JP2017518845A - Method and system for diagnosis of muscle pain - Google Patents

Abstract

Systems and methods are provided for assessing muscle pain in a patient by determining the magnitude of the minimal stimulus that can detect one or more physiological pain signals within the patient's selected muscle. In one aspect, a system for assessing pain in at least one selected muscle of a patient is disclosed herein. The system may comprise at least one stimulus source, at least one sensor, and processing circuitry.

Description

Field The present invention relates to systems and methods for identifying and assessing muscle pain.

Background Current procedures for identifying muscle as the cause of pain are performed by electrical stimulation or palpation of the muscle. Sites identified as probable causes of pain can be injected with various substances or dry needles, and can generally be injected into a specific spot, often referred to as the trigger point (TrP). In many cases, the specific muscle in which TrP is present is not specified. Palpation is often an unreliable means of identifying a painful site, and injection into a painful spot in the muscle identified as the cause of pain by palpation without considering the entire muscle Produces sub-optimal results. Marcus, NJ. Gracely, E .; Keefe, K .; (2010) “A comprehensive protocol for diagnosing and treating muscle-onset pain can reliably reduce or eliminate pain in a chronic pain population. of Muscular Origin May Successfully and Reliably Decrease or Eliminate Pain in a Chronic Pain Population), Pain Medicine, 11 (1). This is incorporated herein by reference in its entirety.

  Current electrical stimulation systems for the diagnosis of myalgia are fixed pulse frequencies and waveforms to generate enough current to cause visible contraction in standard muscles, typically trapezius Requires the clinician to adjust the amperage. In many patients, particularly those with ataxia or obesity, it can be difficult to observe muscle contraction, so an excess amperage exceeding the minimum required for any contraction can be selected. If a significant excess of current is used, the patient may report false positives because any muscle overcontraction can cause discomfort. The possibility of false negatives is equally important, and false negatives can occur when unwanted stimulation of the cutaneous nerve produces a mild sensation, which is caused by muscle contraction that causes pain Concomitant discomfort can be hidden. These issues are largely ignored and / or not addressed by current pain diagnostic systems and methods.

  Therefore, there is a need for more sophisticated methods and systems for diagnosing muscle pain.

Overview In one aspect, a system for assessing pain in at least one selected muscle of a patient is disclosed herein. The system may comprise at least one stimulus source, at least one sensor, and processing circuitry. Each stimulus source may be configured to selectively apply a selected stimulus to at least one selected muscle of the patient according to a plurality of stimulus parameters. The plurality of stimulation parameters may comprise a stimulation magnitude, a stimulation phase, a stimulation waveform, and a stimulation frequency. Each stimulation parameter of the plurality of stimulation parameters may have a selectively adjustable value. The at least one sensor may be configured to detect at least one physiological signal within at least one selected muscle of the patient. The processing circuit may be in operative communication with at least one stimulus source and at least one sensor. The processing circuit may be configured to determine a minimum stimulus magnitude for a selected stimulus of at least one stimulus source. The minimum stimulus magnitude corresponds to the lowest possible magnitude of the selected stimulus in which at least one physiological signal detected by the at least one sensor indicates contraction in at least one selected muscle of the patient Can do. A method of using the disclosed system is also described.

  Additional advantages are set forth in part in the following description or can be learned by practice. Such advantages will be realized and attained by means of the elements and combinations particularly pointed out in the appended claims. It is to be understood that both the above general description and the following detailed description are exemplary and explanatory only as claimed and not limiting.

  The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate examples and, together with the description, serve to explain the principles of the method and system.

FIG. 2 is a schematic diagram illustrating various aspects of an exemplary pain assessment system disclosed herein. FIG. 2 is a schematic diagram illustrating various aspects of an exemplary pain assessment system disclosed herein. FIG. 3 is a circuit diagram illustrating an exemplary waveform generator and controller used in the pain assessment system disclosed herein. FIG. 6 is a circuit diagram illustrating an example modulator circuit for a stimulus generator of the pain assessment system disclosed herein. FIG. 3 is a circuit diagram illustrating an exemplary differential sensing element of the pain assessment system disclosed herein. 1 is a schematic diagram illustrating an exemplary differential sensing element of the pain assessment system disclosed herein. FIG. FIG. 3 is a circuit diagram illustrating an exemplary differential sensing element of the pain assessment system disclosed herein. FIG. 3 illustrates an exemplary color-coded muscle pain state diagram for use with the pain assessment system and method disclosed herein. FIG. 6 is an exemplary evaluation diagram used in the pain evaluation system and method disclosed herein. 2 illustrates various aspects of an exemplary pain assessment system disclosed herein. 2 illustrates various aspects of an exemplary pain assessment system disclosed herein. 2 illustrates various aspects of an exemplary pain assessment system disclosed herein. 2 illustrates various aspects of an exemplary pain assessment system disclosed herein. 2 illustrates various aspects of an exemplary pain assessment system disclosed herein. 2 illustrates various aspects of an exemplary pain assessment system disclosed herein. 2 is a flowchart illustrating various aspects of an exemplary pain assessment method disclosed herein. 1 is a schematic diagram illustrating an exemplary pain assessment system disclosed herein. FIG. 1 is a perspective view of an exemplary freestanding pain assessment device disclosed herein. FIG. FIG. 6 is a block diagram illustrating an exemplary operating environment for performing the disclosed pain detection method. It is a figure which shows a test subject's back muscles and thoracolumbar fascia.

DETAILED DESCRIPTION Before disclosing and describing the method and system, it is to be understood that the method and system are not limited to a particular method, particular component, or particular configuration. It is also to be understood that the terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting.

  As used in this specification and the appended claims, the singular forms “a”, “an”, and “the” include plural referents unless the context clearly dictates otherwise. Ranges can be expressed herein as from “about” one particular value and / or to “about” another particular value. When such a range is expressed, another embodiment includes from the one particular value and / or to the other particular value. Similarly, when values are expressed as approximations, using the antecedent “about,” it will be understood that the particular value constitutes another embodiment. Furthermore, it will be understood that the end point of each of the ranges is important both in relation to the other end point and independent of the other end point.

  “Any” or “arbitrarily” means that an event or situation described later may or may not occur, and the explanation is for when the event or situation occurs and for the event or situation Means that it does not occur.

  Throughout the description and claims, the word “comprise” and variations of the word such as “comprising” and “comprises” include “but are not limited to”. It is not meant to exclude other additions, components, completeness or steps, for example. “Exemplary” means “one example” and is not intended to represent a preferred or ideal embodiment. “Such as” is used in an illustrative rather than a limiting sense.

  Disclosed are components that can be used to perform the disclosed methods and systems. These and other components are disclosed herein, and combinations, subsets, interactions, groups, etc. of these components are disclosed, but each of these various individual and collectives Where specific references to combinations and permutations cannot be explicitly disclosed, it is understood that each is specifically discussed and described herein for all methods and systems. This applies to all aspects of this application including, but not limited to, steps in the disclosed methods. Thus, if there are various additional steps that can be performed, it is understood that each of these additional steps can be performed by any particular embodiment or combination of embodiments of the disclosed method.

  The method and system can be understood more readily by reference to the following detailed description of the preferred embodiments and the examples contained therein, as well as the drawings and their above and following descriptions.

