By Jennifer Davis

Vibration can help reduce some types of pain, including pain from fibromyalgia, by more than 40 percent, according to a new study published online in the European Journal of Pain.

When high-frequency vibrations from an instrument were applied to painful areas, pain signals may have been prevented from traveling to the central nervous system, explains Roland Staud, MD, professor of rheumatology and clinical immunology in the University of Florida College of Medicine in Gainesville.

Dr. Staud explains that if you think of a pain impulse having to travel through a gate to cause discomfort, the vibrations are closing that gate. “When the gate is open, you feel the pain from the stimulus. It goes to the spinal cord. When you apply vibration you close the gate partially.” You can still feel some pain, but less than you would have felt without the vibrations, he adds.

For this study, participants were split into three groups: 29 had fibromyalgia, 19 had chronic neck and back pain and 28 didn’t have any pain at all. Dr. Staud and his research team applied about five seconds of heat to introduce pain to each participant’s arms and followed that with five seconds of vibrations from an electric instrument that emits high-frequency vibrations that are absorbed by skin and deep tissue.

“A biothesiometer is an electric vibrator with a plastic foot plate that can be brought into contact with the patient’s skin,” Dr. Staud explains. “While the frequency is always set at 100 Hz, the intensity of the vibration can be adjusted.”

Following the use of heat and vibration, researchers led by Dr. Staud asked patients to rate the intensity of their pain on a 0-to-10 scale and found that the experimental pain, as opposed to their chronic pain, was reduced by more than 40 percent with the use of vibration. Dr. Staud says what’s particularly interesting is that the patients in the study with fibromyalgia appeared to have the same mechanisms in their body to block or inhibit pain through the use of vibration as those in the pain-free group.

“Fibromyalgia patients are often said to have insufficient pain mechanisms, which means they can’t regulate their pain as well as regular individuals. This study showed that in comparison to normal controls, they could control their pain as well,” Dr. Staud explains.

Researchers discovered that the vibration provided more pain relief when it was applied to the same arm where the pain stimulus was placed. What they don’t know is how long the pain relieving effects will last. Paul Howard, MD, a rheumatologist and director of Arthritis Health in Scottsdale, Ariz., says that’s an important question. “How long does it last for? Ten minutes or 10 hours?” he asks.

Even though that isn’t yet known, Dr. Howard says this study is still very interesting. “Vibration is another way of minimizing pain, and it sounded like it would be more helpful for regional or local pain rather than widespread pain,” he says.

Dr. Staud says this theory is still very much in the testing stages and the vibrating instrument used in this study isn’t available to the public. “Although we didn’t test it, I think that the size of the foot plate of the biothesiometer is relevant. I wouldn’t suggest that everybody should go out and by any vibrator to use for pain relief. But pending a commercial product this is entirely feasible,” he explains.

Until then, Dr. Staud’s message for patients is that vibration involves touch, and that can provide pain relief.

Dr. Howard agrees that this study reinforces the importance of touch therapy, like massage, and even movement therapy, like gentle exercise, for people with chronic pain.

“When you have pain, you want to stop what you’re doing and protect the area. But for some types of pain that’s not the right thing to do,” Dr. Howard says.

You do need to know what types of pain touch is good for and for which ones it isn’t. Dr. Howard says his general rule of thumb is to baby your joints and bully your muscles.

“In general, if it’s joint-related pain, baby it. If it’s a muscular type of pain, touch would be a good thing,” he explains. “Fibromyalgia patients often shrink away from touch therapy and movement. The foundation of treatment is to use movement and touch and stimulus to help with their pain, but their natural reaction is to withdraw and avoid tactile activity. Don’t be afraid. Don’t avoid it,” Dr. Howard says.

Good forms of touch therapy include massage and the use of temperature – both hot and cold. Good forms of movement therapy include tai chi, yoga and swimming.

(reproduced with kind permission of Arthritis Today)

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• The procedure involves a 30 – 40mm incision over the outer aspect of your elbow.
• This allows access to the affected tendon, which can be fully assessed and treated.
• The incision will be closed with sutures.
• Local anaesthetic is instilled into the elbow to provide pain relief in the immediate post-operative period.

Effects

• It is normal to feel slight discomfort within the elbow immediately after the procedure.
• Power should return over an 8-12 hour period following the procedure.
• You will be given pain relief whilst you are in hospital if you require it and you will also be given pain relief to take home.
• It is advisable to take the pain relief given to you even if the pain you are experiencing is bearable. This will help to keep the overall discomfort under control.

Dressings

• The stitches, if not dissolvable will normally need to be removed 10-14 days after your operation; this can be done by your practice nurse at the GP surgery.
• Your elbow will be covered with a wool dressing and crepe bandage. This dressing will need to remain in place until the surgeon has seen you and the nurse is ready to discharge you. Under the bandage the incision will be covered by a smaller adhesive dressing.
• A support bandage and an arm sling will be given to you before you leave the hospital for you to use when you have removed the wool bandage. The support can normally be removed when you are comfortable without it.
• You will need to keep your dressing/wound dry for three to five days, after this time you may have light showers.
• After 10-14 days you can start bathing as long as your wound is completely healed with no wet/oozy areas.
• Physiotherapy
• Your elbow should remain in a sling for the first three to four days following the surgery.

