iSaw 01.07- Musculoskeletal Pain Riddles and New Ideas

Good idea
Last week I attended the above-named free, 4-hour symposium at the Brigham and Women’s Hospital. B&W is a well-known Boston institution that regularly host events to ‘encourage cross-disciplinary, “out of the box” communication on a topic that is in great need of new solutions’. See

Session 1 – Translating New Ideas Into Better Patient Care
To open the session, Dr. Thomas Thornhill stated that doctor empathy will greatly improve outcomes post-total knee replacement. Despite this, he said, 15-20% of new knees will be unhappy knees. Jeffry Shaefer, DMD had slides showing Travell and Simons MTrPs in the masseter muscle. Without expanding on MTrPs he explained the disproportionate amount of TMD pain in women by an excess of estrogen receptors. Marco Loggia, PhD showed images of the brain in pain showing widely distributed and functionally connected parts, with the insula more active in fibromyalgia. Jian Kong, MD suggested self-healing, placebo and specific interventions are a valid threesome in solving musculoskeletal pain. The subject of mindfulness and the difficulty of multiple intervention research concluded the opening session.

Session 2 – Where is the Pain Coming From?
Scott Martin, MD showed slides of hip labrum damage that looked very painful. THJRs have better pain-free recovery than TKJRs. Why’s that? Nobody knows. Fascial researcher Helene Langevin, MD showed us the familiar slides of Jay Shah and Siddhartha Sikdar of the NIH (we love these guys), but she would not use the phrase ‘trigger point’. Instead she used ‘tender nodules’. Central and peripheral sensitization was also discussed. Jeffrey Neal, PT talked about ‘shirt-on’ mechanoreceptors – those that act fast, acknowledge the presence of shirt-on-skin, and then switch off, because they can. He compared these to the nociceptive free-nerve endings that transmit slow, constant, relentless messages. (The permanent ‘shirt-on’ cases are some of the toughest we see at 360 NMT and we have had to develop some cunning ways of dealing with them.)

Panel discussion
To have conventional orthopedists, surgeons and researchers mix with other LAc’s, PhD’s & MD’s who explore the spectra of fascia, mind-body exercise and placebo is quite nice. To have them agree that damage and pain don’t always correlate, and also admit that pain is tricky is even nicer. My question to the panel was “where was the ‘muscle’ in musculoskeletal pain? What about trigger points?” Answers were non-committal. But what about this! One of the illuminati admitted that after his own back surgery a holiday massage in Greece surprisingly helped his back pain. Hello…