Saturday, November 21, 2009

National epidemic far worse than H1N1

An epidemic far worse than seasonal flu and H1N1 flu combined has swept the United States. To make matters worse, this epidemic is ignored and even supported by large corporations, the media and the government. This epidemic is that of prescription drugs. In fact, prescription drugs now cause more deaths each year in the US than street drug overdoses according to Leonard Paulozzi of the Centers for Disease Control and Prevention (CDC).

Consider that as of November 17, 2009, worldwide mortality from Swine Flu is 8,118. Deaths in the US from Swine Flu as of that date are 1,918. The CDC reports that over 26,000 Americans die each year from drug overdoses. Deaths in the US due to drug overdoses are more than 13 times more frequent than death from Swine Flu.

This comparison leads immediately to two observations. Firstly, there is no war on prescription drugs. In fact, prescription drug advertising in all forms of media including television continues to increase. Secondly, according to all recent studies, flu vaccines and medications are of no benefit in either reducing the severity of flu symptoms or shortening the time a patient needs to recover from the flu. Further, the use of medications such as Tamiflu may be harmful to some patients according to a study published in the British Medical Journal. The medications can be directly harmful to patients and their use may increase viral mutations to strains that resist any attempt to moderate symptoms.

Influenza has caused morbidity and mortality throughout human history. Some epidemics and pandemics have caused more harm than others. It is human nature to seek ways to ameliorate suffering whenever it appears and this is admirable. We should continue to investigate was in which pain and suffering might be reduced but we have not yet reached the point where this can be safely or effectively accomplished.

Most drug deaths result from addiction to medications used to reduce pain. According to the National Institute on Drug Abuse, addiction to pharmaceutical drugs is the fastest growing segment of this problem. Death from prescription drugs more than tripled between 1999 and 2006. This is truly an unrecognized epidemic that warrants far more attention than the current panic about the flu.

Alternative methods of pain relief will be discussed in future articles.

Sunday, August 2, 2009

How To Avoid Pain

Avoidable pain is frequently associated with injury to muscles, tendons, ligaments, bursae, discs and joints. While it is unlikely to live completely free of these common aches and pains, it is possible to minimize their severity, frequency and duration. There are 4 general rules to accomplish this goal.

1. Maintai
n the biomechanics of your body. This requires a periodic visit to your chiropractor even when you are feeling well. The chiropractor will help restore proper biomechanical alignment to your spine and extremities before any problem becomes clinical.

2. Exercise regularly. Do not over-exercise, however. The goal in exercise is to increase your heart rate but not to get out of breath. For some, this may be as little a
s stretching to maintain range of motion. All joints need motion to assist in repair and maintenance. In fact, studies show that if a good joint is immobilized, it will degenerate. Joint motion brings in nutrients the body needs for maintenance and removes waste product generated by normal activity.

3. Find ways to keep stress levels low. Rest following exercise. Learn relaxation techniques. Take up meditation. Explore Tai Chi. Find activities that promote a calm state-of-mind.

4. Pay attention to nutrition. The body will only maintain and rebuild most effectively based on the nutrients it has available. Foods today don’t contain the same levels of nutrients as in the past. The soil in which foods grow is depleted of some important nutrients. High quality nutritionals from specialized sources (not the supermarket or phar
macy) are critical.

The solution is simple and needs only a little planning. Avoid junk foods and fast foods. Use high quality foods that can be found in natural and organic stores like Whole Foods Markets. Obtain high quality supplements from health food stores or your health care professional, not supermarkets and drug stores. Get some exercise. Find ways to relax. See your chiropractor when needed but no less than once a month. This lifestyle will help keep you pain-free for many years.

Wednesday, July 22, 2009

Universal Health Care

The United States is the only industrialized country that does not have universal health care. There are an estimated 47 million U.S. citizens without health insurance. This places unimaginable stresses on the emergency departments of most hospitals because that is where people go when they have no other options. Overburdened emergency departments treat a very high percentage of indigent patients because it is against the law to withhold treatment to someone who needs it. This is only one of the factors that drive up health care costs in this country.

Expensive Health System
Current estimates put U.S. health care spending at more than 15% of GDP. This is a greater portion than any other United Nations member except for the Marshall Islands. Yet the U.S. lags far behind much of the rest of the world in both access to health care and quality of health care. Those Americans who do have access are receiving care that currently ranks only 37th in the world. Despite spending far more money than necessary to cover a limited number of citizens, Americans have a lower average life expectancy than those in other industrialized nations with universal health care, such as Australia, the United Kingdom, Canada, and Sweden. Infant mortality rates also remain higher in the U.S., despite declines in recent decades, and are higher than that of the European Union.

Most of the top 10 health care systems in the world are members of the European Union. Those citizens have not suffered from the woes of universal coverage as we've been warned by some commentators and politicians in the U.S. and the insurance industry in the E.U. is not suffering. Having discussed universal health care with a number of people being served by that system, I conclude that there is not now nor will there ever be a mass movement from national health to the U.S. health system. Despite the occasional foreign patient in our hospitals, the vast majority of people living under universal health care would not tolerate changing back to such an anti-democratic health system as the one in this country.

