trigger point • SD Standard deviation • VAS Visual analogue scale Declarations Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Bnai Zion Medical Center (protocol code 0056-16-BNZ). Patient consent was waived due to the retrospective, anonymized nature of the data collection. Consent for publication Not applicable. Availability of data and materials The datasets used during the current study are available from the corresponding author upon reasonable request. Competing interests M.G. was a co-founder of Nervomatrix Ltd. Other authors declare no competing interests. Funding This research received no external funding. Authors' contributions Conceptualization: M.G. and A.A.; methodology: T.G.; software: M.G.; validation: M.G., T.G., and A.A.; formal analysis: M.G.; investigation: T.G. and A.A.; resources: M.G., T.G., and A.A.; data curation: T.G.; writing—original draft preparation: M.G.; writing—review and editing: A.A.; visualization: T.G.; supervision: M.G.; project administration: A.A. All authors have read and agreed to the published version of the manuscript. Acknowledgments The authors thank Dr. Kilian Lilienfein (Orthopädische Praxis, Rottweil, Germany), Dr. R. Kim Etheredge (Etheredge Chiropractic, The Villages, Florida, USA), and Ori Kanner (Nervomatrix, Israel) for their contributions in providing data for this study. References Feldman DE, Nahin RL. Disability among persons with chronic severe back pain: results from a nationally representative population-based sample. J Pain. 2022;23(12):2144-54. https://doi.org/10.1016/j.jpain.2022.07.016. Ferguson SA, Merryweather A, Thiese MS, Hegmann KT, Lu ML, Kapellusch JM, et al. Prevalence of low back pain, seeking medical care, and lost time due to low back pain among manual material handling workers in the United States. BMC Musculoskelet Disord. 2019;20:243. https://doi.org/10.1186/s12891-019-2594-0. Fernández-de-las-Peñas C, Dommerholt J. Myofascial trigger points: peripheral or central phenomenon? Curr Rheumatol Rep. 2014;16(1):395. https://doi.org/10.1007/s11926-013-0395-y. Farley T, Stokke J, Goyal K, DeMicco R. Chronic low back pain: history, symptoms, pain mechanisms, and treatment. Life (Basel). 2024;14(7):812. https://doi.org/10.3390/life14070812. Li W, Gong Y, Liu J, Guo Y, Tang H, Qin S, et al. Peripheral and central pathological mechanisms of chronic low back pain: a narrative review. J Pain Res. 2021;14:1483-94. https://doi.org/10.2147/JPR.S306280. Mosabbir A. Mechanisms behind the development of chronic low back pain and its neurodegenerative features. Life. 2023;13:84. https://doi.org/10.3390/life13010084. Tough EA, White AR, Richards SH, Campbell JL. Variability of criteria used to diagnose myofascial trigger point pain syndrome—evidence from a review of the literature. Clin J Pain. 2007;23(3):278-86. https://doi.org/10.1097/AJP.0b013e31802fda7c. Shah JP, Thaker N, Heimur J, Aredo JV, Sikdar S, Gerber L. Myofascial trigger points then and now: a historical and scientific perspective. PM R. 2015;7(7):746-61. https://doi.org/10.1016/j.pmrj.2015.01.024. Lucas N, Macaskill P, Irwig L, Moran R, Bogduk N. Reliability of physical examination for diagnosis of myofascial trigger points: a systematic review of the literature. Clin J Pain. 2009;25(1):80-9. https://doi.org/10.1097/AJP.0b013e31817e13b6. Shultz SP, Driban JB, Swanik CB. The evaluation of electrodermal properties in the identification of myofascial trigger points. Arch Phys Med Rehabil. 2007;88(6):780-4. https://doi.org/10.1016/j.apmr.2007.03.012. Gorenberg M, Schiff E, Schwartz K, Eizenberg E. A novel image-guided, automatic, high-intensity neurostimulation device for the treatment of nonspecific low back pain. Pain Res Treat. 2011;2011:152307. https://doi.org/10.1155/2011/152307. Gorenberg M, Schwartz K. Imaging-guided hyperstimulation analgesia in low back pain. J Pain Res. 2013;6:487-91. https://doi.org/10.2147/JPR.S47540. Gorenberg M, Kanner O. Soleve image-guided targeted hyperstimulation analgesia show promising clinical results in chronic low back pain. Pain Physician. 2017;20(2):E342. Gorenberg M, Kanner O. Image guided targeted hyperstimulation analgesia is superior to placebo in chronic low back pain. Pain Physician. 2017;20(2):E338-E341. Alghadir AH, Anwer S, Iqbal A, Iqbal ZA. Test-retest reliability, validity, and minimum detectable change of visual analog, numerical rating, and verbal rating scales for measurement of osteoarthritic knee pain. J Pain Res. 2018;11:851-6. https://doi.org/10.2147/JPR.S158847. Bird SB, Dickson EW. Clinically significant changes in pain along the visual analog scale. Ann Emerg Med. 2001;38(6):639-43. https://doi.org/10.1067/mem.2001.118012. Olsen MF, Bjerre E, Hansen MD, Hilden J, Landler NE, Tendal B, et al. Pain relief that matters to patients: systematic review of empirical studies assessing the minimum clinically important difference in acute pain. BMC Med. 2017;15(1):35. https://doi.org/10.1186/s12916-016-0775-3. Fricton JR, Kroening R, Haley D, Siegert R. Myofascial pain syndrome of the head and neck: a review of clinical characteristics of 164 patients. Oral Surg Oral Med Oral Pathol. 