  Disclosed herein are pain assessment systems and methods in various aspects. In an exemplary aspect, with reference to FIGS. 1-19, a system for assessing pain in at least one selected muscle of a patient includes at least one stimulus source, at least one sensor, and processing. A circuit. In an exemplary aspect, the at least one selected muscle may correspond to a site complaining of pain in the patient's upper back, lower back, or thoracolumbar fascia, but the selected muscle is anywhere in the patient's body. It may be located.

  In one aspect, each stimulation source of the at least one stimulation source may be configured to selectively apply the selected stimulation to at least one selected muscle of the patient according to a plurality of stimulation parameters. In this aspect, the plurality of stimulation parameters may comprise at least a stimulation magnitude, a stimulation phase, a stimulation waveform, and a stimulation frequency. It is contemplated that each stimulation parameter of the plurality of stimulation parameters may have a value that is selectively adjustable to produce a selected stimulation. In exemplary aspects, the at least one stimulation source may comprise at least one of a stimulation pad and a stimulator head, such as but not limited to an aluminum stimulator head.

  In another aspect, the at least one sensor can be configured to detect at least one physiological signal within at least one selected muscle of the patient. Optionally, in this aspect, each sensor of the at least one sensor is a small capacitor, an omnidirectional microphone, a microelectromechanical system (MEMS) microphone, a MEMS accelerometer, and, for example, an electrocardiogram (EKG) sensor pad Etc., but not limited thereto, selected from the group consisting of adhesive contact electrical signal sensor pads. Thus, it is contemplated that the at least one sensor may be configured to detect any physiological signal within the at least one selected muscle, the physiological signal being a pressure associated with, for example, an internal organic or inorganic process Examples include, but are not limited to, waves, electrical signals, acoustic signals, and acceleration. In an exemplary aspect, the at least one stimulus source may be located anywhere along each selected muscle from its origin to its insertion. In these aspects, it is believed that each selected muscle can be stimulated along its entire length from origin to attachment.

  In a further aspect, the processing circuit may be in operative communication with at least one stimulus source and at least one sensor. In this aspect, the processing circuitry may be configured to determine a minimum stimulus magnitude for a selected stimulus of at least one stimulus source. The minimum stimulus magnitude corresponds to the lowest possible magnitude of the selected stimulus in which at least one physiological signal detected by the at least one sensor indicates contraction in at least one selected muscle of the patient It is considered possible. In addition, applying a selected stimulus with minimal stimulus magnitude would allow the system and / or clinician to determine whether the selected muscle is responsible for the pain.

  Optionally, in one aspect, the at least one stimulus source may comprise at least one of an electrical signal generator and a mechanical force generator.

  Optionally, in a further aspect, the pain assessment system may further comprise a housing. In this aspect, the at least one stimulus source and the at least one sensor can be positioned within the housing.

  Optionally, in another aspect, the at least one stimulus source may comprise at least one external stimulus source provided separately from the at least one sensor.

  Optionally, in a further aspect, each sensor of the at least one sensor can be configured to generate an output indicative of at least one physiological signal detected by the sensor. In this aspect, the processing circuit may be configured to receive an output from each sensor of the at least one sensor.

  In one exemplary aspect, the at least one stimulus source may comprise at least one electrical signal generator. Optionally, in this aspect, referring to FIGS. 3-4, at least one electrical signal generator may be configured to apply an interfering electrical stimulation waveform to at least one selected muscle of the patient. The interference stimulus waveform may optionally comprise at least two electrical signals. It is contemplated that each electrical signal of the at least two electrical signals may have a frequency of about 1 to about 3,000 Hz. In a further exemplary aspect, each electrical signal of the at least two electrical signals can have a corresponding waveform parameter. In these aspects, the waveform parameters may comprise at least amplitude, frequency, phase value, and amplitude modulation, and at least one of the waveform parameters of each electrical signal may be selectively adjustable. In operation, the waveform parameter is one of the internal body processes of interest, the specific muscle or muscle group of the patient being monitored, and the patient's body type and body composition such as body fat percentage, residual muscle tone, etc. It is believed that it can be selectively adjusted based on one or more. Optionally, in a further aspect, the at least one electrical signal generator may comprise an electronic circuit. In these aspects, the electronic circuit may comprise at least two semiconductor transistors, and the at least two semiconductor transistors may be configured to multiply at least two electrical signals into an interference stimulus waveform. In a further aspect, the at least one stimulation source can further comprise at least one electrode positioned to operatively communicate with the at least one electrical signal generator. In these aspects, the at least one electrode may be configured to receive an interference stimulation waveform from the electrical signal generator and apply the interference stimulation waveform to at least one selected muscle of the patient.

  In another exemplary aspect, the at least one stimulation source may comprise at least one electrical signal generator. In this aspect, with reference to FIGS. 3-4, the at least one electrical signal generator may comprise an electronic circuit, which itself comprises at least two semiconductor transistors. Optionally, the at least two semiconductor transistors can be configured to multiply at least two time-varying electrical signals into a synthetic interference stimulus waveform, wherein the at least one electrical signal generator is at least one selected of the patient It can be configured to apply the interference stimulation waveform to the muscle. In a further aspect, the at least one stimulation source can further comprise at least one electrode positioned to operatively communicate with the at least one electrical signal generator. In these aspects, the at least one electrode may be configured to receive an interference stimulation waveform from the electrical signal generator and apply the interference stimulation waveform to at least one selected muscle of the patient.

  In a further exemplary aspect, the electronic circuitry of the at least one electronic signal generator can be configured to generate at least two pairs of interference stimulus waveforms. In these aspects, at least one stimulation source may be configured to deliver the interference stimulation waveform to at least one selected muscle of the patient. Optionally, the at least one pair of interfering stimulus waveforms can be configured to be a reference channel that is compared to other stimulus sources of at least one stimulus source.

  In yet another exemplary aspect, with reference to FIGS. 10-11, the at least one sensor may comprise a plurality of sensors. In this aspect, the plurality of sensors can cooperate with the processing circuitry to define a plurality of sensing channels and a plurality of processing channels, each sensing channel being operatively connected to a corresponding processing channel. It is contemplated that each sensing channel may comprise at least one of a plurality of sensors. Optionally, in an exemplary aspect, each processing channel of each of the plurality of processing channels may be configured to receive the output of each sensor of at least one sensor of the corresponding sensing channel. In these aspects, the output of each sensor may indicate at least one physiological signal detected by at least one sensor of the corresponding sensing channel.

  In a further exemplary aspect, with reference to FIGS. 5-7 and 12-15, the processing circuitry is positioned to communicatively communicate with at least one sensor. Can be equipped with an amplifier. In this aspect, each sensor of the at least one sensor can be configured to generate an output indicative of at least one physiological signal detected by the sensor, and the instrumentation amplifier is from each sensor of the at least one sensor. May be configured to receive the output. Optionally, in a further aspect, the processing circuit may further comprise at least one adaptive averaging circuit. In these aspects, the instrumentation amplifier may be configured to generate an output corresponding to the output received from each sensor of the at least one sensor. In operation, the at least one adaptive averaging circuit may be configured to receive a respective output of each of the instrumentation amplifiers, and the at least one adaptive averaging circuit receives at least one physiological signal from ambient noise. It may be configured to separate and thereby generate a separated output signal. In a further aspect, the at least one adaptive averaging circuit may be configured to compare the separated output signal with a fixed voltage signal. Optionally, in other exemplary aspects, the pain assessment system may further comprise at least one display. In these aspects, the at least one adaptive averaging circuit may be positioned in operative communication with the processing circuit, the processing circuit being a visual indication of the comparison of the isolated output signal and the fixed voltage signal. May be configured to be generated on the display. In yet another exemplary aspect, each adaptive averaging circuit may have a corresponding signal processing parameter. In these aspects, the signal processing parameter may comprise at least a processing period and an averaging period. It is contemplated that at least one of the processing period and the averaging period may be selectively adjustable. Optionally, in a further exemplary aspect, the pain assessment system may further comprise a database in operative communication with the processing circuitry. In these aspects, the database may comprise a plurality of signal processing parameter data sets, and the processing circuit is at least one of the processing period and the averaging period of each adaptive averaging circuit according to the selected signal processing parameter data set. Can be configured to adjust one. Alternatively, it is contemplated that the operator may selectively manually adjust at least one of the processing period and averaging period of each adaptive averaging circuit.