Patient Information

• Physiotherapy is a vital part of the post-operative recovery. An out-patient referral will be made for you as Physiotherapists do not visit the Day surgery Unit.
• Complications
• Complications from this procedure are very rare.
• Watch for any signs of infection; if you experience any of the following you should seek help:
• The amount of pain in the wound increases after the obvious initial discomfort.
• The amount of redness and/or swelling increases.
• You may notice any unpleasant discharge.
• There will be swelling, this is normal and will generally settle down on its own with elevation and appropriate physiotherapy.
• Returning to Work/ Driving
• Your comfort level should be your guide for returning to work. Most people are able to return to work within one to two weeks, but it does depend on the kind of work you do. The surgeon/nursing staff will be able to tell you how long you will require to stay off work for.
• Patients are normally advised not to drive for one week; driving is only allowed once you feel that you can control the car and that the elbow will allow you to turn the wheel in an emergency.
• Sports Activities
• You will be advised as to when you are allowed to start sporting activities again after your operation. This time can be anything up to 12 weeks after your operation, depending on the complexity of the surgery.

Follow-up Appointment

• The surgeon will usually come out and see you before you go home, and will also arrange to see you again in an out-patient clinic after approximately six to eight weeks. Your follow-up appointment will be sent to you in the post soon after your operation.

Check out the list here

Researchers in Australia tested different treatments on three separate groups of patients with tennis elbow. One group of participants were allocated the ‘wait and see’ approach – they were reassured that the condition would eventually settle down and encouraged to wait. They were also given specific instructions on modifying their daily activities so to avoid aggravating their pain.

A second group were given a local corticosteroid injection and advised to gradually return to normal activities. The final group received eight treatments of physiotherapy of 30 minutes over six weeks and were taught home exercises and self-manipulation. The physiotherapy group also received a resistant exercise band and exercise instruction booklet. Each group’s progress was measured at six weeks, and again after a year.

Initially, corticosteroid injections were the most successful treatment, with 78% of those in the group reporting improvements, followed closely by physiotherapy with a 65% success rate when compared to just 27% in the ‘wait and see’ group.

However, after 52 weeks the injection group rates of improvement were significantly worse than those of the physiotherapy group. The injection group also had the most reported recurrences, with 72% of participants’ condition deteriorating after three or six weeks – which could be due, in part, to a quicker initial recovery leading to greater use and over-taxing of the elbow. The research also found that the superior long-term effects of physiotherapy were replicated by the wait and see approach – at the end of the study participants in both the physiotherapy and wait and see group had either much improved or completely recovered.

The authors say that “the…poor overall performance of corticosteroid injections should be taken under consideration by both the patient and their doctor in management of tennis elbow.” The study findings also support the idea that tennis elbow is, in most cases, a self-limiting condition. They conclude that “patients with tennis elbow can be reassured that, in the majority of cases, they will improve in the long-term when given information and ergonomic advice about their condition.”

The research on vibration therapy has been around since 1983 and we’ve managed to acquire a copy of the original research by Lundeberg who discovered the effect. You can read an except below or if you’ve got a particularly scientific mind, download the entire pdf at the end of the article.

Article Summary:

In the present study 366 patients suffering acute or chronic musculoskeletal pain of different origin were given vibratory stimulation for the pain. Many of the patients had previously had treatments of various kinds without satisfactory relief. The effect of vibratory stimulation was assessed during and after stimulation using a graphic rating scale. Sixty-nine per cent of the patients reported a reduction of pain during vibratory stimulation. The best pain reducing site was found to be either the area of pain, the affected muscle or tendon, the antagonistic muscle or a trigger point outside the painful area. In most patients the best pain reducing effect was obtained when the vibratory stimulation was applied with moderate pressure. To obtain a maximal duration of pain relief the stimulation had to be applied for about 25-45 min.

Article Introduction:

A great number of methods have been used to relieve or diminish the pain arising from muscles, tendons or fascia. In general these methods provide only temporary and partial relief of pain. Many of them involve stimulation of skin receptors by rubbing or massage, application of heat or cold, or the use of transcutaneous electrical nerve stimulation (TENS) [2,5,6,13,27]. Still another technique by which pain relief may be obtained is mechanical vibratory stimulation. Although this method appears to have been widely used, its practical implications have not been
systematically studied except for patients suffering acute or chronic orofacial pain [l&23]. The aim of the,present study was to evaluate the effects of vibratory stimulation in patients suffering musculoskeletal pain using a scheme presented in Table I. Preliminary results have been presented earlier.