1985;60:615-23. https://doi.org/10.1016/0030-4220(85)90364-0. Han SC, Harrison P. Myofascial pain syndrome and trigger-point management. Reg Anesth. 1997;22(1):89-101. https://doi.org/10.1016/s1098-7339(06)80062-3. Ramsook RR, Malanga GA. Myofascial low back pain. Curr Pain Headache Rep. 2012;16:423-32. https://doi.org/10.1007/s11916-012-0290-y. Quintner JL, Bove GM, Cohen ML. A critical evaluation of the trigger point phenomenon. Rheumatology (Oxford). 2015;54:392-9. https://doi.org/10.1093/rheumatology/keu471. Simons DG. New views of myofascial trigger points: etiology and diagnosis. Arch Phys Med Rehabil. 2008;89(1):157-9. https://doi.org/10.1016/j.apmr.2007.11.016. Simons DG, Travell JG, Simons LS. Travell and Simons' myofascial pain and dysfunction: the trigger point manual, volume 1. 2nd ed. Baltimore: Williams & Wilkins; 1999. Jafri MS. Mechanisms of myofascial pain. Int Sch Res Notices. 2014;2014:523924. https://doi.org/10.1155/2014/523924. Simons DG. Diagnostic criteria of myofascial pain due to trigger points. J Musculoskelet Pain. 1999;7(1-2):111-2. https://doi.org/10.1300/J094v07n01_11. Dommerholt J, Bron C, Franssen J. Myofascial trigger points: an evidence-informed review. J Man Manip Ther. 2006;14(4):203-21. https://doi.org/10.1179/106698106790819991. Kramer S, Winterhalter K, Schober G, Becker U, Wiegele B, Kutz DF, et al. Characteristics of electrical skin resistance at acupuncture points in healthy humans. J Altern Complement Med. 2009;15(5):495-500. Hong CZ. Treatment of myofascial pain syndrome. Curr Pain Headache Rep. 2006;10(5):345-9. https://doi.org/10.1007/s11916-006-0058-3. Alvarez DJ, Rockwell PG. Trigger points: diagnosis and management. Am Fam Physician. 2002;65:653-60. Scott NA, Guo B, Barton PM, Gerwin RD. Trigger point injections for chronic non-malignant musculoskeletal pain: a systematic review. Pain Med. 2009;10(1):54-69. https://doi.org/10.1111/j.1526-4637.2008.00526.x. Ay S, Evcik D, Tur BS. Comparison of injection methods in myofascial pain syndrome: a randomized controlled trial. Clin Rheumatol. 2010;29:19-23. https://doi.org/10.1007/s10067-009-1307-8. Brady S, McEvoy J, Dommerholt J, Doody C. Adverse events following trigger point dry needling: a prospective survey of chartered physiotherapists. J Man Manip Ther. 2014;22(3):134-40. https://doi.org/10.1179/2042618613Y.0000000044. Cheng R, Pomeranz B. Electrotherapy of chronic musculoskeletal pain: comparison of electroacupuncture and acupuncture-like transcutaneous electrical nerve stimulation. Clin J Pain. 1986;2(3):143-50. https://doi.org/10.1097/00002508-198602030-00001. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 02 Jan, 2026 Reviewers agreed at journal 19 Dec, 2025 Reviewers invited by journal 12 Dec, 2025 Editor invited by journal 14 Nov, 2025 Editor assigned by journal 13 Nov, 2025 Submission checks completed at journal 13 Nov, 2025 First submitted to journal 09 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8068098","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":560134417,"identity":"8dd5a0f9-aaeb-44cc-841c-484a898979d2","order_by":0,"name":"Miguel Gorenberg","email":"","orcid":"","institution":"Bnai Zion Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Miguel","middleName":"","lastName":"Gorenberg","suffix":""},{"id":560134418,"identity":"79362318-638e-4823-bff8-81ab2f2a1db5","order_by":1,"name":"Talila Gorenberg","email":"","orcid":"","institution":"Bnai Zion Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Talila","middleName":"","lastName":"Gorenberg","suffix":""},{"id":560134420,"identity":"49a263a5-ac62-4f4f-b0a9-cca725a816d0","order_by":2,"name":"Abed Agbarya","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCklEQVRIiWNgGAWjYDACCTA6AGIyPkioAFLMzA1Ea2E2eHAGRDESr4VN8mEb2Db8WvhnNx+88ePXHXnzGcnPJBLn1UbztwO1/KjYhtuSO8eSLXv7nhnOuZFmbJG47XjujMOMDYw9Z27jtuZGjpkEb89hxhkSCYY3Ercdy20AamFmbMOtRf5G/jfJvz2H7WdIpH+QSJxzLHc+IS0GN3LYpHl+HE6cIZFjJJHYUJO7gZAWwzvHjK1lG54lz+B5U2yQcOxA7kagloP4/CJ3u/nhzTd/7tjOYE/f+PBHTV3uvPOHDz74UYHH+yDACIoOgQQQ8zBY4AB+9SDwB4j5werqCCseBaNgFIyCEQcAiptolFjDhuUAAAAASUVORK5CYII=","orcid":"","institution":"Bnai Zion Medical Center","correspondingAuthor":true,"prefix":"","firstName":"Abed","middleName":"","lastName":"Agbarya","suffix":""}],"badges":[],"createdAt":"2025-11-09 09:23:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8068098/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8068098/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":98453797,"identity":"6ec6a577-05b1-45f4-a088-7dfd5dffd8db","added_by":"auto","created_at":"2025-12-17 18:04:47","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":40717,"visible":true,"origin":"","legend":"","description":"","filename":"BMCMUSCULOSKELETALDISORDERSLOWBACKPAIN.docx","url":"https://assets-eu.researchsquare.com/files/rs-8068098/v1/ec5e445cf3f16acd3454141b.docx"},{"id":98453798,"identity":"388abbfb-2ce9-4cb6-a922-431ffec1b3c7","added_by":"auto","created_at":"2025-12-17 18:04:47","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":5599,"visible":true,"origin":"","legend":"","description":"","filename":"a2d0800651574f69b661f20bc8cb2b53.json","url":"https://assets-eu.researchsquare.com/files/rs-8068098/v1/0c10e8b242ee48507b19cf6a.json"},{"id":98453800,"identity":"6e31364c-8927-44c8-ac05-4f3d4afe3aa3","added_by":"auto","created_at":"2025-12-17 