  In another exemplary aspect, the pain assessment system may further comprise a memory in operative communication with the processing circuitry. In this aspect, each sensor of the at least one sensor can be configured to generate an output indicative of at least one physiological signal detected by the sensor, and the processing circuit receives the output of the at least one sensor. May be configured to generate a plurality of outputs. In operation, at least one output of the plurality of outputs may correspond to an output of at least one sensor, and at least one output of the plurality of outputs is a minimum stimulus magnitude for the selected stimulus. It can correspond to. The memory may be configured to receive and store multiple outputs from the processing circuitry. In an exemplary aspect, the memory may be configured to receive and store diagnostic / therapy data from the processing circuitry simultaneously with multiple outputs. Optionally, in some aspects, the system may further comprise a display positioned to operatively communicate with the processing circuitry. In these aspects, at least one sensor and display may be operatively secured to the housing. In operation, the display may be configured to visually display at least one output of the plurality of outputs of the processing circuit. In some optional aspects, the display may be integrated into or otherwise operably coupled to a remote computing device that is operatively in communication with the processing circuitry. Optionally, in these aspects, the remote computing device can be selected from the group consisting of smartphones, tablets and computers, and the display can be a host program and a graphical user interface stored within the remote computing device. : GUI)). Optionally, in one exemplary aspect, the display may be an LED display mounted in the same housing as the at least one sensor.

  In yet another exemplary aspect, referring to FIG. 17, the pain assessment system may further comprise a system controller. In this aspect, the system controller can be operatively connected to at least one stimulus source, at least one sensor, and processing circuitry. The system controller may be configured to selectively adjust one or more parameters associated with at least one of at least one stimulus source, at least one sensor, and processing circuitry. In operation, the system controller may be configured to maintain synchronization of at least one stimulus source and at least one sensor. Optionally, in some exemplary aspects, the system may further comprise a remote computing device that is in operative communication with at least one stimulus source and the system controller. In response to one or more inputs from the user, the remote computing device may be configured to make a selective adjustment of one or more control parameters associated with the operation of the at least one stimulus source. In further optional aspects, each sensor of the at least one sensor may be configured to generate an output indicative of at least one physiological signal detected by the sensor. In these aspects, the processing circuit may be configured to receive the output of at least one sensor and generate a plurality of outputs indicative of processing parameters of the processing circuit. After the stimulus selected by the at least one stimulus source is applied, the system controller evaluates the output generated by the at least one sensor and processing circuit to at least one stimulus source, at least one sensor and processing circuit May be configured to determine an optimal parameter for at least one of the. Optionally, the system can further comprise a display in operative communication with the controller, and the controller can be configured to visually display optimal parameters using the display. Optionally, in operation, the controller can be configured to apply a selected stimulus to at least one selected muscle using optimal parameters. It is believed that the output of at least one sensor when applying an optimized signal can be monitored as described above. Furthermore, it is believed that the optimization and monitoring cycle can be continued as needed to identify the desired parameters. In an exemplary aspect, the system controller may comprise software configured to allow retrieval of the output generated by at least one sensor and selective remote adjustment of at least one sensor parameter. Similarly, in other exemplary aspects, the system controller is configured to allow retrieval of output generated by at least one stimulus source and selective remote adjustment of at least one stimulus source parameter. Software can be provided.

  Optionally, in exemplary aspects, the at least one stimulation source may comprise at least one electrode. In these aspects, the at least one electrode can comprise a first electrode spaced from the second electrode. In operation, the second electrode can optionally be configured to be positioned on the patient's body at a location different from the location of the first electrode, the second electrode being at least one choice of the patient The reference stimulation signal may be configured to be applied to the trained muscle. In a further aspect, the optimization and monitoring procedures disclosed above for selected stimuli are considered applicable to multiple stimuli and sensor elements. Thus, as disclosed herein, optimization and monitoring procedures are considered applicable to both primary and reference stimulus signals.

  In further optional aspects, referring to FIG. 1, the pain assessment system may further comprise a remote computing device and a medical record database. In these aspects, the medical record database may optionally include historical pain data associated with the patient. The remote computing device can be positioned in operative communication with the medical record database, and the remote computing device can receive a stimulus selected by at least one stimulus source within at least one selected muscle of the patient. It may be configured to receive one or more inputs indicating the pain experienced by the patient when added. In operation, the remote computing device may be configured to update a medical record database based on one or more inputs. In an exemplary aspect, each input of one or more inputs received by a remote computing device may correspond to one of no pain, persistent pain, and transient pain. In a further exemplary aspect, the remote computing device may be configured to display historical pain data associated with the patient before or during the application of the stimulus selected by the at least one stimulus source. In these aspects, the remote computing device may include a muscle diagram of the body and a diagram for muscle evaluation and treatment to guide the clinician during and / or after stimulating the patient, for example. May be configured to display at least one of the following.

  In a further exemplary aspect, the remote computing device may be configured to selectively retrieve historical pain assessment / treatment data associated with a patient from a medical record database. In yet another exemplary aspect, it is contemplated that the medical record database may be accessible by multiple remote computing devices at a given time. Optionally, the remote computing device can retrieve data from the medical record database in the form of a printable report, which is optionally displayed by the remote computing device, stored in local memory, and It is believed that it can be delivered to a printer and / or printed.

  In yet another exemplary aspect, referring to FIG. 8, the remote computing device of the pain assessment system may be configured to display a list of patient muscles and / or an anatomical illustration of patient muscles. . Optionally, in some aspects, each muscle in the muscle list and / or muscle illustration may be displayed in association with the selected color indicator. In these aspects, each selected color indicator can correspond to a respective muscle pain rating / treatment state, such as no pain, persistent pain, transient pain, Examples include, but are not limited to, persistent pain for less than 3 months after injection, and persistent pain for 3 months or more after injection. In operation, the selected color indicator may be selectively adjustable by the clinician while applying stimulation to the patient.

  In an exemplary aspect, referring to FIGS. 11 and 13, the at least one stimulus source, the at least one sensor, and the system controller are separate, individually connected operatively using a conventional wired or wireless connection. It can be provided as a unit packaged in the box. In another exemplary aspect, with reference to FIGS. 10, 12, and 14, at least two of the at least one stimulus source, the at least one sensor, and the system controller are integral, optionally portable. It is conceivable that they may be provided together as a unit. In yet another exemplary aspect, it is contemplated that the at least one stimulus source, the at least one sensor, and the system controller may be provided together as an integral, optionally portable unit.

