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A: It isn't unusual for myofascial trigger points to develop after injury, and that is what seems to be happening. the IBS is often a function of multifidi and abdominal TrPs. The dizziness is most often from sternocleidomastoid (SCM) TrPs. Have this checked out by a competant TrP- savvy doctor, nurse practitioner or physical therapist.
AMMELIORATION ?
A: No. It has been known for a LONG time that FMS is a chronic illness.
Often it is couples with misdiagnosed or undiagnosed MPS. You must discover
the perpetuating factors and deal with them. Q: (cont. from above Q.) Is it part of the IAIYH (It's all in your head) garbage? A: Yes.
ARTHRITIS & FM
A: They are not. Rheumatoid arthritis is an auto-immune
problem, and a progressive, inflammatory degenerative condition. Fibromyalgia
is none of these things. RA does often give rise to myofsacial trigger points,
which are mistakenly diagnosed as FMS. The pain load of a lot of RA patients
could be alleviated without use of extra meds if the trigger
points were treated with specific physical therapy.
BODY TEMPERATURE
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| DIZZINESS
Q: When dizziness happens I have no warning or very little. I was ironing and all of a sudden the room just started spinning and a wave of nausea washed over me. Just before the dizzy feeling hit, I noticed that my right ear would go completely numb. A:This is a typical sternocleidomastoid (SCM) TrP scenario. This muscle has two parts, alongside of the neck. The symptom list from this TrP astounding. Check out my website at http://www.sover.net/~devstar, my book or video. You can also get a free Gebauer TrP chart by calling them in Ohio at 800-321-9348. You could be developing Myofascial Pain Sydnrome, which would aggravate Reynauds and other problems. Devin Q:I, too, get a terrible headache from moving my eyes in that way. But last night I asked others about it, and those who are hale and healthy said it hurt their eyes to do the excercise too. A: Many people who are otherwise healthy have these trigger points. Most of us look down too often and don't look up enough. Even less, do we look up and to the side. As the years go on, we develop more trigger points, so as elderly folks we are often restricting our movements to avoid pain, including our eye movements. I believe, with Janet Travell, that a lot of what is called old age can be attributable to the tightened restricted myofascia due to trigger points. Devin
FLUID RETENTION
A: This can be caused by several problems. The easiest to check is piriformis trigger points. These TrPs can entrap blood vessels as well as nerves. The most common piriformis TrPs can be reached by tennis ball compression to the back of the buttocks, about 2/5ths down from the top of the curve of the buttock. One is along the spine, and the other is a little over half the distance to the outer edge of the buttock from the first one, and a little lower. If TrPs are there, it will hurt. It is wise to also check for other causes. Devin
FOOT PAIN
A: This is from a trigger point in the long flexors of the toes.
It is found in the calf, about 5 inches or so from the back of the knee crease,
amd about an inch or two towards the inside edge from midline of the calf.
The pain can go from there to the ankle and then to the instep, but it is
worse on the sole of the foot. This is perpetuated by having the foot extended,
as it is at night.
Q: Does anyone else ever experience pain in the top of their
feet?
GASTRIC REFLUX A: This can also come from reactive hypoglycemia, which can come with FMS. If you crave carbohydrates/chocolate and have hypoglycemia symptoms and have been putting on weight, you may have to modify your diet. Also, certain myofascial TrPs can aggravate reflux. Devin
GENETICS
A: It is not contageous. There is no greater incidence of FMS in mates of fibromites. There has been a study indicating an autosomal dominant trait. There have been several genes implicated in FMS, with more research to be done. We have a local family of 7 sisters in our local group, and most of them have FMS. Their husbands do not. Devin
GUAIFENESIN
A: I also trust Paul St.Amand. What ELSE are you doing for the FMS and MPS? You may have many perpetuating factors. The more you take care of yourself, the more you help your body detox, and >the less unpleasant the reverse cycling is. Drink a lot of water, put moist heat on the parts that ache, and take it easy. Do some gentle stretches, one of each stretch. Develop a program of mindwork and bodywork that helps you to feel better.