Garbage In; Garbage Out
At present, the United States is attempting to assemble a patchwork of changes designed to make no one happy but irritate as few people as possible. The end result may be slightly better than what we have now but will be far too expensive and inefficient to work. It will be garbage in and we can only expect garbage out after this endless series of compromises. The only winners will be the insurance companies. Such is the state of political polarization in the U.S. This also represents the level of political courage exhibited by our elected officials. Many of them know that the versions being considered in the House of Representatives and the U.S. Senate are far more expensive than necessary and are unworkable. Our legislators are supposed to put the country and its citizens above all else but this is not the situation in Washington, D.C. at the present time. A significant percentage of our elected officials are no more than cowardly politicians masquerading as statesmen. While pretending to protect the citizens of the United States from the dreaded “socialism”, they are, in fact, using that term (misunderstood by most Americans) to scare citizens into supporting a system that benefits only corporations, not real people.

Screwed By Insurance
Currently, several artificial layers of bureaucrats (insurance company employees) are positioned between you and your health care professional. Those layers are there to prevent you from getting the health care you desire when it doesn’t please your insurance company. They are extremely efficient at collecting your premiums but loath to authorize the treatments you need. Further, when treatment is authorized, you are often responsible for paying co-pays, deductibles and any difference between what the doctor charges and what little the insurance company considers “usual and customary rates” (UCR). At this time, most people who think they are covered by good health insurance are actually paying the insurance company and also paying the doctors and hospitals.

There can be no doubt that the health care system in the U.S. urgently needs changed. Insurance companies are an extremely expensive and inefficient method of rationing health care for this nation. Without the profit motive, covering every citizen of the U.S. would not be much more than the current costs for protecting (poorly) only a portion of the population. There are several innovative ways to pay for this health care as exhibited by systems already in place around the world. A peculiarly American system should not be hard to configure but for the trepidation of our legislators and their reluctance to show even a little political courage. Universal health care is the most logical choice for a nation that wants excellent and cost effective health care for its citizens. What we will need are politicians with the courage to become statesmen and place the people of the United States above the profits of insurance companies. They need, also, to rise above an irrational fear of a word, "socialism", they don’t understand. Stop pretending to work on this problem while you are actually looking for ways to explain to the citizens of the United States that they don't deserve the same quality of health care enjoyed by everyone in many other countries.

Sunday, July 12, 2009


Nutritional Considerations and Other Things to Remember

I must reiterate that myofascial pain syndromes are not inflammatory processes. Some comorbid conditions that frequently accompany MPS are inflammatory, but treating inflammation will not address the root of the problem. The root(s) of MPS appear to exist in the realms of the biochemical, neurologic and psychosocial. Solutions to this problem will, by the nature of the condition, need to address all those aspects to be successful. Anything less will not achieve the goal of reducing chronic pain. One man did not walk on the moon by himself. There were countless thousands of others who contributed to this success.

High quality nutrients play a critical role in your biochemistry. Some products are mass marketed with cost and convenience as a selling point. Taking a dose once a day is probably not beneficial. Your body frequently takes what it needs from the available supply when it is presented and the rest passes through. This is particularly true with most minerals and the water-soluble vitamins. So these need to be reintroduced periodically throughout the day.

The cost factor is deceptive. There are two ways to determine cost. One reduces to “cost per dose” and the other “cost per amount used”. Cost per dose can be appealing because it focuses on how cheaply you can buy what you need. But there is a problem with this. Without getting into an explanation of stereoisomerism, lets just say that a nutrient that your body uses can have a mirror image that is of no benefit to you. That chemical can also be called by the same name. It is cheaper to sell the non-beneficial one at a low cost. But you aren’t getting the benefit you are buying.

The “cost per amount used” method recognizes a concept called “bioavailability”. This takes into consideration the amount of a nutrient that your body actually absorbs and uses. While this method may appear to be more expensive per dose, it is cheaper based on the actual benefit you derive from it. You absorb and use more of what you are paying for. (My personal opinion is that supplements you find in grocery, drug or mall-type stores do not supply the appropriate quality. For this you need to find a reliable store that specializes in products with high bioavailability. Essentially, you get what you pay for.)

Because myofascial pain syndromes and fibromyalgia are multi-faceted, it is unlikely that any single approach will achieve a complete and permanent remission of symptoms. Your physician can help with physical and nutritional aspects. Clergy in your selected path and/or a psychologist can help with mental and emotional aspects. Your friends, family and support circle are crucial in helping in most of the areas as well as social aspects of your full life. Form a team consisting of your physician, spiritual advisor, psychologist, friends and family to help restore balance to your life. Just as a painting by Michelangelo contains more than one color, so you, as a sufferer from a complex condition, cannot be painted with one large brush. Don’t ignore some parts of yourself in favor of others. All of your uncountable shades must be addressed for the treatment to be complete.