  In an exemplary aspect, the processing circuitry disclosed herein is configured to develop an algorithm for detecting a selected muscle stimulation of a patient according to pain stimulation data collected on the patient pool. It is thought that it can be done. In these aspects, it is believed that the processing circuitry may be configured to apply the algorithm to evaluate whether the selected muscle may be the cause of pain.

  Although described herein with respect to myalgia assessment, it is believed that aspects of the disclosed system can be used in a variety of applications. For example, aspects of the processing circuitry disclosed herein may be used in other medical applications, fiber optic communications, local area networking, wide area networking, wireless communications, etc., but are not limited thereto. It is not a thing.

  In use, the disclosed pain assessment system can be used to perform a method for assessing pain in at least one selected muscle of a patient. In an exemplary aspect, the method may comprise determining a minimum stimulus magnitude for a selected stimulus of at least one stimulus source using the disclosed system. In these aspects, it is believed that the minimum stimulus magnitude may be zero when the stimulus occurs naturally within the patient's body.

  Optionally, in some exemplary aspects, the method may comprise the step of selectively adjusting one or more of the stimulation parameters to generate the selected stimulation. In these aspects, selective adjustments can optionally be made using a remote computing device.

  Optionally, in a further exemplary aspect, the method employs at least one electrical signal generator, as disclosed herein, to interfere with at least one selected muscle of the patient. A step of applying a stimulation waveform may be provided. Optionally, in yet another exemplary aspect, the method uses at least one electrical signal generator as disclosed herein for at least one selected muscle of the patient. The step of applying a synthetic interference stimulus waveform may be included. Optionally, in yet another exemplary aspect, the method uses at least one electrical signal generator as disclosed herein for at least one selected muscle of the patient. Adding at least two pairs of interfering stimulus waveforms may be provided.

  Optionally, in yet another exemplary aspect, the method may comprise receiving the output of at least one sensor using a processing circuit. Optionally, in yet other exemplary aspects, the method is separated using processing circuitry to separate at least one physiological signal from ambient noise, as disclosed herein. Generating a further output signal. Optionally, in yet another exemplary aspect, the method may further comprise comparing the separated output signal to a fixed voltage signal, as disclosed herein. Optionally, in yet another exemplary aspect, the method further comprises the step of generating a visual display of the comparison of the separated output signal and the fixed voltage signal, as disclosed herein. Can be prepared. Optionally, in yet another exemplary aspect, the method uses a processing circuit, as disclosed herein, for each adaptation of the processing circuit according to a selected signal processing parameter data set from a database. The method may further comprise adjusting at least one of a processing period and an averaging period of the averaging circuit. Optionally, in yet another exemplary aspect, the method may further comprise storing a plurality of outputs from processing circuitry in the memory. Optionally, in yet another exemplary aspect, the method visually displays on a display at least one output of the plurality of outputs of the processing circuit, as disclosed herein. May further be provided.

  Optionally, in yet another exemplary aspect, the method uses at least one of at least one stimulus source, at least one sensor, and processing circuitry using a system controller, as disclosed herein. There may be the step of selectively adjusting one or more parameters associated with the one. Optionally, in yet another exemplary aspect, the method comprises maintaining synchronization of at least one stimulus source and at least one sensor using a system controller, as disclosed herein. Can be prepared. Optionally, in yet another exemplary aspect, the method uses a system controller to evaluate the output generated by the at least one sensor and processing circuit to provide at least one stimulus source, at least one sensor, and Determining an optimal parameter for at least one of the processing circuits may be provided. Optionally, in yet another exemplary aspect, the method may further comprise visually displaying optimal parameters using a display, as disclosed herein. Optionally, in yet another exemplary aspect, the method may further comprise applying a selected stimulus to at least one selected muscle of the patient using optimal parameters. Optionally, in yet another exemplary aspect, the method may comprise applying a reference stimulus signal to at least one selected muscle of the patient, as disclosed herein.

  Optionally, in a further exemplary aspect, the method uses the disclosed system to at least one of the pain and discomfort experienced by the patient when a stimulus selected by at least one stimulus source is applied. Update historical pain data associated with the patient in the medical record database based on the presence of the two. Optionally, in yet another exemplary aspect, the method uses a remote computing device to identify a muscle diagram and treatment diagram to guide the clinician before, during or after stimulating the patient. Displaying at least one may be provided. Optionally, in yet another exemplary aspect, the method can comprise using a remote computing device to selectively adjust the assessment / treatment status of pain in each muscle of a patient to be stimulated. . Optionally, in yet another exemplary aspect, the method may comprise selectively retrieving historical pain assessment / treatment data associated with the patient from a medical record database using a remote computing device.

Exemplary Application The disclosed pain assessment system is generally referred to below as a painful muscle detection instrument (PMDI). As further disclosed herein, the PDMI device represents a multi-faceted approach to the assessment and treatment of functional myalgia. By providing automatically generated electrical stimulation that is strong enough to contract voluntary striated muscles, certain muscles can be tested to determine whether they are causing pain. . The PMDI device automatically determines the minimum stimulus intensity required to cause muscle contraction, whereas the prior art approach estimates the appropriate stimulus intensity by observing muscle contraction. Deviates from the prior art. PMDI devices also depart from the prior art in that they include embedded software that helps suggest to the clinician all the muscles that may possibly be the source of pain. This provides an educational component that allows clinicians who are not proficient in muscle anatomy to identify all of the various muscles that can cause pain. The software also stimulates certain muscles when the instrument is properly placed, and whether the particular muscle is causing the pain, rather than the adjacent muscle that might be mistaken It is configured to provide a diagram for instructing the clinician to determine. For example, tender points on the skin may represent that several muscles overlap each other. Unless tenderness is drawn along the muscle path, from start to finish (from initiation to attachment), the clinician cannot know exactly whether the suspicious muscle is actually the cause of the pain . As will be appreciated, this is important. This is because all TrPs in the muscle adhesion part and muscle function as pain sources. Therefore, identifying a specific muscle relative to the trigger point (TrP) is necessary to determine where the needle should be placed during treatment. In contrast to community standards that identify by muscle palpation the muscles suspected of causing pain, it is believed that moving the muscles replicates what happens in vivo. Furthermore, tenderness due to palpation of resting muscles is not an excellent test for muscle pain because it does not replicate what happens in most patients with muscle-based pain (ie pain due to activity or long-term positioning). It is done. Still further, producing minimal contraction is believed to more accurately reproduce typical pain-generating activity. Therefore, it is further believed that the use of minimal contraction would be a more effective indicator of the muscles that cause pain relative to the pain caused by compression, where the pain caused by that compression is related pain associated with another muscle. It can be a messy response based on the reflection of or the palpation pressure on the overlapping muscles.

  As further disclosed herein, the PMDI may be configured to automatically shift to a diagnostic mode after determining the minimum stimulus magnitude. Corresponding stimuli can be provided by a stimulator (eg, an aluminum stimulator head) along a suspicious muscle path. One example is a site complaining of pain in the upper back (see FIG. 20 showing the back and thoracolumbar fascia). Overlapping muscles and / or adjacent muscles can cause pain. Thus, PMDI is placed along the muscle path from the origin / attachment of each muscle that is considered suspicious, and the muscle is stimulated along its entirety from the origin to the attachment. Non-limiting examples of muscles that can be tested using the disclosed systems and methods include rhomboid muscles (from the medial edge of the scapula to the thoracic and lower cervical vertebrae), scapular muscle (from the cervical spine) And after palpating the origin on the upper medial corner of the scapula to which it is stimulated) and trapezius (from the acromion to the upper thoracic and cervical vertebrae and the occipital region). However, it is understood that other muscles may be tested and evaluated using the disclosed systems and methods.

