I subscribe to a yahoo group called myofascialtherapy@yahoogroups.com

Every now and then there is a flurry of activity. Recently, a patient’s (Deena) enquiry was posted asked for advice when gentle pressure led to nausea and intolerable pain. It prompted me to make the following contribution.

“As an instructor for Myopain Seminars and as a business owner seeing nothing but severe and seemingly enigmatic cases of muscle pain and myofascial pain I would like to share some resources that myself and my fellow therapists and course graduates use to help solve them.

The two 2010 texts ‘Muscle Pain, Vol 1&2′ by Mense and Gerwin are the foundations of the Pain Science lectures that I teach. They have certainly helped me better understand pain chronicity. Many of the terms that people in this forum are using have medical equivalents. The book’s explanations of allodynia, hyperalgesia, central and peripheral sensitization, and role of the HPA axis add to the understanding of Deena’s pain and her strong reactions to seemingly gentle treatment. A simple test for allodynia would give a lot of information.

In cases of allodynia, I use interventions that make use of the gate control mechanism (specifically to stimulate just the encapsulated-end-organs and their A-Beta nerve fibres). I use prickling hedgehogs, heat/cold, vibration, jostling, scrapers, ice-and-stretch, Capsaicin creme, and Lowe’s ‘grounding’ techniques, often all within the same treatment. I also use a form of Feldenkrais re-patterning and other left brain/right brain connecting activities (think rubbing your stomach and patting your head). Info on this comes from the book ‘Awareness Heals’ by Shafarman. Pressure-based therapy should be better tolerated after a few sessions of these less provocative techniques.

A website that I recommend (even though it’s an Aussie one :-)) is www.bodyinmind.org. They have regular guest bloggers on all aspects of pain. These Aussie PTs and Docs have quite different ways of exploring and explaining pain. Some of my favourite books include ‘The Culture of Pain‘ – Morris, ‘The Pain Chronicles‘ – Thernstrom, ‘Explain Pain‘ – Butler, and ‘Pain: The Science of Suffering‘ by Patrick Wall. For the lay person the $70 outlay for Butler’s spiral bound, fully illustrated ‘Explain Pain’ may actually be a good investment, although the much cheaper ‘Pain Chronicles’ may suffice.

Perpetuating factors also need to be looked at. These include measuring levels of Vitamin D, B12, Mg, and Iron in the form of Ferritin.  Insufficiencies in these (you may still be in the low-normal range) have associations with prolonged pain. I treat so many women who have chosen not to eat red meat, or even dark meat chicken (the tastiest part). Just saying. One also has to acknowledge thyroid status (hypothyroidism), endocrine and digestive health, posture, ergonomics and sleep quality to name a few more.

I conclude by admitting that each new client tests me and I have my failures. Nothing about chronic pain is simple and direct. What works for one person may not work for another. I especially bear in mind that ‘not everything is a trigger point!‘ as my mentor Jan Dommerholt drummed into me.

Consistent with my admiration for the creative commons concept, sharing all our stuff can’t help but make us improve.”

Best for now,

Stewart