Saturday, June 27, 2009


Exercising Your Mind

In my last blog post we talked about the complexity of human beings regarding how health care must be approached in order to be effective. We also talked a bit about physical exercise as a component of health maintenance. Nutritional support in pain reduction was the subject of an earlier post. Today, the topic is the mental aspects of people.

Very little has as much affect on your overall well-being as mental acuity and attitude. This is, as with your health in general, not just the absence of a diagnosable condition. It is more the presence of a number of positive characteristics. The goal is to have a balance between all as
pects of your life; work, rest, recreation, exercise, etc. This takes recognition that good mental health is a result of as many different factors as good physical health. There are quite a number of good books on the subject for both professionals and lay-people.

Staying mentally active means different things to different people. For some, watching cable news stimulates thinking. For others, it may be visiting your favorite museum. I know people who can tell you baseball statistics for a given day. Any mental activity that stimulates your interest is probably helpful in maintaining mental fitness. Several web sites that I have found interestin
g are AddictingGames and Kongregate. They offer a large number of online activities that stimulate the mind. One of particular interest is called 6 Differences. To play this game through AddictingGames, follow "A-G 6 Differences". For the same game through Kongregate, click "K-6 Differences". The object, as the name suggests, is to find 6 differences between two, seemingly identical, scenes. Some differences are easy to find and others are very difficult. Most players, though, seem to enjoy the music and this stimulating activity.

Computer games are another enjoyable way to stay alert. There are a variety of genres under the computer game umbrella such as action, ro
le-playing, battle/war and others. I personally don't feel the need to challenge my reflexes any longer so I avoid those games that involve kill or be killed scenarios. My favorite games are in the problem solving genre. One series of games that has been around for many years is Myst. There are at least five games in the series. All require puzzle solving and integrative skills that help maintain mental acuity.

Whatever you find interesting, it is to your benefit to fi
nd things to do that entertain and stimulate your mind. Myofascial Pain Syndromes and Fibromyalgia are more likely to respond to the multi-faceted treatment plan than to any “take a pill” approach. Next time we’ll briefly discuss the interrelatedness of emotional-social-spiritual aspects of healing.

Sunday, June 7, 2009


The Patient as a Holistic Entity

Successful treatment of Myofascial Pain Syndromes must include all aspect of the holistic health care approach. Holistic health is an approach that recognizes that people are not vessels bringing isolated complaints to the doctor but are a complex of the physical, mental, emotional, social and spiritual components inextricably woven together. Any attempt at healing must take all these aspects into consideration. People are not one of these things or another; but all of these.

Nutrition, as discussed in the previous post, is part of your physical aspect. Another part of your physical life is exercise. Early in most treatment protocols, a mild level of physical activity seems helpful for most patients. Depending on your fitness level; gentle, controlled stretching might be a good place to start. If this is not a challenge, then mild aerobic activity, concentrating on the large muscle groups, is good. Keep in mind that the typical “American” aerobic activity is really anaerobic. Work into more strenuous exercise as your body tells you.

Here is a valuable rule: If, in the middle of your workout, someone says “Hi, how are you?”, you should be able to respond without having to take a
series of deep breaths. If you have to “catch your breath” before responding then you have gone beyond aerobic exercise into anaerobic. This is not your goal. It is uncomfortable and non-productive. Over-exercise isn’t fun and it increases the chance that you’ll burn out and quit exercising. Exercise should be fun!

Beware! You are about to enter a muscle physiology paragraph. I will avoid the bioelectrical chemistry involved in how this happens, but it is important to recognize several facts. One major component of your overall energy
level and THE source of energy for your muscles is a component within each muscle cell called mitochondria. These are microscopic power plants that create the molecules your body uses for energy. The more aerobically fit we are, the more mitochondria are found in each cell. Picture this: A marathon runner has so many mitochondria in each muscle cell that they burn more calories and create more energy while sleeping than most of us do when we’re exercising!

Your body will create as many mitochondria as it thinks it needs. This does not happen overnight and does not happen with anaerobic exercise. Slowly increasing your aerobic fitness over a 3 to 6 month period will change your energy levels and, as a pleasant side-effect, will help you convert body fat to lean muscle mass. For more information on this subject in an easy to read book, look for “Fit or Fat” by Covert Bailey.

As I mentioned at the beginning of this article, the human being is made up of a number of components. Treating the physical aspect alone will make you feel somewhat better but will not completely solve the problem. Mental, emotional, social and spiritual considerations have to come into play. I will continue to discuss these in the next post, “Exercising Your Mind”.

Wednesday, June 3, 2009


Some Things That Seem To Help

Some patients over the years have responded well to some or all of the following components. I cannot say the patients achieved complete recovery from MPS because remaining pain-free requires a lifestyle change rather than a treatment protocol. A number of patients have maintained this change and enjoy relatively “normal” lives. Others found it too difficult to make the necessary shift in realities. Everyone is different and what works for some doesn’t necessarily work for all.