  The operator can record the results of the muscle test according to the methods disclosed herein, and the method can optionally comprise pressing the appropriate button on the PMDI. As disclosed herein, information can optionally be transmitted wirelessly to a remote computing device. The results of the examination can be recorded in a medical record database, such as but not limited to an electronic medical records (EMR) database, and the results It can be used for discussions or submitted for insurance claims. It is believed that a treatment plan can be provided with the knowledge that moving certain muscles causes pain.

  When it is determined that the muscle has a sustained structural change that would benefit from injection technology, PMDI can either automatically (based on software) or manually (in response to operator input). , Can shift to treatment mode. In an exemplary application, PMDI tells the clinician how to insert the needle to penetrate completely the muscle attachment and tissue according to the method disclosed in US Pat. No. 6,432,063. A diagram and / or video of the selected muscle may be displayed with the instructions shown. US Pat. No. 6,432,063 is hereby incorporated by reference in its entirety.

  The injected muscle, injection date and other paint / treatment data can be sent to a medical records database for future retrieval. Optionally, the medical record database may be updated to provide a historical view of the patient's pain / treatment progress. If pain persists in the area where a particular muscle has been injected, it is likely that another uninjected muscle is the cause of the pain, which is the same painful In contrast to the traditional community standard of trigger point injection, where repeated injections into the muscle (or site) are within the standard treatment.

  In use, PMDI can automatically detect muscle contractions that are hardly noticed by the patient using at least one sensor, as disclosed herein.

  PMDI is designed to help clinicians who may not actually have good knowledge of muscle anatomy to accurately identify and test muscles that are not normally considered in the diagnosis and treatment of common pain syndromes. It is believed that a means can be provided.

  In one exemplary process, when a muscle receives a selected stimulus with an automatically determined minimum stimulus magnitude to provide contraction, the patient has two reactions: (1) discomfort. None, or (2) (a) something like a bruise, (b) full of bruises, (c) "feels very squeezed", or (d) discomfort expressed as pain when touched , One of the following. When discomfort occurs, the application of the stimulus can continue. If the patient reports a decrease in discomfort and even the disappearance of discomfort after about 30 seconds to about 1 minute, it can be recorded as “transient” pain. If the discomfort does not change or the intensity decreases but still remains, it can be recorded as “persistent” pain.

  If the patient presents pain present for less than 3 months, or if the pain is transient, US Pat. No. 6,432,063 and Marcus, NJ. Gracely, E .; Keefe, K .; (2010) “A comprehensive protocol for diagnosing and treating muscular-onset pain can reliably reduce or eliminate pain in a chronic pain population (A Comprehensive Protocol to Diagnose and Treat Pain). of Muscular Origin May Successfully and Reliably Decrease or Eliminate Pain in a Chronic Pain Population), Pain Medicine, 11 (1); 25-34. Movement may be sufficient, as described in US Pat. No. 6,432,063 and Marcus, NJ. Gracely, E .; Keefe, K .; (2010) are both incorporated herein by reference in their entirety.

  If pain is present for more than 3 months (or if it is intermittent and recurring pain), a puncture procedure can be proposed. The clinician may choose to use various techniques found in the literature. PMDI is thought to be able to provide a unique function that identifies muscles as the cause of pain, perhaps not as related pain by another muscle that causes pain. Furthermore, palpation is considered unable to make that distinction. In an exemplary aspect, it is believed that the muscle can be completely injected into muscle tissue, TrP and attachment. However, it is contemplated that partial injection may also be used.

  When the clinician is ready for treatment, the PMDI can be selectively transitioned to a treatment mode. A muscle can be selected from the stored list of identified muscles, and the selected muscle can be displayed on the display. With the selected muscle displayed on the display, the suggested muscle puncture site may be labeled and / or displayed in a diagram or video.

  Once injected, the muscle can be classified as “injected” under the treatment module for future reference. Identified muscle pain / treatment status can be dated and color coded to allow for a quick reexamination of the patient's muscle status, and various colors can be used for the following conditions: no pain, transient It corresponds to pain, persistent pain, persistent pain injected during the last 3 months, or persistent pain injected more than 3 months ago.

  For any test, the results need to be recorded. For muscles that hurt when touched, this can be extremely important due to the dynamic nature of muscle pain. Muscles that cause pain can cause increased pain (due to central sensitization) and decreased pain (due to extensive nociceptive regulation (see 0075 below)) in other muscles. When muscle is the cause of persistent pain, it causes changes in the spinal cord and brain that make nerve cells (neurons) that receive information from that muscle more sensitive (central sensitization (CS)). Will let you. Hypersensitivity can cause a decrease in threshold for cell depolarization. In other words, here, less muscle stimulation than would normally be required to activate neurons would cause cell activation. Sensitized neurons open connections (nervous tracts) that previously did not function, so that neurons that receive signals from other muscles in the body are also more sensitive. Usually, a strong sensation in the muscle is necessary to depolarize (fire) the neurons corresponding to that muscle in the spinal cord. In the presence of CS, fewer stimuli as described above will cause ignition. Thus, muscle contraction that was painless in normal muscle becomes painful here, which is called muscle or mechanical allodynia (usually pain from a painless stimulus). This same phenomenon (muscle allodynia) can occur in another muscle to which the stimulus is directed, causing the associated muscle pain. Muscles with associated pain hurt when palpated, but muscle fibers are not dysfunctional (neurons only), so in many cases, stimulation with PMDI will only hurt temporarily.

  The following rules can be followed to initiate an intramuscular injection. (1) start with the most painful tested muscle in the pain-prone area, (2) inject into the proximal muscle prior to the distal muscle (closest to or farthest from the trunk), And (3) The rule is that the surface muscle is injected prior to the deep muscle (the surface muscle can cause pain in the deep muscle). The injected muscle can no longer be a source of pain, so this would no longer be the case if it was a factor that caused pain in other muscles by CS or reference pattern. Thus, after each muscle has been injected, the next suspicious muscle based on the patient's current pain report can be retested prior to any injection. This is done because suspicious muscles are no longer positive in the test at that time due to associated pain and central sensitization. Therefore, it would have been insignificant to have injected it without testing for its suspicious ongoing pain generation characteristics.

  On the other hand, competing phenomena contribute to clinical findings—diffuse noxious inhibitory control (DNIC), which is now referred to as conditioned pain modulation (CPM). . It is a phenomenon in which pain in one area of the body suppresses pain in another area. Upon successful treatment of the most painful muscles, the retest may be able to identify another previously unidentified muscle as a new painful muscle that contributes to the pain syndrome.

  For clinicians who want to do clinical research on the various muscle pain reference patterns that can ultimately provide practitioners with a more detailed understanding of the complexity of expressing muscle pain, a collection of serial data Can also be important.

  As will be appreciated by those skilled in the art, the methods and systems disclosed herein may take the form of an entirely hardware example, may take the form of an entirely software example, or It may take the form of an embodiment that combines aspects and hardware aspects. Further, the methods and systems may take the form of a computer program product on a computer readable storage medium that incorporates computer readable program instructions (eg, computer software). More specifically, the present methods and systems may take the form of computer software executed by the web. Any suitable computer readable storage medium may be utilized including hard disks, CD-ROMs, optical storage devices, or magnetic storage devices.