18:04:48","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":49797,"visible":true,"origin":"","legend":"","description":"","filename":"a2d0800651574f69b661f20bc8cb2b531enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8068098/v1/cc904e974e3067973eb6a40c.xml"},{"id":98453802,"identity":"906aa2bd-ddcd-4c8a-ba26-3695b8319770","added_by":"auto","created_at":"2025-12-17 18:04:48","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":48872,"visible":true,"origin":"","legend":"","description":"","filename":"a2d0800651574f69b661f20bc8cb2b531structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8068098/v1/149d0b0764bf55eaeea6b60c.xml"},{"id":98453799,"identity":"3d6c15a8-e042-4337-b614-fc96692a707f","added_by":"auto","created_at":"2025-12-17 18:04:48","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":56792,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8068098/v1/b83b30b7cf719aeba5872d98.html"},{"id":98623529,"identity":"1c1543f1-df1b-445b-b23b-66ed7fc48441","added_by":"auto","created_at":"2025-12-19 17:06:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":624089,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8068098/v1/7cbafc77-7fab-4704-8517-8cb1b01ff87e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Treatment of chronic low back pain by electric hyperstimulation analgesia of myofascial trigger points: a retrospective multicenter study","fulltext":[{"header":"Background","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eChronic low back pain (CLBP) is a leading cause of disability in U.S. adults and a major contributor to lost workdays [1,2]. While its etiology is often multifactorial, a subset of patients presents with myofascial pain syndrome, chracterized Myofascial Trigger Points (MTrPs)\u0026mdash;hyperirritable nodules located within taut bands of skeletal muscle. These trigger points can generate referred pain, limit range of motion, and cause local tenderness [3]. Other causes of CLBP include discogenic pain, facet joint arthropathy, and central sensitization syndromes [4\u0026ndash;6].\u003c/p\u003e \u003cp\u003eThe diagnosis of MTrPs relies primarily on clinical palpation, although its reliability has been questioned [7,8]. A 2009 systematic review by Lucas et al. [9] highlighted inconsistencies in physical examination findings, indicating the need for more objective diagnostic tools. Changes in electrodermal conductance at MTrP sites have been documented, where active trigger points often show decreased skin impedance due to localized autonomic and inflammatory changes [10].\u003c/p\u003e \u003cp\u003eElectric Hyperstimulation Analgesia (EHA) delivers focused, low-frequency electrical stimulation to peripheral nerve endings at MTrP locations, aiming to interrupt pain pathways. However, its use has been limited by the complexity of accurately identifying MTrPs. To address this challenge, the Soleve\u0026trade; system (Nervomatrix Ltd., Israel) was developed as a robotic device equipped with 26 miniature impedance-sensing probes that scan the lower back to generate a topographic map of skin resistance. Prior validation studies [11\u0026ndash;14] have shown promising outcomes using this technology for treating nonspecific CLBP.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe objective of this retrospective study was to investigate the effectiveness and safety of this automated neurostimulation system in the management of CLBP.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and participants\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThis retrospective multicenter study analyzed data from patients with CLBP who underwent Soleve\u0026trade; treatment at two outpatient centers: Etheredge Chiropractic (The Villages, Florida, USA) and Orthop\u0026auml;dische Praxis, (Rottweil, Germany) between January 2014 and September 2015.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eInclusion criteria were: age\u0026thinsp;\u0026ge;\u0026thinsp;18 years, baseline pain score\u0026thinsp;\u0026ge;\u0026thinsp;4 cm on the visual analogue scale (VAS), and presence of trigger points in the lumbar region. Exclusion criteria included: cardiac pacemaker, implanted cardiac defibrillator or other metallic/electronic devices, pregnancy, or postpartum status within one year.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\u003cp\u003e The study was approved by the Bnai Zion Medical Center ethics committee (protocol number 0056-16-BNZ) in accordance with the Declaration of Helsinki. Patient consent for medical record review was waived by the ethics committee due to the retrospective, anonymized nature of the data collection.\u003c/p\u003e\n\u003ch3\u003eIntervention protocol\u003c/h3\u003e\n\u003cp\u003eThe intervention consisted of six treatment sessions scheduled 2\u0026ndash;4 days apart. Each session began with patients positioned supine on the treatment table with the lower back exposed and hygienically prepared. The Soleve\u0026trade; device's 26 probes were positioned over the posterior superior iliac spine.