The first consideration in any comprehensive approach is nutrition. A balanced diet rich in high quality foods is a necessary starting point. Avoid Fast Foods! Become a familiar face at your local farmer’s market. Try to eat whate
ver is in season in your region. But even in the best circumstances, foods grown in our nutrient depleted soils will not supply you with everything necessary to confront MPS. Supplementation with high-quality nutritionals in bio-available forms is crucial. Start with a multi-vitamin/mineral and add in further supplementation as needed.

Helpful nutrients include malic acid, magnesium, manganese and the B vitamins. Malic acid seems to help as a transport molecule to move other nutrients to where they are needed. It also helps facilitate the use of oxygen in energy production.

m, in a chelated form, helps reduce pain and feeds the energy production cycle. It also helps with absorption of other nutrients. Since magnesium can also act as a laxative (like “Milk of Magnesia”), it is important to use chelated or double bond forms rather than oxides or sulfates.

Manganese, in an amino acid chelated form, assists in transporting vital amino acids into your body for use in rebuilding injured soft tissue with less fibrosis. It also has a beneficial affect on brain function. Manganese is a component of SOD (superoxide dismutase); an important enzyme that acts as an anti-oxidant that helps prevent free radical damage to muscles. Keep in mind, though, that while it is essential for human life, too much manganese can cause toxicity with significant symptoms up to and including death.

The B Vitamins, particularly thiamin (B1) and pyridoxine (B6), are useful in neurologic balance and muscular relaxation. They are also critical factors in energy production. In the absence of B Vitamin metabolism, energy levels are depressed. This is one cause of lethargy and muscle fatigue.

I recommend using supplements that are of pharmaceutical grade. These are frequently available through your chiropractor or other non-allopathic health care provider. Avoid supermarket and drug store supplements. These tend to be inferior. Brands I have grown to trust include Metagenics, Anabolic Laboratories and Standard Process. At first glance, these supplements appear to cost more but when you factor in the amount you actually absorb and use, they are the least expensive on the market.

The treatment of Myofascial Pain Syndromes requires a holistic approach. Holism is an ancient health care tradition that was largely forgotten in the last century. It recognizes the patient as an entity comprised of physical, mental, emotional and spiritual components. Without encompassing all these, successful treatment is unlikely. In my next post I will address some of these features.


Tuesday, May 26, 2009


How Does This All Work?

Impressive sub-title, huh? The reality is that we don’t really know how it all works. Right now, research is snapping at the edges of what promises to be a very complex set of conditions. This is one good reason for legitimate scientific research funding from governments. Certainly, there is good and valuable research funded by private enterprise and non-governmental organizations (NGOs) but those entities often have specific agendas regarding the directions and results of research they fund. Those organizations, as the old adage states, “…have a dog in the race.” Their profits and/or organizational values are foremost in any decision to fund research. This profoundly affects the questions put forth in the investigation and in how the study is constructed.

Also, to dredge up another old adage, “When your only tool is a hammer, all problems begin to look like nails.” At risk of belaboring the point, let me explain. Private enterprise is most interested in research that promotes whatever product the company manufactures or sells. NGOs want to support investigations whose results closely align with their values. For example, pharmaceutical manufacturers want results that prove a recently developed drug is the best treatment for a problem and any solution other than use of that drug 2nd best. A NGO may want to prove the best solution to a problem is to follow the specific course of action advocated by the organization. Other, possibly better, solutions are ignored because the NGO wants to impose it’s value system on the target population to the exclusion of more efficient approaches.

Governmental support of basic science or health research is less likely to attempt to influence the direction of that investigation. As a result, much of the technological and scientific advancements that placed the United States at the vanguard of innumerable fields have come from government support of basic research. Many of these investigations offered no immediate benefit, only the opportunity to advance the general knowledge base of society. One example is the space program, out of which entire industries were created that did not exist even 30 years ago.

To say that we don’t know how it all works is true. But we have a pretty good idea how some of it works. There are a number of conditions or circumstances that seem to contribute to myofascial pain syndromes.

Sleep disorders may be closely associated with MPS. If you wake in the morning feeling that you are still tired, you may have a sleep disorder. Your body needs a particular sleep cycle sequence in order to heal and resupply with necessary hormones, biochemicals and anti-bodies. If your sleep cycle is disrupted, these critical tasks are not accomplished. Sleep is loosely divided between a phase called Rapid Eye Movement (REM) and Non-Rapid Eye Movement (NREM). REM sleep is also considered the dreaming phase of sleep and its importance is not understood. This may be when memories are moved from short-term to long-term storage but that is only a guess. NREM sleep is more cogent to our discussion because it is during this phase that synthesis of necessary chemicals is done as is much of the healing and repair required to keep your body functioning.

Studies have shown that sleep disorders and MPS are closely associated. In fact, 70% of MPS patients recognize that poor sleep makes their symptoms significantly worse. This is an area that should be pursued by MPS patients in a complete approach to reducing symptoms.

Depression is also found in many MPS patients. Again, the specifics of this connection are not defined. Some believe there is a direct and intimate relationship between the two while others are firm that any depression in MPS patients is primarily due to sleep deprivation. Pharmaceutical solutions to sleep disorders and depression are not a cure. In fact, neither sleep disorders nor depression have shown to respond particularly well to drug treatment alone. Both, however, seem to diminish with an appropriate regimen of exercise, dietary modification and stress management. (I recommend discussing your desires and goals with your physician and working out a suitable program together.)

