Q. Talk about your background. How did you get involved in pain management
Hocking: I am a former chronic pain sufferer. About eighteen years ago, I had two back operations and was suffering terribly from debilitating pain. At the time the various modalities that were being applied to me such as drugs, physical therapy and chiropractic, were not working or even touching my pain levels. I sank into a deep depression. Then, a sympathetic relative sent me a little hand-held micro-current point stimulator, a specialized, advanced form of TENS, to see if it would work. Although TENS units, [transcutaneous electrical nerve stimulation, which is an application of electrical impulses to the nerve points to block the pain impulse from the site to the brain] have been around for many years, they were unsuccessful in relieving my pain. This new device did not use pads, and the stimulation felt much different, more like Acupuncture. In desperation, I experimented with the unit and applied it to my lower back and down my legs. After several days of self applications, like magic, I received substantial pain relief (about 90%)! I was so impressed with the results that I quit my job as a financial advisor, and started studying acupuncture and researching pain management so I could help other pain sufferers.

Q. After you left the business world, what kind of training did you get in pain management?
Hocking: I started studying traditional acupuncture here in Toronto, Canada. I was moderately satisfied with the course, but not totally impressed because they didn't focus that much on pain management, which is the primary use of acupuncture. So from there, I traveled to Asia for a prolonged period to study more advanced acupuncture techniques, including integrating anatomical trigger points with acupuncture for pain management. After combining these various approaches, my outcomes significantly improved, but I still had some patients who suffered from pain. Determined to succeed, I went to the West Coast, and over a two-year period, studied an advanced trigger point technique called Intramuscular Stimulation (IMS) with some of the top pain physicians in the field. That period substantially helped me gain an understanding of the neurological approach to pain management, which again, I added on to my previously combined techniques, and got far superior outcomes. From that point on, I continued to expand and push the realms of pain therapy over many years until it evolved into its present form, ETPS Neuromechanical Acupuncture (NMA).

Q. What exactly is ETPS Neuromechanical Acupuncture (NMA)?
Hocking: ETPS stands for Electro Therapeutic Point Stimulation, a non-invasive therapy that applies concentrated, low frequency, DC stimulation to special combinations of acupuncture points, triggers points, and contracted motor bands. By integrating Eastern and Western approaches, and applying this specialized form of acupuncture stimulation, you get a really nice approach to pain management that helps a lot of people find relief.

ETPS is very unique in its approach to pain management. Our high success rate is due to the fact that we are completely original, in fact, we are usually opposite to the current thinking of other pain experts.

Q. You use a special device in this approach. What is it? Is it something you invented? Can practitioners buy it and use it anyway they want to, or is special training required?
Hocking: We had to completely redesign technology in order to produce the results I was looking for. Fifteen years ago we took an existing device and redesigned it with University of Toronto Biomedical engineering in order to comply with current medical research in endorphins, muscle relaxation, and pain management. The upgraded device was re-introduced to the Canadian market in 1992 and received FDA approval in 1995. The unit has been very popular with physiatrists, physical therapists, and chiropractors in the US and Canada since then. It's extremely safe, and since it produces 100 times less current the traditional TENS, it can be bought over-the-counter in most countries, except the United States where a prescription is required.

Our postgraduate training program developed out of necessity, as we discovered that most physicians and physical therapists have no formal education in pain management. So our company wears two hats. In addition to producing the remarkable device, we provide continuing education courses to professionals on how to diagnose and treat pain using ETPS techniques. We teach them how to neurologically recognize where a patient's pain is probably arising from, and how to apply stimulation to acupuncture and trigger points in order to isolate, and then eliminate, the sources of chronic pain.

Over the past seven years we've trained over 13,000 physical therapists, occupational therapists, massage therapists, nurse practitioners, physiatrists, anesthesiologists, and acupuncturists on how to properly diagnose and treat just about any pain condition known with ETPS. They all deal with this chronic pain puzzle on a daily basis, but most don't have the training or background to properly handle with it. When therapists integrate ETPS with their practice and techniques, they get significantly improved outcomes. Our research and feedback proves it!

Q. Is your work based on particular beliefs about the root causes of most chronic pain conditions?
Hocking: Yes. We believe that chronic pain is purely a lifestyle disorder. So even if a patient is in a car accident, it's often how they led their lives before the accident that will determine whether or not they'll develop into a chronic pain patient. For example, a yoga teacher who gets into a car accident will probably do better afterward than a coach potato.

We also believe that almost all chronic pain come from what we call the core of the body, which consists of the gait—the hips, the spine, and the lumbar-sacral region of the body.

We also believe that one-sided dominance developed since childhood (whether you're right handed or left-handed) significantly influences the chronic pain process. Your body is supposed to be symmetrical, but because the body develops asymmetrically (predominantly using one side) it causes the hips and the sacrum to rotate, and therefore, the lower part of the spine to misalign. When a muscle deep in your bottom (the piriformis which connects the trochanter, or the leg bone, to the sacrum) shortens, it pulls the dominant leg (so if you’re right-handed, it will pull to the right) upwards out of alignment, causing a leg length discrepancy and rotating the sacrum. This is very important theory because the sacrum controls the spine, and the spine has one primary role—to compensate. Spinal compensation is necessary in order to keep the eyes and inner ears (Eustachian tubes) level, so you may walk upright without falling. So, if the sacrum is rotated, the spine is forced to overcompensate, speeding up the degenerative process throughout the spine (called arthritis), and eventually entrapping the nerves (called radiculopathy) and causing chronic pain. Therefore, this hip misalignment MUST be a major precipitating factor in all chronic pain syndromes.