HEARTBURN
A: Many things can cause the heartburn cycle. Many of the foods we eat can relax the esophageal sphincter, and allow the gases and eventually the liquids to "reflux" back from the stomach. The gases are very acidic, as is the liquid, and they burn. Chocolate and caffeine are two items that relax the sphincter. For many of us, this is a sign of reactive hypoglycemia and it may be wise to have a trial run of the Zone diet. The external oblique trigger points that are on the frontward edge of the ribs are often a factor in perpetuating reflux. Try tennis ball acupressure along this region by lying on your belly on the ball, and rolling it along these edges. If it is screamingly painful, there are TrPs. this action will help break the TrPs up, but you may want to start on a sofa or other softer surface before graduating to the floor. {{{}}} Devin
HIP & LEG PAIN
A:This is usually due at least partly to gluteus minimus trigger points, if it forms a "sciatic" pattern radiating down the leg. These can be broken up with tennis ball acupressure--it hurts but it is worth it. Using a pillow under your knees when you sleep can avoid some of the stress on the hips. Devin
HORMONE REPLACEMENT THERAPY Q:My GP wants me to go on Homone Replacement Therapy. I have no uterus so it would just be estrogen. The things I have read are all positive but am wondering about how it will affect my FM.
HPA-AXIS Q: Anyone out there have trouble with their pituitary gland? I had a pituitary adenoma removed in 1982 and there is another one growing in there now.
HUMAN PAROVIRUS Q: Is this the human version of what dogs get? A: I am with PRO-med, a listserv organization monitoring infectious disease outbreaks. There are many kinds of parvovirus. Fifth Disease is something different from canine or feline parvo. They are just in the same family. Human PV is common and many people with it are symptom free. Devin
IAIYH (It's All In Your Head)
Q: I recently went to a doctor trying to find the cause of my
dizziness. After the physical exam, he said "Maybe its a pyschosomatic disorder,
or maybe its related to your fibromyalgia, If fibromyalgia is indeed a REAL
disease, I don't know...." A: Why do you pay someone who knows less than you do? Devin
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| INFLAMMATION
Q: Given many case reports of the "feel" of symptoms, the positive
responses to drugs that function as anti-inflammatories (apart from their
other effects), and the things that trigger flares often being so similar
to things that trigger inflammation, I and some others feel that there may
in fact be inflammation involved but that the current available diagnostic
tests for inflammation don't pick up this inflammation. A: There may be secondary inflammation especially with myofascial trigger point involvement. The constricted myofascia can pull muscles and bones out of alignment, and create imbalances of gait that can themselves produce inflammation. This does not mean that either FMS or MPS is inflammatory.They are not. The anti-inflammatories often function as analgesics. Unfortunately, they also have side-effects, especially with long-term use. Devin
ITCHING Q: Does anyone else have this feeling that it is itching deep inside your ear, and no matter how deep you probe, you can't scratch it?
