Last March, Mead resident Cindy Roth was in pain a year after an automobile accident—long after her tweaked back muscles should have healed, she says.

A treatment called intramuscular stimulation (IMS), which Roth underwent as an outpatient at St. Luke's Rehabilitation Institute, in Spokane, has freed her from the pain, says the school yearbook sales representative and mother of two.

As the anniversary of the accident approached, Roth's pain was getting worse, blurring her vision, causing migraine headaches, and even leading to "mental fogginess," she says.

Massage therapy and chiropractic treatments provided only short-term relief, she says. Then, her physician referred her to Dr. Steven Goodman, a specialist in physical medicine and rehabilitation at St. Luke's.

Goodman is trained in IMS, a treatment that involves inserting fine, flexible pins into the muscles that he says become shortened following an injury or surgery, or due to certain other abnormalities.

A shortened muscle irritates connected tendons and nerve endings, causing persistent pain in areas that otherwise might appear to be healed, Goodman says. Muscle shortening is a recognized condition, although it isn't understood widely, he says.

"It's a common cause of persistent pain, but it's commonly overlooked," Goodman says.

The IMS technique that Goodman performs was developed more than 20 years ago by Dr. Chan Gunn, a Vancouver, British Columbia-based physician and a professor at the University of Washington Pain Center, in Seattle. Gunn trained Goodman in the technique in 1993.

"It's not new, but it's new here in Spokane," says Goodman, who was hired at St. Luke's last year to lead outpatient development programs there.

IMS is a type of trigger-point therapy, he says, adding that other forms of trigger-point therapy include massage and manipulation techniques that apply pressure to muscles and connective tissue to relieve pain and dysfunction.

In some cases, IMS can help a patient avoid surgery or drug treatments, Goodman says. Unlike trigger-point injections of painkillers or steroids, IMS doesn't inject anything, he adds.

Although pins used in IMS are adapted from traditional acupuncture needles, IMS and acupuncture are rooted in different principles, Goodman says. IMS focuses on localized nerve and muscle dysfunction, while acupuncture deals with the flow of energy through certain meridians, or pathways between parts of the body, he says.

The pins used in IMS elicit a spinal reflex that briefly contracts and then releases a specific part of the muscle, Goodman says.

"It's like a tiny reflex hammer," he says. "Instead of causing the entire muscle to contract, it causes a more localized reflex within the muscle in the area surrounding the pin."

Roth describes the sensation caused by the pin as "a good pain," comparable to a deep massage of a sore muscle.

"It was uncomfortable, but when it fixes it, it's totally worth every little bit of discomfort," she says.

Following the first treatment, the fog disappeared from her vision and mind, and most of the pain was gone, she says.

"When I stood up, I didn't even know if I needed to come back," she says.

The next treatment brought further pain relief.

"It was even better," Roth says. "I could look over my shoulder."

Roth's results were ideal, Goodman says. Factors that affect the results of IMS include the length of time a muscle has been shortened, the age of the patient, and any scarring, he says.

A candidate for IMS typically is someone who is in pain three months after suffering an injury, Goodman says. The technique also is effective in treating certain patients who have persistent soft-tissue pain months after surgery.

"Some people may be able to reduce medications and become more active," Roth says of the treatment.

"People diagnosed with rheumatoid arthritis, diabetes-related nerve damage, or fibromyalgia aren't candidates for IMS," Goodman says.

One advantage IMS has over other forms of trigger-point therapy is that it can get deeply into the muscle, he says.

"The pin goes as deep as it needs to deactivate a trigger point," Goodman says. "That can be several inches."

The course of treatment usually involves four to six weekly sessions that each take 15 to 30 minutes, and each session involves 10 to 50 pin insertions, Goodman says.

IMS is augmented with home exercises to help the muscles maintain their normal state when they're relaxed, he says.

"If muscle shortening isn't severe, and the patient is healthy, IMS can provide relief from persistent pain that lasts many years," Goodman says.

Roth says she hasn't had a migraine since her treatments, and she has more energy since the treatments.

"I just feel good," she says.