  Embodiments of the method and system are described above with reference to block diagrams and flowchart illustrations of methods, systems, apparatuses, and computer program products. It will be understood that each block of the block diagrams and flowchart illustrations, and combinations of blocks in the block diagrams and flowchart illustrations, respectively, can be implemented by computer program instructions. These computer program instructions may be loaded onto a general purpose computer, special purpose computer or other programmable data processing device to generate a machine and consequently executed on the computer or other programmable data processing device. The instructions generate means for performing the functions specified in the flowchart blocks.

  These computer program instructions may also be stored in computer readable memory, which may direct a computer or other programmable data processing device to function in a particular manner, and as a result, stored in computer readable memory. The generated instructions produce an article of manufacture that includes computer readable instructions for performing the functions defined in the flowchart blocks. Computer program instructions are also loaded into a computer or other programmable data processing device to cause a series of operational steps to be executed on the computer or other programmable device to generate a process executed by the computer. As a result, the instructions executed on the computer or other programmable device provide steps for performing the functions defined in the blocks of the flowchart.

  Thus, the blocks in the block diagrams and flow chart diagrams include a combination of means for performing the specified function, a combination of steps for performing the specified function, and a function for performing the specified function. Supports program instruction means. Each block in the block diagrams and flowchart diagrams, and combinations of blocks in the block diagrams and flowchart diagrams, are special purpose hardware-based computers that perform a specified function or step or combination of special purpose hardware and computer instructions It will also be understood that it can be performed by the system.

  The system has been described above as consisting of units. One skilled in the art will appreciate that this is a functional description and that each function can be performed by software, hardware, or a combination of software and hardware. The unit may be software, hardware, or a combination of software and hardware. The unit may comprise pain diagnostic software 106 shown in FIG. 19 and described below. In one exemplary aspect, the unit may comprise the computer 101 shown in FIG. 19 and described below. As an example, the computer 101 may be the pain assessment system disclosed herein. As another example, computer 101 may be a computing device connected to a pain assessment system.

  FIG. 19 is a block diagram illustrating an exemplary operating environment for performing at least some of the disclosed methods. This exemplary operating environment is only one example of an operating environment and is not intended to suggest any limitation as to the scope of use or functionality of the operating environment architecture. Neither should the operating environment be interpreted as having any dependency or requirement relating to any one or combination of components illustrated in the exemplary operating environment.

  The methods and systems may operate with numerous other general purpose or special purpose computing system environments or configurations. Examples of well-known computing systems, environments and / or configurations that may be suitable for use with such systems and methods include, but are not limited to, personal computers, server computers, laptop devices and multiprocessor systems. Is not to be done. Further examples include set-top boxes, programmable consumer electronics, network PCs, minicomputers, mainframe computers, distributed computing environments with any of the above systems or devices, and the like.

  The processes of the disclosed methods and systems may be performed by software components. The disclosed systems and methods can be described in the general context that computer-executable instructions, such as program modules, are executed by one or more computers or other devices. Generally, program modules comprise computer code, routines, programs, objects, components, data structures, etc. that perform particular tasks or perform particular abstract data types. The disclosed methods may also be practiced in grid-based distributed computing environments where tasks are performed by remote processing devices that are linked through a communications network. In a distributed computing environment, program modules may be located in both local and remote computer storage media including memory storage devices.

  Moreover, those skilled in the art will appreciate that the systems and methods disclosed herein may be performed by a general purpose computing device in the form of computer 101. The components of computer 101 may include, but are not limited to, one or more processors or processing units 103, system memory 112, and system bus 113 that couples various system components including processor 103 to system memory 112. Is not to be done. In the case of multiprocessing unit 103, the system can utilize parallel computing.

  The system bus 113 uses several of various possible bus architectures, including a memory bus or memory controller, a peripheral bus, an accelerated graphics port, and several possible types of buses, including a processor or local bus. Corresponds to one or more of the structures. By way of example, such architectures include Industry Standard Architecture (ISA) buses, Micro Channel Architecture (MCA) buses, Enhanced ISA (EISA) buses, and Video Electronics Standards Association. (Video Electronics Standards Association: VESA) Local Bus, Accelerated Graphics Port (AGP) Bus, Peripheral Component Interconnects (PCI), PCI-Express Bus, Personal Computer Memory Card An industry association (Personal Computer Memory Card Industry Association: PCMCIA), a universal serial bus (USB), or the like may be provided. In addition, the bus 113 and all the buses defined in this description may be realized via a wired or wireless network connection and each subsystem. The subsystem includes the processor 103, the mass storage device 104, Operating system 105, pain diagnosis / evaluation software 106, pain diagnosis / evaluation / treatment data 107, network adapter 108, system memory 112, input / output interface 110, display adapter 109, and display device 111. , A human machine interface 102. Bus 113 and all buses defined in this description are also included in one or more remote computing devices 114a, 114b, 114c in physically separate locations connected via this form of bus. To achieve a virtually completely distributed system.

  Computer 101 typically includes a variety of computer readable media. An exemplary readable medium may be any available medium that can be accessed by computer 101 and includes, for example, both volatile and nonvolatile media, removable media and non-removable media. Including, but not limited to, media. The system memory 112 comprises computer readable media in the form of volatile memory, such as random access memory (RAM), and / or non-volatile memory, such as read only memory (ROM). System memory 112 is generally readily accessible by processing unit 103 and / or data such as diagnostic and treatment data 107 currently operating by processing unit 103, and / or operating system 105 and pain diagnostics. Program modules such as software 106 are included.

  In another aspect, the computer 101 may also include other removable / non-removable, volatile / nonvolatile computer storage media. As an example, FIG. 1 illustrates a mass storage device 104 that can provide non-volatile storage for computer 101 with computer code, computer readable instructions, data structures, program modules, and other data. For example, the mass storage device 104 may be a hard disk, a removable magnetic disk, a removable optical disk, a magnetic cassette or other magnetic storage device, a flash memory card, a CD-ROM, a digital versatile disk (DVD). Or other optical storage devices, random access memory (RAM), read only memory (ROM), electrically erasable programmable read only memory (EEPROM), etc. It is not intended to be limited to them.

  Optionally, any number of program modules including operating system 105 and pain diagnostic software 106 as examples may be stored in mass storage device 104. Each of operating system 105 and pain diagnostic software 106 (or some combination thereof) may comprise a programming element and pain diagnostic software 106. Diagnosis and treatment data 107 may also be stored in the mass storage device 104. Diagnosis and treatment data 107 may be stored in any of one or more databases known in the art. Examples of such databases include DB2 (registered trademark), Microsoft (registered trademark) access, Microsoft (registered trademark) SQL server, Oracle (registered trademark) mySQL, PostgreSQL, and the like. The database may be centralized or distributed across multiple systems.

  In another aspect, the user may enter commands and information into the computer 101 via an input device (not shown). Examples of such input devices include tactile input devices such as keyboards, pointing devices (eg, “mouse”), microphones, joysticks, scanners, gloves and other objects that cover the body, etc. It is not limited to. These and other input devices may be connected to the processing unit 103 via a human machine interface 102, which is coupled to the system bus 113 but includes a parallel port, a game port May be connected by other interfaces and bus structures, such as an IEEE 1394 port (also known as a firewire port), serial port or universal serial bus (USB).