Cognitive Dysfunction is a decreased ability to think, learn, remember or reason. This is a common problem with MPS and may actually cause more trouble than any other symptom. I’ve seen this referred to as “fibro-fog” and is due to alterations in various types of memory storage and reasoning systems in your brain. Obviously, with moderate to severe cognitive dysfunction your school, career, personal relationships, emotional well-being and even your physical safety can be impaired.

CNS Imbalances, as mentioned in an earlier post, document a number of chemicals and neurotransmitters that can have a detrimental affect on your ability to think, do your job and even increase your perceived pain levels.

Physical and Emotional Stresses can have the unfortunate affect of making symptoms worse and then, as your functional abilities decrease, cause misunderstandings with your co-workers, friends and family. This, of course, further increases those same stressors, thus creating a vicious cycle that feeds on itself.

The last few parts of this topic have touched on a few aspects of MPS but I haven’t discussed much about what can be don to alleviate your symptoms. The next section (part 7) “Some Things That Seem To Help”, will address a few treatment considerations I have found helpful over the years.

Tuesday, May 19, 2009


What Else May Be Involved?

Fibromyalgia and TP syndromes have some similarities. Both, for instance, subject you to the discomfort of tender muscles, even with fairly light pressure. Pain from pressure on trigger points sends pain to other areas. This is called “referred pain”. But pain associated with fibromyalgia tends to be only where pressure is applied. This is “localized pain”. The important point to remember, though, is that you can have both!

Patients with TP syndromes can certainly experience other conditions at the same time. This situation is called “comorbidity”. But, by-and-large, comorbidity in TP syndromes is coincidental and you are just as likely to experience only the trigger points without other complicating circumstances.

Fibromyalgia, on the other hand, frequently occurs along with other conditions or diseases. The existence of these comorbidities makes diagnosis and treatment much more difficult. The exact nature of the relationship between fibromyalgia and one or more other conditions is poorly understood. Does one cause another? We simply do not know.

The following is a list of conditions frequently associated with fibromyalgia:
Irritable Bowel Syndrome, Headaches (various types), Dysmenorrhea (painful menstruation), Unexplained Skin Sensations, TMJ, Mitral Valve Prolapse, Restless Leg Syndrome, Allergies, Chemical Sensitivity, Disorders of Muscular or Ligamentous Attachments to Bones, Disorders of the Esophagus, Vision Disturbances, Anxiety, Lung or Breathing Problems, Reynaud’s Phenomenon, Thyroid Dysfunction, Lyme’s Disease, Silicone Breast Implant Syndrome, Rheumatoid Arthritis, Systemic Lupus Erythematosus, Frequent Infections, Osteoarthritis, Chronic Fatigue Syndrome, Carpal Tunnel Syndrome, Hyperventilation, PMS, Depression, Cognitive Dysfunction, Sleep Disorders, Others I did not list.

If you have fibromyalgia, one or more of the conditions above can aggravate your symptoms and make treatment significantly more difficult. It has been suggested that the causes of comorbid conditions and the causes of fibromyalgia may be similar or even the same. Much more research is required to sort out this complex situation.

As you can see, it is all too easy to treat one or more of the above conditions without recognizing there is a concomitant fibromyalgia that also requires treatment. It is little wonder that many MPS sufferers spend years, spend money and change doctors often; without achieving the pain relief they seek.

Next I will look more closely at some of the conditions in the above list. This will be the topic of my next post: Current Thought on Pain Reduction in Myofascial Pain Syndromes (part 6) How Does This All Work?

Monday, May 11, 2009


Who Gets MPS?

Myofascial Pain Syndromes don’t appear to affect everyone equally. While the U.S. population seems to have only a 2% to 8% rate of MPS, this translates to a minimum of 8 million people at any given time. The condition, for reasons unknown, affects women more than men. Women are more likely to suffer from MPS by a ratio of about 7:1. Interestingly, though, the difference in incidence between girls and boys is negligible. Obviously, a lot more research must be done on this issue because by explaining this difference may point to better ways to treat the condition.

MPS can affect people of all ages but the diagnosis usually happens between the ages of 20 and 55 years. There is some speculation that younger people aren’t diagnosed as often because their muscles and fascia are better able to cope with stresses.

Race appears to have no affect upon the likelihood of contracting this condition. It seems to occur equally in all races and cultures. MPS has been found worldwide with very similar rates as noted for the U.S.

How does this affect the broader society? With some form of MPS experienced by as many as 1/10th of the population, there must be immeasurable consequences to all aspects of social structure. MPS patients are not the only victims of the condition. Family, friends and co-workers are also affected. Studies have shown that about 1/3 of patients must alter their work habits to accommodate for disabilities related to job requirements. These alterations may result in a slower work pace and/or may require co-workers to do extra work to compensate.