\u003c/p\u003e \u003cp\u003eEach session included a 4.5-minute automated back impedance screening to identify MTrPs and select the 10 locations with lowest impedance levels. Each selected MTrP was consecutively treated for 2 minutes according to proprietary algorithms, resulting in a total treatment time of 20 minutes per session.\u003c/p\u003e\n\u003ch3\u003eTechnical specifications\u003c/h3\u003e\n\u003cp\u003eThe Soleve\u0026trade; device (Nervomatrix Ltd., Israel) used 26 miniature probes (0.4 cm diameter) to perform automated screening over a 20 \u0026times; 30 cm area of the lower back across 15 levels. The system measured impedance at each point and identified the 10 MTrPs with the lowest resistance using data analysis software and image processing algorithms.\u003c/p\u003e \u003cp\u003eThe electrotherapy parameters included:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eAsymmetrical two-phase rectangular waveform\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eMaximum voltage output: 320V (\u0026plusmn;\u0026thinsp;5%) positive phase, 24V negative phase\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eOutput current: 16mA (\u0026plusmn;\u0026thinsp;5%) at 500Ω positive phase, maximum 0.125mA negative phase\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePulse width: 300 microseconds\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eFrequency: 8 Hz\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eMaximum phase charge: 9.6 \u0026micro;C\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStimulus amplitude range: 0.4-16mA\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe stimulus amplitude was individually determined through a tolerability test, with gradual increases until patients reported a strong but tolerable sensation.\u003c/p\u003e\n\u003ch3\u003eOutcome measures\u003c/h3\u003e\n\u003cp\u003eThe primary outcome was change in pain intensity measured using a 10 cm VAS, where 0 represents no pain and 10 represents worst pain imaginable [15]. VAS scores were recorded at baseline (before first treatment) and before each subsequent treatment session.\u003c/p\u003e \u003cp\u003eSecondary outcomes included VAS class reduction (mild: 0\u0026ndash;3, moderate: 4\u0026ndash;6, severe: 7\u0026ndash;10) and the proportion of patients achieving clinically meaningful improvement (\u0026ge;\u0026thinsp;3 cm reduction).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using SPSS version 20 (IBM, NY, USA). The primary efficacy variable (Delta_VAS) was calculated by subtracting the final VAS score from the baseline VAS score. Patients were stratified by baseline VAS scores into moderate (4\u0026ndash;6 cm) and severe (7\u0026ndash;10 cm) groups.\u003c/p\u003e \u003cp\u003eStatistical comparisons used paired \u003cem\u003et\u003c/em\u003e-tests for continuous variables and chi-square tests for categorical variables. Pearson correlation analysis examined relationships between VAS improvement and patient characteristics. Repeated measures ANOVA analyzed VAS changes over time. Statistical significance was set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003ePatient characteristics\u003c/h2\u003e \u003cp\u003eA total of 168 patients completed the study (103 females [61.3%], 65 males [38.7%]) with a mean age of 64.85\u0026thinsp;\u0026plusmn;\u0026thinsp;14.92 years (range 20\u0026ndash;90) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Patients received an average of 5.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.45 treatments (range 2\u0026ndash;17). The mean baseline VAS score was 6.51\u0026thinsp;\u0026plusmn;\u0026thinsp;1.27 cm, with 81 patients (48%) in the moderate pain category and 87 patients (52%) in the severe pain category.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePrimary outcomes\u003c/h2\u003e \u003cp\u003eTreatment resulted in a significant reduction in VAS scores compared to baseline (mean reduction 2.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.08 cm, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This reduction exceeded the established minimal clinically important difference (MCID) of 1.8\u0026ndash;1.9 cm for CLBP.\u003c/p\u003e \u003cp\u003ePatients with severe baseline pain showed greater improvement (2.47\u0026thinsp;\u0026plusmn;\u0026thinsp;2.19 cm) compared to those with moderate baseline pain (1.49\u0026thinsp;\u0026plusmn;\u0026thinsp;1.82 cm) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.005). Gender analysis revealed significant differences in improvement, with males showing slightly greater pain reduction (2.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.27 cm) compared to females (1.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19 cm) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSecondary outcomes\u003c/h2\u003e \u003cp\u003eForty percent of patients (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;68) achieved VAS improvement of \u0026ge;\u0026thinsp;3 cm (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Among patients with moderate baseline pain, 48% (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;39) demonstrated one VAS class reduction. In the severe pain group, 68% (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;59) showed one class reduction, while 22% (n\u0026thinsp;=\u0026thinsp;19) achieved two-class reduction to mild pain levels.