CURRENT THOUGHT ON PAIN REDUCTION IN MYOFASCIAL PAIN SYNDROMES (Part 9)

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 aspects 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 interesting 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, role-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 find 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.

CURRENT THOUGHT ON PAIN REDUCTION IN MYOFASCIAL PAIN SYNDROMES (Part 8)

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”.

CURRENT THOUGHT ON PAIN REDUCTION IN MYOFASCIAL PAIN SYNDROMES (Part 7)

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 whatever 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.

Magnesium, 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.

Chiromobile

CURRENT THOUGHT ON PAIN REDUCTION IN MYOFASCIAL PAIN SYNDROMES (Part 6)

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.

CURRENT THOUGHT ON PAIN REDUCTION IN MYOFASCIAL PAIN SYNDROMES (Part 5)

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?

CURRENT THOUGHT ON PAIN REDUCTION IN MYOFASCIAL PAIN SYNDROMES (Part 4)

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?

CURRENT THOUGHT ON PAIN REDUCTION IN MYOFASCIAL PAIN SYNDROMES (Part 3)

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.