Customer Reviews

Gunn Approach to the Treatment of Chronic Pain: Intramuscular Stimulation for Myofascial Pain of Radiculopathic Origin

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Dr. Gunn has written a practical manual describing his personal approach in the treatment of patients with chronic myofascial pain. His conception of Intramuscular Stimulation and mechanism of pain relief is based on neurophysiologic concepts with the technique and implements borrowed from traditional acupuncture. Dr. Gunn concludes that myofascial pain syndromes can occur in any part of the body. "But since pain and neuropathic manifestations in all of these conditions respond to the same type of treatment regardless of the location of the pain, the underlying mechanism is the same, wherever the syndrome may be present. Thus, there may be hundreds of conditions but only one cause - radiculopathy." The causes of neuropathy may be numerous. The goal of treatment is to release muscle shortening.

The text is very well organized. The introduction explains what intramuscular stimulation is and how it was developed. The pathophysiology explaining the radiculopathic etiology of chronic myofascial pain is clearly described, together with the intramuscular stimulation needle technique. The technique of dry needling is described which in many ways resembles the traditional trigger point injection approach. A chapter on guidlines for diagnoses and general examination of the patient together with individual chapters dealing with specific regional examination and treatment are written very clearly. Excellent diagrams enable the practitioner to identify bony landmarks and muscle attachments. The cervical spine, upper limbs, back and lower limbs are covered in the regional examination and treatment section. Dr. Gunn is extremely enthusiastic concerning the number of muscular skeletal conditions that he describes can occur when when muscles are shortened. He includes a list which would encompass most of the muscular skeletal pain that a physician would encounter in daily practice. Many previous papers written by Dr. Gunn are noted in the Appendix Abstracts. They include his approach in treating low back pain, shoulder pain, and tennis elbow. Dr. Gunn's emphasis on the neuropathic etiology of myofascial pain and tenderness at motor points is a very valuable contribution.

The etiology and mechanisms of chronic myofascial pain is a multifacitorial one.

Although Dr. Gunn's text does not deal with a multidisciplinary approach emphasising the importance of follow-up physical therapy, exercise programs and the importance of precipitating factors, it is a well focused text and succeeds in it's purpose.

Edward S. Rachin, MD, FACS Assistant Clincial Professor of Orthopedic Surgery UMDNJ-Robert Wood Johnson School of Medicine New Brunswick, NJ

Assistant Clinical Professor of Anesthesiology Pain Management Center UMDJ-New Jersey School of Medicine Newark, NJ

Visiting Assistant Professor of Rehabilitation Medicine Albert Einstein College of Medicine of Yeshiva University New York, NY

This is the best book for all practitioners who treat myofascial pain syndromes. Dr. Gunn clearly explains the origin of chronic pain based upon "denervation supersensibility", a physiological phenomena based upon Canon and Rosenblueth Law of Denervation. When a nerve has a disfunction or damage (i.e. neuropathy), its organs and tissues that innervates become hipersensitive:

- The sensitive fibers become hipersensitive, generating pain, hiperalgesia, disestesia and allodynia (which explains the symptoms of neuropathic pain).
- The autonomic fibers become hipersensitive, generating goose bumps, peripheric vasoconstriction, trophic changes, and less electrical skin resistance (that is how the "acupuncture point finders" work), etc. (it also explains some visceral symptoms due to somatic injuries).
- The motor fibers become hipersensitive, generation taut bands and contraction knots, characteristics of myofascial pain described by Travell and Simons.

I definitely recommend this book. Dr. Gunn has been awarded for his contribution in the field of chronic pain several times, and he has written a chapter in "Bonica's management of pain" (the "byble of pain") For all Physiatrists (physical medicine and rehabilitations physicians) and Physical therapists, this is a must.

For anyone interested in myofascial dry needling and management of chronic pain, this book is a definite buy. Mr Gunn gets to the heart of the problems with easy to follow protocols.

I have used the treatment plans in my clinic and gained great results. May he long continue to educate us.