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient characteristics and treatment outcomes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eValue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDemographics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal patients, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e168 (100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e103 (61.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 (38.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, years (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64.85\u0026thinsp;\u0026plusmn;\u0026thinsp;14.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of treatments (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePain scores\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline VAS, cm (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.51\u0026thinsp;\u0026plusmn;\u0026thinsp;1.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS improvement, cm (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.00\u0026thinsp;\u0026plusmn;\u0026thinsp;2.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate baseline pain (4\u0026ndash;6 cm), \u003cem\u003en\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- VAS improvement, cm (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.49\u0026thinsp;\u0026plusmn;\u0026thinsp;1.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere baseline pain (7\u0026ndash;10 cm), \u003cem\u003en\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- VAS improvement, cm (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.47\u0026thinsp;\u0026plusmn;\u0026thinsp;2.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of VAS improvement.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS improvement (cm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatients, \u003cem\u003en\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePercent of total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eRepeated measures ANOVA demonstrated a statistically significant time effect for VAS scores across all treatment sessions (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). No significant correlations were found between VAS improvement and age (r = -0.028, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.772) or number of treatments (r\u0026thinsp;=\u0026thinsp;0.042, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.586).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eSafety outcomes\u003c/h2\u003e \u003cp\u003eNo side effects or adverse events were reported during the study period.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis retrospective multicenter study demonstrates that automated neurostimulation targeting MTrPs using the Soleve\u0026trade; system resulted in clinically meaningful pain reduction in patients with CLBP. The mean VAS reduction of 2.0 cm exceeded established MCID thresholds [16,17], supporting the clinical relevance of these findings.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eMechanism and rationale\u003c/h2\u003e \u003cp\u003eMTrPs are increasingly recognized as a common source of musculoskeletal pain in CLBP patients [18\u0026ndash;20]. The underlying pathophysiology remains incompletely understood [21], but Simons' integrated hypothesis suggests that decreased adenosine triphosphate levels caused by reduced blood flow render muscle fibers with insufficient energy to return calcium to the sarcoplasmic reticulum [22\u0026ndash;25]. This results in sustained sarcomere contracture, leading to local hypoxia and release of pain-producing biochemicals. These physiological differences may account for the observed decrease in skin resistance at pathological sites compared to surrounding areas [ 26,27].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eComparison with existing treatments\u003c/h2\u003e \u003cp\u003eTraditional MTrP treatments include manual therapies, pharmacological agents, dry needling, and injection therapy [ 28\u0026ndash;30]. Dry needling and trigger point injections have consistently shown effectiveness in MTrP inactivation [ 31] but carry risks of adverse events. Brady et al. [32] reported minor adverse events in 36.7% of dry needling treatments, including bleeding (16.0%), bruising (7.7%), and treatment-related pain (5.9%).\u003c/p\u003e \u003cp\u003eEHA offers a non-invasive alternative that avoids needling complications while providing targeted therapy. Previous controlled studies have shown positive responses to EHA in 87% of patients [9, 33]. The automated nature of the Soleve\u0026trade; system addresses limitations of manual point-finding devices, which can be time-consuming and subject to operator variability.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eClinical significance\u003c/h2\u003e \u003cp\u003eThe observed pain reduction patterns showed that patients with severe baseline pain achieved greater absolute improvements than those with moderate pain, suggesting that the treatment may be particularly beneficial for patients with higher pain levels. The 40% of patients achieving\u0026thinsp;\u0026ge;\u0026thinsp;3 cm improvement represents a substantial clinical response that exceeds many conventional treatments for CLBP.