So with ETPS Therapy, we initially stretch the piriformis muscle, balancing the leg lengths and realigning the sacrum, which in turn, will realign the spine. We then treat tight muscles in the bottom and at the nerve root innervating the patient’s pain problem, taking the pressure of the nerves and significantly relieving their pain. When we treat pain, we're not masking the pain like a traditional TENS unit or a pill will do. The ETPS device actually changes the muscles tissue, relaxing muscles which entrap nerves, and allowing the body to naturally relieve its own pain for long periods of time.

Q. Can you tell us briefly how you address the body in a different way through acupuncture?
Hocking: Although acupuncturists look at the body through an overall perspective, they believe disruptions in energy flow (Bi syndromes) and emotions (organ imbalances) cause pain. There is very little attention paid to the body’s misalignment or to nerve root entrapment. In Western medicine they believe that nerve entrapments cause pain, but no attention to why nerves become entrapped (gait and hip imbalances), body misalignments, energy flows or emotions of the body. Both approaches are right and they're both wrong. We have found that the key in pain management is to combine approaches, and then determine which system, or combination of systems, is correct. In some patients it's the energetic flow, others its emotions, still others it's a neurological entrapment. With ETPS, we can determine which one it is. Once you determine that, then you can easily treat the pain. For some, a few acupuncture points in the hands or feet can alleviate the pain, for others we have to treat the nerve root. Some it’s a combination. We have an efficient method to treat quickly and determine which method will work best. It's quickly individualized, and simple enough patients can easily apply it at home. It's a very good home therapy.

Q. How do you determine the origins of the problem?
Hocking: By using a system of trial and error and measuring the outcomes. With ETPS, we use a predetermined series of steps to determine the root cause of the problem by outcomes. If after any step the patient feels better, we've found the cause. If not, we go on to the next step. For example, a migraine headache, can have many causes such as the sacrum and lower back, the upper cervical occipital area, or through hormonal imbalances. With our approach we isolate different areas of the body and assess and treat those areas. We start with a few acupuncture points in the hand (hormonal), move on to (if necessary) to treating the lower back and sacrum, then apply stimulation to the back of the neck and trapezius regions, and finish off with local points. My experience is 90% of migraines are caused in the sacrum, so if your therapist is not treating there, you’re probably not getting the results you want.

We've broken down every pain condition to a simple series of steps. It allows the therapist or patient to quickly determine the optimal points to treat. For example if someone complains of elbow pain, it's almost never caused near the elbow. It’s usually a problem in the neck, lower back, or muscles in the gluteal area (piriformis). You have to step outside the box to successfully treat pain conditions today. A major problem in Western and Eastern medicine is that they isolate the pain conditions to their way of thinking without looking at how the rest of the body influences the problem.

Q. Earlier, you hinted that a person's lifestyle could have an effect on healing. Can you talk more about that?
Hocking: . Although ETPS can easily help break the pain cycle, we must also educate people about their lifestyle, ergonomics and bad habits. For instance, highly acidic foods such as soda pop, coffee, or orange juice, help creates an acidic state in the body, which contributes to muscles tightening up. So we ask people to eliminate them and consume foods which are alkaline, and drink LOTS of water!

Also, small things, like a man wearing a wallet in the back pocket, or women wearing tight bras, can significantly contribute to the pain process. We also know limbic system or emotional system also contributes to the chronic pain process by adversely affecting the autonomic nervous system, which controls pain levels. When we treat this with ETPS, we use traditional acupuncture to calm the fears, angers and worries that patients experience. So if a patient is angry, we treat through liver points. If they are scared, we treat kidney points. In some patients all they need are those emotional points to relieve their pain. It’s incredible.

Exercise is a huge thing for me. If you have identical twins and one practices yoga, stretches daily, breathes, and eats properly, and the other sits on the couch watching TV, their bodies will respond completely differently after an accident. Obviously, the one with the better lifestyle will recovers faster, and the other often never recovers. So I recommend that patients exercise more, with Yoga, tai chi, dance, and meditation my favorite exercises for chronic pain patients as they keep the hips and spine loose.

Q. What types of conditions respond best to ETPS?
Hocking: The easiest conditions for us to treat are neuromyofacial conditions such as back pain, fibromyalgia, and migraine headaches, RSD and carpal tunnel syndrome. These are the hardest to treat with traditional therapies, but for us they are the easiest because we step outside the box. ETPS is also very effective for sports injuries.

Bruce Hocking, D.Ac. M.D., M.A., is an international lecturer and developer of ETPS. He serves as a Professor of Oriental Medicine at Capital University School of Integrative Medicine and is author of several books and articles on pain management.