Family may suffer due to the patient’s need to work fewer hours thus bringing home smaller paychecks. Some patients are forced to exchange their jobs for less strenuous ones that pay less. Interpersonal relationships can suffer due to depression, frustration or impatience. Financial commitments due to medical treatments may increase as income decreases, thus further increasing stress levels.

It is estimated, based upon a number of reports that long-term disability awards have been made to 15% to 45% of MPS patients. Considering disability payments and loss of productivity, the cost to society must be truly significant. One study found that MPS costs the U.S. economy an estimated $9 billion annually.

Another aspect of MPS is that it rarely occurs alone. It is frequently accompanied by one or more other conditions or diseases. We’ll discuss this topic in the next post, Part 5: Current Thought On Pain Reduction In MPS: What Else Might Be Involved?

Tuesday, May 5, 2009


Despite having a long history (as far back as the 1600s), fibromyalgia was not recognized as an actual medical issue until the 1980s. Some physicians still do not accept fibromyalgia as a distinct condition in spite of its inclusion in the official list of diagnoses since 1987.

Fibromyalgia is complex to diagnose and to treat. There is no defining orthopedic or laboratory test that is diagnostic for fibromyalgia. The physician must look for a combination of exam findings and correlate those with pertinent information from a detailed history. If certain criteria are met, then the doctor can assume you have fibromyalgia.

Treating fibromyalgia can be complicated and, sometimes, frustrating for you and your doctor. Although inflammation is frequently present with fibromyalgia, it seems unconnected with the condition. There may be a connection, either as a cause or an affect, but recent research shows no demonstrable relationship. This is unfortunate because it precludes treating an inflammatory condition and having pain go away. Treating inflammation when you have concurrent fibromyalgia may decrease or eliminate some pain but the fibromyalgia and associated symptoms remain.

What causes fibromyalgia is not clear. As studies continue, more information emerges. Currently, it appears that fibromyalgia is associated with changes to the central nervous system (CNS). More specifically, there seems to be a change in how your body processes pain messages. It is unclear at this point whether this change is due to a previously minor pain message being “multiplied” by your nervous system or because your CNS has become hypersensitive to pain stimuli. This is similar to hearing a radio more loudly but not being sure if the cause was someone turning up the volume or that your ear is working better.

Most recent studies suggest that the problem may lie with alterations in normal chemical activity in your body. A number of CNS chemicals are frequently found to be outside normal ranges in fibromyalgia patients. I will gladly forward more specific information on these imbalances to those who are interested.

There also appears to be a familial component to fibromyalgia. In other words, there may be a genetic predisposition toward fibromyalgia because it seems prevalent in some families but not in others. Remember, though, that a genetic predisposition is like a gun. If the trigger isn’t pulled, the gun doesn’t fire. Similarly, if you don’t do a sequence of activities or behaviors that might initiate the fibromyalgia, it is unlikely to occur.

I will discuss other findings and selected treatment considerations in part 4 of our discussion.

Sunday, April 5, 2009


In Part 1 of this discussion of myofascial pain syndromes (MPS), we talked about symptoms caused by trigger points (TP). While this type of pain syndrome is aggravating for the sufferer and complex for a physician to treat, it is actually fairly straightforward in comparison to those without trigger points. The TP generated pain conditions are caused by lesions that are local and readily identifiable once the symptom pattern and history are considered. Myofascial pain in the absence of TPs is a different matter.

Some people regard this as a completely separate condition but that may be splitting hairs. The results of both are similar in that there is muscle pain, joint pain, tenderness, and inflammation. In fact, the American Medical Association’s (AMA) coding manual used by almost every physician, insurance company and workers’ compensation organization uses the same code number for myofascial pain syndrome, myofascitis, myositis, fibromyositis and fibromyalgia. For clarity, we will refer to this form as Fibromyalgia and the pain caused by trigger points as TP Syndrome.

While the AMA, the National Institutes of Health (NIH) and the World Health Organization (WHO) recognize the existence of Fibromyalgia, some physicians do not. Consequently, many patients spend years and visit a number of physicians looking for an accurate diagnosis. Patients become frustrated with treatments that do little or nothing to address their complaints; some even undergo surgeries that are, at best, unnecessary.

There are clear differences, though, between Fibromyalgia and TP Syndromes. Fibromyalgia is more systemic than the localized TP Syndromes. Both cause and affect of Fibromyalgia are more widespread. Most recent research supports central nervous system (CNS) involvement. It is thought that the CNS is made overly sensitized to stimuli.

Defining the problem is necessary but is certainly not a solution. It is only a first step. What must follow are investigations into characteristics of the condition. Research has shown chemical, endocrine and hormonal differences between Fibromyalgia sufferers and the wider population. What findings differentiate the Fibromyalgia group from the “normal” population? What causes the changes in some patients? What can be done to alleviate the symptoms? What can be done to assist the patient in eliminating this painful and debilitating condition completely? These are complex questions I will attempt to address in the next part of our discussion.