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eStudy limitations\u003c/h2\u003e \u003cp\u003eSeveral limitations should be acknowledged. The retrospective design limits causal inference and prevents randomization or blinding. The absence of a control group makes it difficult to separate treatment effects from natural history or regression to the mean. Long-term follow-up data were not available to assess durability of treatment effects. Additionally, the study population was predominantly older adults, potentially limiting generalizability to younger patients with CLBP.\u003c/p\u003e \u003cp\u003eThe lack of systematic impedance monitoring post-treatment represents a missed opportunity to document physiological changes at MTrPs. Future studies should incorporate longitudinal impedance assessments to better understand treatment mechanisms.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eFuture directions\u003c/h2\u003e \u003cp\u003eThese preliminary findings support the need for randomized controlled trials to establish efficacy compared to standard care or placebo treatments. Future studies should include longer follow-up periods, standardized outcome measures, and direct comparison with established treatments such as physical therapy or pharmacotherapy.\u003c/p\u003e \u003cp\u003eInvestigation of optimal treatment protocols, including session frequency and duration, would help refine clinical applications. Additionally, studies examining cost-effectiveness and patient-reported outcomes beyond pain intensity would provide valuable insights for clinical decision-making.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis retrospective multicenter analysis demonstrates that automated neurostimulation targeting MTrPs using the Soleve\u0026trade; system resulted in clinically meaningful pain reduction in patients with CLBP. The treatment appeared safe with no reported adverse events. These findings support further investigation through randomized controlled trials to establish the efficacy of this novel non-pharmacological approach for CLBP management.\u003c/p\u003e "},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; CLBP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eChronic low back pain\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; EHA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eElectric hyperstimulation analgesia\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; MCID\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMinimal clinically important difference\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; MTrP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMyofascial trigger point\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; SD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandard deviation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; VAS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eVisual analogue scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Bnai Zion Medical Center (protocol code 0056-16-BNZ). Patient consent was waived due to the retrospective, anonymized nature of the data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eM.G. was a co-founder of Nervomatrix Ltd. Other authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: M.G. and A.A.; methodology: T.G.; software: M.G.; validation: M.G., T.G., and A.A.; formal analysis: M.G.; investigation: T.G. and A.A.; resources: M.G., T.G., and A.A.; data curation: T.G.; writing\u0026mdash;original draft preparation: M.G.; writing\u0026mdash;review and editing: A.A.; visualization: T.G.; supervision: M.G.; project administration: A.A. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank Dr. Kilian Lilienfein (Orthop\u0026auml;dische Praxis, Rottweil, Germany), Dr. R. Kim Etheredge (Etheredge Chiropractic, The Villages, Florida, USA), and Ori Kanner (Nervomatrix, Israel) for their contributions in providing data for this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eFeldman DE, Nahin RL. Disability among persons with chronic severe back pain: results from a nationally representative population-based sample. J Pain. 2022;23(12):2144-54. https://doi.org/10.1016/j.jpain.2022.07.016.\u003c/li\u003e\n\u003cli\u003eFerguson SA, Merryweather A, Thiese MS, Hegmann KT, Lu ML, Kapellusch JM, et al. Prevalence of low back pain, seeking medical care, and lost time due to low back pain among manual material handling workers in the United States. BMC Musculoskelet Disord. 2019;20:243. https://doi.org/10.1186/s12891-019-2594-0.\u003c/li\u003e\n\u003cli\u003eFern\u0026aacute;ndez-de-las-Pe\u0026ntilde;as C, Dommerholt J. Myofascial trigger points: peripheral or central phenomenon? Curr Rheumatol Rep. 2014;16(1):395. https://doi.org/10.1007/s11926-013-0395-y.\u003c/li\u003e\n\u003cli\u003eFarley T, Stokke J, Goyal K, DeMicco R. Chronic low back pain: history, symptoms, pain mechanisms, and treatment. Life (Basel). 2024;14(7):812. https://doi.org/10.3390/life14070812.