The Otto 128 is used for pain management, muscle spasms, or circulation. It promotes relaxation by stimulating the nervous system and the release of nitric oxide. Nitric oxide, a gas in our blood vessels, is known to relieve pain and promote relaxation and health. — Includes carry pouch — — Made in the USA by Omnivos Therapeutics — Be sure the "Sold By" information at the top of this page says Omnivos Therapeutics, others claim to be selling our quality tuning forks but are not. — — Our professional grade aluminum tuning forks are made of impact resistance aluminum making it approximately 26% harder and giving it a ring time up to 20% longer than other manufacturers. It has lower levels of impurities with the highest rating for surface finish per the Reynolds Aluminum Engineering Study. As are result, our material is more immune to corrosion and pitting. — All of our forks are tuned to within .5% of the indicated frequency at 20 degrees Celsius, 68 degrees Fahrenheit and is subject to at least three inspection processes to eliminate imperfections. Other manufacturers tune to as high as 2.5%. Each fork comes with a carry bag, please note that the bag color may be different than what you see in the picture.