Tuesday, March 31, 2009


Myofascial Pain Syndromes
Have you found making it through the day seems to be harder and harder because of muscle stiffness, soreness and pain? You may be suffering from a myofascial pain syndrome. Myofascial pain syndromes (MPS) are a growing problem in the United States and beyond. There are quite a few variations of this malady; nearly as many as there are people who suffer from the symptoms. A general presentation might (but, then again, might not) include an inflammation of the thin covering over a muscle or muscles (fascia), muscle pain, joint pain, focal tenderness and muscle tension. These are frequently made worse by stress (physical, emotional or spiritual), weather changes, physical activity, injury to an internal structure or organ, repetitive motion and/or inactivity.

One Important Form of MPS
One feature frequently found in MPS is the existence of trigger points (TP).
These small, tender nodules can be found by palpating (touching) the skin with a firm pressure. They often occur in predictable locations and have the ability to create pain patterns that have little to do with the location of the trigger point. For example, a trigger point found near the place where your neck connects to your body can create pain in your forearm. A trigger point in a low back muscle is quite capable of creating pain that seems to be coming from your foot.

A number of techniques have been developed over the years to treat trigger points. These include a variety that run from gentle non-invasive through aggressive non-invasive to frankly invasive procedures. Gentle non-invasive techniques might include electrical muscle stimulation and moist heat. More aggressively, therapeutic massage that focuses on trigger points has been shown to relieve pain and dissipate trigger points. A more invasive technique is trigger point injections to help break up tenacious TPs that refuse to dissolve as described by Dr. Janet Travell in her book, “Myofascial Pain and Dysfunction: The Trigger Point Manual”.

What is a trigger point?
Trigger points are frequently created as a result of the natural activities of your own body. During normal muscle activity, waste products are created (lactic acid and other materials). Your body wants to rid itself of this noxious waste and usually does so by having it removed by the blood and lymphatic systems. But if, for example, tight muscles prevent normal blood and lymphatic flow, the waste can accumulate in small pools near the muscles. These are trigger points.

Treatment expectations
Pain referral patterns of trigger points can sometimes mimic other conditions. I have treated patients with diagnoses of carpal tunnel syndrome and sciatica who were concerned about recommended surgeries. Using trigger point therapy those symptoms were frequently resolved without surgical intervention. This is no guarantee that your symptoms will respond in a like manner, but it is usually a good idea to treat from least invasive to most invasive one step at a time. As you progress through your program, the specifics of treatment will change based upon your progress. This takes time so you should have patience and stick to the treatment instructions to move from elimination of the trigger point to rehabilitation of the muscles.

Treatment results are less predictable than we’d like and they must be created for each individual patient and change as you move through the healing process.. It is a “hit-and-miss” situation while looking for the ideal strategy. Currently, the “Best Guess” method in determining an appropriate treatment protocol is our only option. I have found that a large majority of patients respond well to a combination of chiropractic adjusting and therapeutic massage. If the symptoms and findings don’t resolve completely, referral to a pain management physician for injections is appropriate. Manipulation under anesthesia can also be beneficial in treating MPS. Finally, a surgical consultation is available if all else fails.

Some forms of MPS do not involve trigger points. I will explore some of these in the next part of our discussion.

Saturday, March 21, 2009


Pain is one of your brain’s interpretations of information received through your nervous system and is the result of some sort of stimulus from outside or from within your body. Most of us have a variety of interpretations available to us, including pain, pleasure, irritation, vibration and others. Pain is the way your brain tells you that something isn’t right and you need to find the cause.

The brain is also frequently capable of discerning the general location of this noxious stimulus. For example, if you feel a pain in your left leg, you initially look at your left leg to see if something from outside your body (exogenous) is causing this pain. If you find the cause, you remove it; a thorn, splinter, bee sting, etc.

Pain from an internal cause (endogenous) is more difficult to identify. But the solution is the same. Identify the cause and remove it. This is best done using approaches starting with the least invasive and moving one step at a time toward most invasive.

There are many possible causes of internally generated pain but it can be classified into two main categories: Acute and Chronic. Pain can also have a number of different descriptors like sharp, electric, stabbing, burning, throbbing, achy, etc. Each gives us information useful in determining the real cause and location of the pain causing lesion.

Acute pain is frequently exogenous but can also be endogenous. This is usually more severe and immediate in the sense that it often appears quickly and demands immediate attention because it instantly alters your daily activities. Chronic pain can also be severe but is longer term. It doesn’t come as a surprise because the sufferer has had this condition for an extended period. Chronic pain can also interfere with your daily activities but many patients have worked out a way to do at least some of their activities by changing how they accomplish these.

The brain can sometimes be fooled, especially by endogenous pain. Pain can be generated by problems with the bones, joints, muscles, ligaments, tendons, blood vessels, lymphatic vessels or the nerves themselves. The situation can be complicated by pain perceived by the brain as occurring in one location but the cause may be in a completely different one. For example, a tear in one of the muscles may cause that left leg pain but it may also be caused by pressure on the nerve that runs to that region suffering interference at a different location.