\u003c/li\u003e\n\u003cli\u003eLi W, Gong Y, Liu J, Guo Y, Tang H, Qin S, et al. Peripheral and central pathological mechanisms of chronic low back pain: a narrative review. J Pain Res. 2021;14:1483-94. https://doi.org/10.2147/JPR.S306280.\u003c/li\u003e\n\u003cli\u003eMosabbir A. Mechanisms behind the development of chronic low back pain and its neurodegenerative features. Life. 2023;13:84. https://doi.org/10.3390/life13010084.\u003c/li\u003e\n\u003cli\u003eTough EA, White AR, Richards SH, Campbell JL. Variability of criteria used to diagnose myofascial trigger point pain syndrome\u0026mdash;evidence from a review of the literature. Clin J Pain. 2007;23(3):278-86. https://doi.org/10.1097/AJP.0b013e31802fda7c.\u003c/li\u003e\n\u003cli\u003eShah JP, Thaker N, Heimur J, Aredo JV, Sikdar S, Gerber L. Myofascial trigger points then and now: a historical and scientific perspective. PM R. 2015;7(7):746-61. https://doi.org/10.1016/j.pmrj.2015.01.024.\u003c/li\u003e\n\u003cli\u003eLucas N, Macaskill P, Irwig L, Moran R, Bogduk N. Reliability of physical examination for diagnosis of myofascial trigger points: a systematic review of the literature. Clin J Pain. 2009;25(1):80-9. https://doi.org/10.1097/AJP.0b013e31817e13b6.\u003c/li\u003e\n\u003cli\u003eShultz SP, Driban JB, Swanik CB. The evaluation of electrodermal properties in the identification of myofascial trigger points. Arch Phys Med Rehabil. 2007;88(6):780-4. https://doi.org/10.1016/j.apmr.2007.03.012.\u003c/li\u003e\n\u003cli\u003eGorenberg M, Schiff E, Schwartz K, Eizenberg E. A novel image-guided, automatic, high-intensity neurostimulation device for the treatment of nonspecific low back pain. Pain Res Treat. 2011;2011:152307. https://doi.org/10.1155/2011/152307.\u003c/li\u003e\n\u003cli\u003eGorenberg M, Schwartz K. Imaging-guided hyperstimulation analgesia in low back pain. J Pain Res. 2013;6:487-91. https://doi.org/10.2147/JPR.S47540.\u003c/li\u003e\n\u003cli\u003eGorenberg M, Kanner O. Soleve image-guided targeted hyperstimulation analgesia show promising clinical results in chronic low back pain. Pain Physician. 2017;20(2):E342.\u003c/li\u003e\n\u003cli\u003eGorenberg M, Kanner O. Image guided targeted hyperstimulation analgesia is superior to placebo in chronic low back pain. Pain Physician. 2017;20(2):E338-E341.\u003c/li\u003e\n\u003cli\u003eAlghadir AH, Anwer S, Iqbal A, Iqbal ZA. Test-retest reliability, validity, and minimum detectable change of visual analog, numerical rating, and verbal rating scales for measurement of osteoarthritic knee pain. J Pain Res. 2018;11:851-6. https://doi.org/10.2147/JPR.S158847.\u003c/li\u003e\n\u003cli\u003eBird SB, Dickson EW. Clinically significant changes in pain along the visual analog scale. Ann Emerg Med. 2001;38(6):639-43. https://doi.org/10.1067/mem.2001.118012.\u003c/li\u003e\n\u003cli\u003eOlsen MF, Bjerre E, Hansen MD, Hilden J, Landler NE, Tendal B, et al. Pain relief that matters to patients: systematic review of empirical studies assessing the minimum clinically important difference in acute pain. BMC Med. 2017;15(1):35. https://doi.org/10.1186/s12916-016-0775-3.\u003c/li\u003e\n\u003cli\u003eFricton JR, Kroening R, Haley D, Siegert R. Myofascial pain syndrome of the head and neck: a review of clinical characteristics of 164 patients. Oral Surg Oral Med Oral Pathol. 1985;60:615-23. https://doi.org/10.1016/0030-4220(85)90364-0.\u003c/li\u003e\n\u003cli\u003eHan SC, Harrison P. Myofascial pain syndrome and trigger-point management. Reg Anesth. 1997;22(1):89-101. https://doi.org/10.1016/s1098-7339(06)80062-3.\u003c/li\u003e\n\u003cli\u003eRamsook RR, Malanga GA. Myofascial low back pain. Curr Pain Headache Rep. 2012;16:423-32. https://doi.org/10.1007/s11916-012-0290-y.\u003c/li\u003e\n\u003cli\u003eQuintner JL, Bove GM, Cohen ML. A critical evaluation of the trigger point phenomenon. Rheumatology (Oxford). 2015;54:392-9. https://doi.org/10.1093/rheumatology/keu471.\u003c/li\u003e\n\u003cli\u003eSimons DG. New views of myofascial trigger points: etiology and diagnosis. Arch Phys Med Rehabil. 2008;89(1):157-9. https://doi.org/10.1016/j.apmr.2007.11.016.\u003c/li\u003e\n\u003cli\u003eSimons DG, Travell JG, Simons LS. Travell and Simons\u0026apos; myofascial pain and dysfunction: the trigger point manual, volume 1. 2nd ed. Baltimore: Williams \u0026amp; Wilkins; 1999.\u003c/li\u003e\n\u003cli\u003eJafri MS. Mechanisms of myofascial pain. Int Sch Res Notices. 2014;2014:523924. https://doi.org/10.1155/2014/523924.\u003c/li\u003e\n\u003cli\u003eSimons DG. Diagnostic criteria of myofascial pain due to trigger points. J Musculoskelet Pain. 1999;7(1-2):111-2. https://doi.org/10.1300/J094v07n01_11.\u003c/li\u003e\n\u003cli\u003eDommerholt J, Bron C, Franssen J. Myofascial trigger points: an evidence-informed review. J Man Manip Ther. 2006;14(4):203-21. https://doi.org/10.1179/106698106790819991.\u003c/li\u003e\n\u003cli\u003eKramer S, Winterhalter K, Schober G, Becker U, Wiegele B, Kutz DF, et al. Characteristics of electrical skin resistance at acupuncture points in healthy humans. J Altern Complement Med. 2009;15(5):495-500. \u003c/li\u003e\n\u003cli\u003eHong CZ. Treatment of myofascial pain syndrome. Curr Pain Headache Rep. 2006;10(5):345-9. https://doi.org/10.1007/s11916-006-0058-3.