  In yet another aspect, the display device 111 may be connected to the system bus 113 via an interface such as the display adapter 109. It is contemplated that the computer 101 may have two or more display adapters 109, and the computer 101 may have two or more display devices 111. For example, the display device may be a monitor, an LCD (liquid crystal display) or a projector. In addition to the display device 111, other output peripheral devices may include components such as a speaker (not shown) and a printer (not shown) that can be connected to the computer 101 via the input / output interface 110. Good. Any step and / or result of the method may be output to the output device in any form. Such output may be any form of visual display, including but not limited to text display, graphic display, animation display, audio display, tactile display, etc. Is not to be done.

  Computer 101 can operate in a networked environment using logical connections to one or more remote computing devices 114a, 114b, 114c. By way of example, the remote computing device may be a personal computer, portable computer, server, router, network computer, peer device or other common network node, or the like. The logical connection between the computer 101 and the remote computing devices 114a, 114b, and 114c may be made via a local area network (LAN) and a general wide area network (WAN). Good. Such a network connection may be via the network adapter 108. The network adapter 108 can be realized in a wired environment or a wireless environment. Such networking environments are conventional and routine in offices, enterprise-wide computer networks, intranets and the Internet 115.

  For illustrative purposes, application programs such as operating system 105 and other executable program components are illustrated herein as separate blocks, but such programs and components may be used on computing devices at various times. It is recognized that it resides in 101 different storage components and is executed by the computer's data processor. An implementation of pain diagnostic software 106 may be stored on some form of computer readable medium or transmitted over some form of computer readable medium. Any of the disclosed methods may be performed by computer readable instructions executed on a computer readable medium. Computer readable media can be any available media that can be accessed by a computer. By way of example, computer readable media may comprise, but is not intended to be limited to “computer storage media” and “communication media”. “Computer storage media” refers to volatile and non-volatile removable and non-removable implemented in any method or technique for storing information such as computer readable instructions, data structures, program modules or other data. With possible media. Exemplary computer storage media include RAM, ROM, EEPROM, flash memory or other memory technology, CD-ROM, digital versatile disk (DVD) or other optical storage device, magnetic cassette, magnetic tape, magnetic disk storage device. Or other, but not limited to, other magnetic storage devices or other media that can be used to store desired information and that can be accessed by a computer.

  The method and system can utilize artificial intelligence techniques such as machine learning and interactive learning. Examples of such techniques are expert systems, case-based reasoning, Bayesian networks, behavior-based AI, neural networks, fuzzy systems, evolutionary computation (eg genetic algorithms), swarm intelligence (eg ant algorithms) And hybrid intelligence systems (such as, but not limited to, expert inference rules generated via neural networks or generation rules from statistical learning).

  Although the method and system have been described in connection with preferred embodiments and specific examples, the embodiments herein are intended to be illustrative rather than restrictive in all respects, and the scope is thus described. It is not intended to be limited to the specific embodiments being described.

  Unless explicitly stated otherwise, any method described herein is not intended to be construed as requiring that the steps be performed in a particular order. . Thus, if a method claim does not actually describe the order in which the steps are to follow, or it is specifically stated in the claims or specification that the steps should be limited to a particular order If not, it is not intended that the order be inferred at all points. This may be due to any possible implied principle of interpretation, including logical matters relating to the sequence of steps or operational flows, an unambiguous meaning derived from grammatical construction or punctuation, and the number or type of embodiments described in the specification. -express basis).

  Throughout this application, various publications are referenced. In order to more fully describe the state of the art to which the methods and systems pertain, the disclosures of these publications are incorporated herein by reference in their entirety.

  It will be apparent to those skilled in the art that various modifications and variations can be made without departing from the scope or spirit. Other embodiments will be apparent to those skilled in the art from consideration of the specification and methodology disclosed herein. It is intended that the specification and examples be considered as exemplary only, with a true scope and spirit being indicated by the following claims.

Claims (43)