One area where this interference frequently occurs is in the spine. There are a number of structures near that nerve where it exits the spine that can put pressure on it. The brain interprets the input as coming from where that nerve terminates rather than at the point of interference. So, leg pain may actually have little or nothing to do with the leg. Physical examination, nerve testing and imaging with x-ray, MRI and CT are invaluable in making the correct diagnosis.

Medications can help with some pain in the sense that the nerve impulses can be interrupted or altered so that the brain no longer interprets pain messages. But these medications are for temporary pain relief only. They do not indentify or eliminate the cause of the pain.

Medications should only be used as a Band-Aid, not as a cure. Hiding your pain with pain relievers, muscle relaxants and anti-inflammatory medications can help you feel better for a little while, but before too long, the continuing damage will worsen to a point that the medications are no longer able mask the pain. Remember that your pain is not caused by a steroid deficiency and that the medications should be used to make you feel more comfortable while you and your physician look for the real cause of the pain.

Thursday, March 12, 2009

Horse and Human: Two Members of One Team

Equestrian activities are among the very few sports with teams made up of members from two different species. Top efficiency of both team members promotes better enjoyment of recreational rides, a higher level of competition and a safer ride for both. Most experienced riders assume that if the team turns in a bad performance, it is never your horse’s fault and always the rider’s responsibility. But it is your horse, alone, that receives the best possible care; some of you even providing equine chiropractic for them. But your horse is only half the team. You need and deserve to be in top form, also. Ultimately, the entire riding experience; enjoyment, performance and safety are dependent upon you and your horse both being at your best.

This partnership requires precise contributions from both team members. Your ability to maintain the most effective seat is as important as your horse’s preparation in both recreational riding and in competition. Critical communication between horse and rider is enhanced when you are structurally aligned and balanced; sending clear messages to your partner rather than ambiguous or contradictory ones. The strength and balance of your abdomen and back and your ability to exert fine control over your thigh’s adductor muscles and buttock muscles intensifies the accuracy of the message you send to your teammate. This enhances your ability to maintain a deep seat and yet with your knees relaxed but flat on the saddle. This communication ultimately frees your horse increasing both performance levels and longevity.

Top athletes, including Olympians and professionals, use chiropractic treatments to amplify the effects of training and improve competitive status. Your goals may include a more enjoyable trail ride, assistance in moving to the next level of competition or even more focus and energy in your ride. Whatever it may be, we can help you with this goal.

Saturday, March 7, 2009

Getting Beyond the Pain

No doctor ever cured anyone of anything. The most we can hope for is to put your body into the best possible position to heal itself.
Having said that, health care in general and chiropractic specifically are replete with stories of “miracle cures” but the most remarkable miracle cures are those that result from long, patient work. Most chiropractic patients arrive with complaints that have been present, in varying intensities, for many years. Typically, they have tried a bewildering number of treatment approaches and enjoyed some success in reducing symptoms. But the symptoms, pain, numbness, tingling, weak muscles, etc., never completely resolve. Many decide to try chiropractic as a last resort.

This puts the chiropractic approach at a disadvantage because of having to address abnormal chronic changes that have established over time. For example,
“With soft tissue injuries there is frequently tearing and stretching of the involved soft-tissues as well as damage produced from local micro-hemorrhage and inflammation. The reaction is the usual bodily response to such trauma and its inevitable sequelae commonly known as “scar tissue”. Scar tissue forms not only on the skin, but on all internal lesions as well; such as muscle tears, sprains, strains, or where internal surgery has been performed. As damaged tissues heal, local areas of inflammation remain chronic sources of irritation because the body repairs a wound, ulcer, or other lesions by increasing its production of the tough, fibrous protein, collagen, at the site of damage. The collagen helps form new connective tissue that covers the area to the lesion. Adhesions are areas of scar tissue that form between internal organs and are a potential complication of not only internal surgeries, such as intestinal operations, but also of sprains, strains, and other soft tissue lesions. This results in area tissues that retain fluid from the inflamed state. This further creates a weakening of the fibers, as well as creating a rigid and fibrotic state due to “healed” but damaged tissue.” (Reference: The American Medical Association Encyclopedia of Medicine, Random House, New York, 1989).

The first step in working with your chronic complaints is to “back out” some of the results and sequelae of previous treatments and the chronic changes inherent in longer-term injuries. This requires commitment, compliance and patience on your part and that of the doctor. Recognizing that the fibrotic tissue of a scar tends to develop in a disorganized ball rather than along organized planes the body needs, the first task is to re-organize that tissue so it works with you rather than presenting an obstacle to normal function.

This is not to say that you will not see benefits fairly quickly because you probably will. But you should keep in mind that to achieve as close to 100% as possible will take time. You do not notice pain until your body reaches a pain threshold. Your chiropractor can often help you back across that pain threshold fairly quickly but that is nowhere near 100%. You are just on the other side of that threshold and the least stress can send you back into pain. The goal is to move you as far from pain as possible and this takes time and treatment. Much of your chiropractic treatment will occur while you are not suffering from acute pain.

Remember, your body didn’t get this way overnight and is not going to achieve repair quickly. However, the goal of achieving and exceeding a pain-free life is well worth the commitment.