\u003c/li\u003e\n\u003cli\u003eAlvarez DJ, Rockwell PG. Trigger points: diagnosis and management. Am Fam Physician. 2002;65:653-60.\u003c/li\u003e\n\u003cli\u003eScott NA, Guo B, Barton PM, Gerwin RD. Trigger point injections for chronic non-malignant musculoskeletal pain: a systematic review. Pain Med. 2009;10(1):54-69. https://doi.org/10.1111/j.1526-4637.2008.00526.x.\u003c/li\u003e\n\u003cli\u003eAy S, Evcik D, Tur BS. Comparison of injection methods in myofascial pain syndrome: a randomized controlled trial. Clin Rheumatol. 2010;29:19-23. https://doi.org/10.1007/s10067-009-1307-8.\u003c/li\u003e\n\u003cli\u003eBrady S, McEvoy J, Dommerholt J, Doody C. Adverse events following trigger point dry needling: a prospective survey of chartered physiotherapists. J Man Manip Ther. 2014;22(3):134-40. https://doi.org/10.1179/2042618613Y.0000000044.\u003c/li\u003e\n\u003cli\u003eCheng R, Pomeranz B. Electrotherapy of chronic musculoskeletal pain: comparison of electroacupuncture and acupuncture-like transcutaneous electrical nerve stimulation. Clin J Pain. 1986;2(3):143-50. https://doi.org/10.1097/00002508-198602030-00001.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Chronic Low Back Pain, Analgesia, Hyperstimulation, Myofascial Trigger Point, Neurostimulation","lastPublishedDoi":"10.21203/rs.3.rs-8068098/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8068098/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eMyofascial trigger points (MTrPs) are associated with chronic nonspecific low back pain (CLBP) in patients presenting musculoskeletal pain. This study evaluated an innovative automated robotic system (Soleve\u0026trade;) that scans patients\u0026rsquo; backs to detect MTrPs, by analyzing skin impedance, followed by Electric Hyperstimulation Analgesia (EHA) therapy. The hypothesis is that EHA provides an analgesic effect by altering the biochemical environment of MTrPs, resulting in autonomic reactions that lead to variations in skin resistance.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis retrospective multicenter study included 168 consecutive CLBP outpatients (103 females, 65 males; mean age 64.85\u0026thinsp;\u003cem\u003e\u0026plusmn;\u003c/em\u003e\u0026thinsp;14.92 years) treated at two centers in the United States and Germany between January 2014 and September 2015. Patients underwent six Soleve\u0026trade; treatment sessions at 2\u0026ndash;4 day intervals. Each session included 20 minutes of treatment targeting the 10 points with lowest impedance. Inclusion criteria were age\u0026thinsp;\u0026ge;\u0026thinsp;18 years and baseline pain score\u0026thinsp;\u0026ge;\u0026thinsp;4 cm on the visual analogue scale (VAS). The primary outcome was change in pain intensity measured on a 10 cm pain VAS.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe mean\u0026thinsp;\u003cem\u003e\u0026plusmn;\u003c/em\u003e\u0026thinsp;SD baseline VAS score was 6.51\u0026thinsp;\u003cem\u003e\u0026plusmn;\u003c/em\u003e\u0026thinsp;1.27 cm. Treatment resulted in a significant decrease in VAS scores compared to baseline by 2.0 cm (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Forty percent of patients achieved VAS improvement of at least 3 cm. Patients with severe initial pain (VAS 7\u0026ndash;10) showed greater improvement (2.47\u0026thinsp;\u0026plusmn;\u0026thinsp;2.19 cm) compared to those with moderate pain (1.49\u0026thinsp;\u0026plusmn;\u0026thinsp;1.82 cm) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.005). No adverse events were reported.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis retrospective analysis provides preliminary evidence that targeted hyperstimulation analgesia using automated MTrP detection is safe and may improve CLBP. The results support further investigation through randomized controlled trials.\u003c/p\u003e","manuscriptTitle":"Treatment of chronic low back pain by electric hyperstimulation analgesia of myofascial trigger points: a retrospective multicenter study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-17 18:04:43","doi":"10.21203/rs.3.rs-8068098/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-01-03T02:14:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"24266714512999232555548120179273353892","date":"2025-12-19T09:59:23+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-12T07:58:44+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-14T07:59:03+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-13T14:33:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-13T14:31:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Musculoskeletal Disorders","date":"2025-11-09T09:16:43+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f55b98a4-a75a-4ebc-915e-b63331030aa5","owner":[],"postedDate":"December 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-17T18:04:43+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-17 18:04:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8068098","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8068098","identity":"rs-8068098","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}