A system for assessing pain in at least one selected muscle of a patient comprising:
At least one stimulation source, each stimulation source configured to selectively apply a selected stimulation to the at least one selected muscle of the patient according to a plurality of stimulation parameters; Parameters include the magnitude of the stimulus, the phase of the stimulus, the waveform of the stimulus, and the frequency of the stimulus, and each stimulus parameter of the plurality of stimulus parameters has a selectively adjustable value, Furthermore,
At least one sensor configured to detect at least one physiological signal in the at least one selected muscle of the patient;
Processing circuitry in operative communication with the at least one stimulus source and the at least one sensor, wherein the processing circuitry determines a minimum stimulus magnitude for the selected stimulus of at least one stimulus source. Configured such that the minimum stimulus magnitude is selected when the at least one physiological signal detected by the at least one sensor is indicative of pain in the at least one selected muscle of the patient. A system that accommodates the lowest possible magnitude of stimulation.   The system of claim 1, wherein the at least one stimulus source comprises at least one of an electrical signal generator and a mechanical force generator.   The system of claim 2, further comprising a housing, wherein the at least one stimulation source and the at least one sensor are positioned within the housing.   The system of claim 1, wherein the at least one stimulus source comprises at least one external stimulus source provided separately from the at least one sensor.   The at least one stimulation source comprises at least one electrical signal generator, wherein the at least one electrical signal generator applies an interfering electrical stimulation waveform to the at least one selected muscle of the patient The system of claim 1, wherein the interference stimulation waveform comprises at least two electrical signals, each electrical signal of the at least two electrical signals having a frequency of about 1 to about 3,000 Hz.   Each electrical signal of the at least two electrical signals has a corresponding waveform parameter, the waveform parameter comprising amplitude, frequency, phase value, and amplitude modulation, and at least one of the waveform parameters of each electrical signal. 6. The system of claim 5, wherein is adjustable selectively.   The at least one stimulus source comprises at least one electrical signal generator, the at least one electrical signal generator comprises an electronic circuit, the electronic circuit comprises at least two semiconductor transistors, and the at least two The semiconductor transistor is configured to multiply at least two time-varying electrical signals into a synthetic interference stimulus waveform, the at least one electrical signal generator for the at least one selected muscle of the patient. The system of claim 1, configured to apply an interfering stimulus waveform.   The at least one stimulation source further comprises at least one electrode positioned in operative electrical communication with the at least one electrical signal generator, wherein the at least one electrode is the electrical signal generator The system of claim 7, wherein the system is configured to receive the interference stimulation waveform from and to apply the interference stimulation waveform to the at least one selected muscle of the patient.   The at least one electrical signal generator includes an electronic circuit, the electronic circuit includes at least two semiconductor transistors, and the at least two semiconductor transistors multiply the at least two electrical signals to form the interference stimulation waveform. The system of claim 5, wherein the system is configured to:   The at least one stimulation source further comprises at least one electrode positioned in operative electrical communication with the at least one electrical signal generator, wherein the at least one electrode is the electrical signal generator The system of claim 9, wherein the system is configured to receive the interference stimulation waveform from and to apply the interference stimulation waveform to the at least one selected muscle of the patient.   The electronic circuitry of the at least one electronic signal generator is configured to generate at least two pairs of interfering stimulus waveforms, and the at least one stimulus source is applied to the at least one selected muscle of the patient. 10. A system according to claim 7 or 9, configured to deliver an interfering stimulus waveform.   The system of claim 11, wherein the at least one pair of interfering stimulus waveforms is configured to be a reference channel that is compared to other stimulus sources of the at least one stimulus source.   2. Each sensor of the at least one sensor is selected from the group consisting of a miniature capacitor, an omnidirectional microphone, a microelectromechanical system (MEMS) microphone, a MEMS accelerometer, and an adhesive contact electrical signal sensor pad. The described system.   The at least one sensor comprises a plurality of sensors, the plurality of sensors cooperating with a processing circuit to define a plurality of sensing channels and a plurality of processing channels, each sensing channel being associated with a corresponding processing channel. The system of claim 13 operatively connected.   The system of claim 14, wherein each sensing channel comprises at least one sensor of the plurality of sensors.   Each processing channel of each of the plurality of processing channels is configured to receive an output of each sensor of the at least one sensor of a corresponding sensing channel, the output being received by the at least one sensor of the sensing channel. The system of claim 15, wherein the system is indicative of the at least one physiological signal detected.   Each sensor of the at least one sensor is configured to generate an output indicative of the at least one physiological signal detected by the sensor, and the processing circuit is configured to output the output from each sensor of the at least one sensor. The system of claim 1, wherein the system is configured to receive   The processing circuit includes a high in-phase signal rejection ratio instrumentation amplifier positioned to operatively communicate with the at least one sensor, each sensor of the at least one sensor being detected by the sensor. The system of claim 1, wherein the system is configured to generate an output indicative of at least one physiological signal, and the instrumentation amplifier is configured to receive the output from each sensor of the at least one sensor.   The processing circuit further comprises at least one adaptive averaging circuit, and the instrumentation amplifier is configured to generate an output corresponding to the output received from each sensor of the at least one sensor, the at least one One adaptive averaging circuit is configured to receive the respective output of each of the instrumentation amplifiers, and the at least one adaptive averaging circuit separates the at least one physiological signal from ambient noise; The system of claim 18, wherein the system is configured to generate an output signal separated by   The system of claim 19, wherein the at least one adaptive averaging circuit is configured to compare the separated output signal with a fixed voltage signal.   And further comprising at least one display, wherein the at least one adaptive averaging circuit is positioned in operative communication with the processing circuit, the processing circuit including the separated output signal and the fixed voltage signal. 21. The system of claim 20, wherein the system is configured to generate a visual representation of a comparison of the display on the display.   Each adaptive averaging circuit has a corresponding signal processing parameter, the signal processing parameter comprising a processing period and an averaging period, wherein at least one of the processing period and the averaging period is selectively The system of claim 19, wherein the system is adjustable.   A database operatively communicating with the processing circuit, the database comprising a plurality of signal processing parameter data sets, wherein the processing circuit is configured to process the processing of each adaptive averaging circuit according to a selected signal processing parameter data set; 23. The system of claim 22, configured to adjust at least one of a period and the averaging period.   And further comprising a memory in operative communication with the processing circuit, wherein each sensor of the at least one sensor is configured to generate an output indicative of the at least one physiological signal detected by the sensor; A circuit is configured to receive the output of the at least one sensor and generate a plurality of outputs, at least one of the plurality of outputs corresponding to the output of the at least one sensor; At least one output of the plurality of outputs corresponds to the minimum stimulus magnitude for a selected stimulus, and the memory is configured to receive and store the plurality of outputs from the processing circuit The system of claim 1.   The display further comprises a display positioned in operative communication with the processing circuit, the at least one sensor and the display being operatively secured to a housing, the display being configured to output the plurality of outputs of the processing circuit. 25. The system of claim 24, configured to visually display at least one of the outputs.   A remote computing device having a display, wherein the remote computing device is in operative communication with the processing circuit, and wherein the display of the remote computing device is at least one of the plurality of outputs of the processing circuit; 25. The system of claim 24, configured to visually display an output.   27. The system of claim 26, wherein the remote computing device is selected from the group consisting of a smartphone, a tablet, and a computer.   A system controller, wherein the system controller is operatively connected to the at least one stimulus source, the at least one sensor, and the processing circuit, the system controller comprising the at least one stimulus source, the at least one stimulus Configured to selectively adjust one or more parameters associated with at least one of a sensor and the processing circuit, wherein the system controller synchronizes the at least one stimulus source and the at least one sensor. The system of claim 1, wherein the system is configured to maintain.   Further comprising a remote computing device, wherein the remote computing device is in operative communication with the at least one stimulus source, and in response to one or more inputs from a user, the remote computing device is the at least one 30. The system of claim 28, wherein the system is configured to selectively adjust one or more control parameters associated with operation of a stimulus source.   Each sensor of the at least one sensor is configured to generate an output indicative of the at least one physiological signal detected by the sensor, and the processing circuit receives the output of the at least one sensor , Configured to generate a plurality of outputs indicative of processing parameters of the processing circuit, and after the stimulation selected by the at least one stimulation source is applied, the system controller includes the at least one sensor and the processing The output configured by a circuit is configured to evaluate and determine an optimal parameter for at least one of the at least one stimulus source, the at least one sensor, and the processing circuit. 28. The system according to 28.   32. The system of claim 30, further comprising a display in operative communication with the controller, wherein the controller is configured to visually display the optimal parameter using the display.   32. The system of claim 30, wherein the controller is configured to apply a selected stimulus to the at least one selected muscle using the optimal parameter.   The at least one stimulation source includes at least one electrode, the at least one electrode includes a first electrode spaced from a second electrode, and the second electrode includes the first electrode. Configured to be positioned on the patient's body at a position different from the position of the one electrode, the second electrode applying a reference stimulus signal to the at least one selected muscle of the patient 32. The system of claim 30, configured as follows.   The medical record database further includes a remote computing device and a medical record database, the medical record database including historical pain data associated with the patient, the remote computing device positioned to operatively communicate with the medical record database And wherein the remote computing device is one or more indicating the level of pain experienced by the patient when a stimulus selected by the at least one stimulus source is applied within the at least one selected muscle of the patient The system of claim 1, wherein the remote computing device is configured to update the medical record database based on the one or more inputs.   35. The system of claim 34, wherein each input of the one or more inputs received by the remote computing device corresponds to one of no pain, persistent pain and transient pain.   35. The remote computing device is configured to display the historical pain data associated with the patient while the selected stimulus is being applied by the at least one stimulus source. System.   40. The system of claim 36, wherein the remote computing device is configured to display at least one of a muscle diagram and a treatment diagram to guide a clinician.   The remote computing device is configured to display a list of muscles of the patient, each muscle in the list of muscles is displayed in association with a selected color indicator, and each selected color indicator is 38. The system of claim 36, corresponding to each muscle pain assessment / treatment state, wherein the selected color indicator is selectively adjustable by a clinician while stimulating the patient.   35. The system of claim 34, wherein the remote computing device is configured to selectively retrieve historical pain assessment / treatment data associated with the patient from the medical record database.   35. The system of claim 34, wherein the medical record database is accessible by a plurality of remote computing devices at a given time. A method for assessing pain in at least one selected muscle of a patient comprising:
41. A method comprising determining a minimum stimulus magnitude for a selected stimulus of at least one stimulus source using the system of any one of claims 1-40.   Updating historical pain data associated with the patient based on the presence of at least one of pain and discomfort experienced by the patient when a stimulus selected by the at least one stimulus source is applied; 42. The method of claim 41.   42. The method of claim 41, wherein the minimum stimulus magnitude is zero.