Myofascial Trigger Point Syndromes and Chronic Pain
Commonly after trauma with subsequent muscle pain, discomfort can not only persist, but can become more intense and wide spread. This phenomenon can also occur after a not so obvious trauma; for example, repeated weight lifting, or merely lifting a bulky box and turning while placing it. In the first case, one can readily associate the pain with the trauma, like a motor vehicle accident with whiplash injury. In the second case, the pain may come on gradually with increasing intensity. In a third case, muscle pain may increase slowly over time, migrating to different areas day to day, and vary in intensity, with no apparent trauma. In any case pain can become chronic and seemingly self- perpetuating. Because painful muscles resist stretch, normal range of motion becomes restricted causing involuntary guarding and stiffness. Walking and grasping patterns can change adding new limits to motion and recruiting alternate muscles to take up the slack of the injured muscles which are too uncomfortable to move. This adds additional strains with the new pain and discomfort not related to the original trauma. In this way, chronic pain patterns can be established.
Various names have been given to these muscular disorders: Fibromyalgia, Fibrositis, Polymyalgia, Rheumatism, etc. Conventional therapy with anti-inflammatories or steroids are not only not very effective, but can cause metabolic side effects which can perpetuate the problem.
What Are Myofascial Trigger Points?
In up to 85% of all such chronic pain cases, active Myofascial Trigger Points (MTP's) within muscles are the primary cause. MTP's were first discovered and researched by Janet Travell, M.D. They are now known to be tender areas within a taut band of muscle, which can give referred pain to other areas of the body, and elicit involuntary nervous system responses such as cold hands and feet, nasal drainage and rapid heart rate. Usually the area of experienced pain is not the source of the pain, but referred from a primary MTP. For example, temporal headaches may be caused by an MTP in the cheek muscle due to TMJ dysfunction. Another example is pain in the groin or in front of the thigh, but caused by a problem of MTPs in the low back in the iliopsoas muscle. Treating the pain in the thigh in this case is important, but will become recurrent unless the primary MTP is treated in the back.
The primary and referred pain from MTPs is due to overactive or facilitated nerve circuits from the trigger point. These pain fibers are in a state of rapid firing, continuously sending pain messages to the brain through the spinal cord. Here, two things occur. First the fibers connect to reflex motor nerves causing spasm back in the muscle. Second, referred pain occurs in the spinal cord where several pain fibers from various parts of the body converge or come together on a single nerve sending pain messages to the brain. The brain in turn cannot determine where the original pain comes from. So a trigger point in the right shoulder could be felt as a pain in the right eye, which will disappear if the MTP in the shoulder is eliminated.
Treatment Of Myofascial Pain
Trigger points and myofascial pain respond well to stretching and pressure therapy which can be given by certified myofascial therapists. However, often stretching and pressure are ineffective in giving permanent relief due to extremely active MTPs and the length of time they have been active. Oral pain and anti-inflammatory drugs can temporarily relieve some of the pain, but do nothing to eliminate the cause. Acupuncture can be quite helpful to calm trigger points and assist in reprogramming the nervous system. But here again, with severe chronicity, acupuncture may only give temporary relief. The most effective treatment I have found for chronic, sever myofascial trigger point pain syndrome is injection of the trigger points using a combination of local anesthetic, calcium and most importantly an extract of the pitcher plant called Sarapin. The calcium replenishes the muscle cells with calcium which has leaked out predisposing the spasm. The Sarapin has a unique action of desensitizing and deactivating the rapid firing pain fibers, thereby breaking the pain-spasm cycle, and blocking pain impulses to the brain. After injecting several MTPs in a session, patients become relaxed and less anxious. Certain metabolic factors such as vitamin deficiencies and subclinical thyroid problems can cause perpetuation or MTPs. These conditions must also be corrected to help restore normal muscle function permanently.