Download the whole article

This procedure is generally only considered if other treatments have failed. It is not clear yet how effective this treatment is and more research is needed. You should discuss the possible benefits and risks with your doctor before you have the procedure.
Blood is taken from you and then injected into the area around the damaged tendons at your elbow. It is thought that the blood helps to heal the tendons. A local anaesthetic is often given as a pain relief during the procedure. Several treatment sessions may be needed. You may need to wear a splint after the procedure and will often be offered physiotherapy.
Possible problems with this procedure include pain, bruising, damage to other structures near the tendon (such as nerves or blood vessels) and infection.

What are the possible side-effects and risks?

Most people who take anti-inflammatories have no side-effects, or only minor ones. Read the leaflet that comes with the tablets for a full list of cautions and possible side-effects. One important caution is that, ideally, you should not take anti-inflammatories if you are pregnant. The following highlight some of the more important side-effects to be aware of.

Bleeding into the stomach and gut
Anti-inflammatories sometimes cause the lining of the stomach to bleed. Sometimes a stomach ulcer develops. Sometimes bleeding is severe, and even life-threatening. Elderly people are more prone to this problem, but it can occur in anybody. Therefore, if you are taking an anti-inflammatory and you develop upper abdominal pains, pass blood or black stools, or vomit blood, then stop taking the tablets and see a doctor as soon as possible, or go to a casualty department.

The risk of bleeding into the stomach is increased if you are taking an anti-inflammatory plus warfarin, steroids, or low-dose aspirin (used by many people to help prevent a heart attack or stroke). These combinations of drugs should only be used if absolutely necessary.

Some people need an anti-inflammatory to ease pain, and yet are at increased risk of stomach bleeding. For example, people over 65, or those with a past history of a stomach or duodenal ulcer. In such cases another drug may also be prescribed to protect the lining of the stomach from the effects of the anti-inflammatory. This usually prevents bleeding and ulcers from developing if you take an anti-inflammatory. Another option sometimes considered is to take an anti-inflammatory that some studies suggest may possibly have a lower risk of causing stomach bleeding. These type of anti-inflammatories are called selective cox-2 inhibitors and include celecoxib, etoricoxib, and lumiracoxib. However, you should not take a selective cox-2 inhibitor if you have ischaemic heart disease (angina, heart attack, heart failure, etc) or cerebrovascular disease (stroke).

If you have asthma, high blood pressure, heart failure or kidney failure
In some people with asthma, symptoms such as wheeze or breathlessness are made worse by anti-inflammatories. Seek medical help if your asthma suddenly becomes worse after taking an anti-inflammatory. Also, anti-inflammatories can sometimes make high blood pressure, heart failure, or kidney failure worse. If you have any of these conditions, you may be more closely monitored if you are prescribed an anti-inflammatory.

Some other side-effects that sometimes occur include:
Nausea (feeling sick), diarrhoea, rashes, headache, dizziness, nervousness, depression, drowsiness, insomnia (poor sleep), vertigo (dizziness), and tinnitus (noises in the ear). If one or more of these occur they will usually ease off if you stop taking the tablets. There are also a number of other uncommon side-effects – see the leaflet in the tablet packet for details.

• Massage to relieve stress and tension in the muscles
• Exercise programmes including; neural and extensor muscle stretches, and progressive conditioning exercises to strengthen the area and prevent re-injury.
• Tapping a band around your forearm to take pressure off the extensor tendons.
• Myofascial release of the forearm extensors (especially extensor carpi radialus brevis)
• Cross frictions to the tendon
• Acupuncture
• Electrotherapy

The cost for an individual treatment can range from around £30 to £45  with up to six visits necessary to complete a course of physiotherapy.  This option is generally regarded as one of the most expensive treatments but can benefit the patient in teaching them how to look after their elbow in the months of recovery after treatment.

Recent studies at the Laboratoire de Neurobiologie Humaine, Université de Provence, Marseille, France have shown that TENS is most effective when combined with vibration therapy for treating Tennis Elbow.

Quote “The analgesic effects of transcutaneous electrical nerve stimulation (TENS) and vibratory stimulation (VS), used both separately and simultaneously, were compared in 24 patients suffering from chronic pain. We tested the hypothesis that these combined procedures might improve the pain reducing effects obtained with a single type of stimulation, since they make it possible to recruit a larger number of large diameter afferents and/or to increase the discharge frequencies. Four 35-minute treatment sessions (VS, TENS, VS + TENS, Sham stimulation) were run with each patient. The vibrations (100 Hz) and TENS (100 Hz) were applied to the surface of the painful region. The sham stimulation treatment consisted of positioning the TENS electrodes without actually delivering any current. The short form of the McGill pain questionnaire was used to assess the subjects’ pain levels. The assessments took place immediately after any treatment (0h.), and again 4 hours and 24 hours later. The results showed that dual stimulation not only alleviated pain in more cases than either VS or TENS alone, but also had stronger and more long-lasting analgesic effects. On the other hand, all three types of stimulation used produced stronger analgesic effects than those obtained with the sham stimulation.”

Guieu R, Tardy-Gervet MF, Roll JP.

The research shows that a combination of vibration therapy and TENS combined gives the maximum pain relief to the patient.