Q: Does anyone have itching skin all over? I seem itch all over my body for no reason. Just wondering. especially on my scalp. What is this from? A: This can come from many reasons. Dry skin, altered response to sensory stimuli (if the brain can't translate a sensation, the default is "itch"), low level trigger points. Devin
KEVORKIAN SUICIDE Q: It just bugged me as total ignorance that a doctor would go on national television, having done a standard autopsy, and say there was nothing wrong with (Judith Curren) really .... I feel like I've already been there and done that, if you know what I mean. A: This bugged me, as well as the fact that if her doctors had know about FMS and MPS, and known that a chronic pain state can cause immune deficiency, that woman would be alive today, and in less pain. So that she did not die in vain, I urge all of you to write to your local newspapers and tell them about fibromyalgia. Explain why the autopsy showed nothing. Let people know your symptoms, your story, and what can be done to help. Tell them about this group, the fibrom-l, and about myofascial pain syndrome, and about the Fibromyalgia Network Newsletter, and local support groups. If those doctors had done as little as read the Network Newsletter, they might have saved that woman. Let's go out and try to save others with what we know about fibromyalgia, which is, in most cases, considerably more than those doctors. Devin
Devin Starlanyl http://www.sover.net/~devstar book & video info 800-748-6273
LOCALIZED PAIN Q: I have been treated for persistent muscle pain and "hot spots " by a chiropractor for several years. The pain is always in the same places (hips, back of the skull, edges of the shoulder blades, and sometimes just below my knee) and although it gets somewhat better, any small injury or overuse causes a flare up that last for weeks - sometimes longer. A: This is not FMS here--that causes generalized achiness. The specific pains mentioned here are probably myofascial trigger points, and are treated differently than FMS tender points. There is a great deal your MD and DC can do about this. They need to be aware of the medical texts on MPS however. Myofascial Pain Syndrome is greatly underdiagnosed, and often miscalled fibromyalgia. Gebauer in Ohio has a free trigger point chart which can be obtined by calling them at 800-321-9348. It is vitally important to treat the TrP and not the painful area, as this is often simply the referred pain zone. there are also other symptoms than pain. Devin
Q: I have a friend who has been in pain for 15 years and
has tried everything. I vary from hip pain to my shoulders
and neck . I am not sure if this is Fibro A: Specific localized pains like this are often due to myofascial trigger points. They can be greatly relieved or eliminated by specific therapies. Devin
LONGER 2ND TOE
Q: I do recall reading an oriental book on reflexology that stated that a longer second toe was a sign of something being wrong elsewhere in the body. A: The real anatomical variation to look for is the longer second metatarsal. I have a picture of it in my book. It is called "Morton's Foot" and can predispose people to myofascial trigger points. It can be aided by a simple modification to a drugstore shoe insert. Devin
Q: concerning the second toe being longer than the first. As a child, I took a lot of different types of dancing classes, and we were told that it was called "Dancer's Foot". A: It isn't the toe, really, it is the second metatarsal that is longer than the first. Looking at the toe may give you a general idea of this. The condition is called Morton's foot, and predisposes to pronation and trigger points, unless you learn how to make a Travell shoe insert. Devin
MAGNETIC FIELD
Q: I was discussing the FM strong magnetic field with my Doctor the other day. We had also been discussing Guafienson therapy and the deposits of phosphorus. He wondered if phosphorus being a double negative charge might influence the magnetic field. A: I am still asking people about this one. I do know that I have gotten rid of a lot of phosphorus excess over almost 3 years of guaifenesin. I still drive electromagnetic equipment crazy, flip out meters, etc. From my mail, this is a very widespread phenomonon. Devin
MEDICATIONS
Q: Even Miryam, Devin and Nye gloss over pain meds as though
they are not needed or wanted. A: I don't think that is true for any of us. We all stress, however, that medications alone will not provide what we need. In my handouts I stress the need for pain control. I have provided ammunition for people who want to verify that narcotics may be needed for pain for some of us. It is just that we all stress that medication is not the only answer, and that a total program of physical therapy, nutrition, sleep modification and whatever else is needed--bodywork/mindwork, postural training--are also important. With the pain from myofascial trigger points, especially when there is nerve entrapment, and the pain amplification of FMS, some of us need strong medication. You need a doctor who understands this. Please reread my medications handout from my website at http://www.sover.net/~devstar and you will see that there is justification for pain medication there. Devin
A: It is not uncommon for people with FMS to have abnormal sensitivity to some medications. How does your doctor know what YOU can tolerate?
IS THIS UNUSUAL or is it just part of the normal variation expected between different patients? (And if it's normal, why is it not accounted for by most doctors I've spoken to about it?) IS THIS SHARED by other fibromyalgia patients or is it completely unrelated? A: There is a normal variation, but nothing like the variation experienced in FMS patients. We react oddly to meds. Some hit us hard, and some seem to affect us the reverse of how they are supposed to, and others don't affect us at all Whether it is caused by FMS or comes along with it caused by something else has not been proven. Q: AM I PROBABLY METABOLIZING THE DRUGS FASTER than most people (over- acheiving liver & kidneys) or do I just require a higher dose and therefore only notice any beneficial effect when the drugs are near their peak concentrations (while other people continue to get use out of their drugs while the concentrations are tapering off)? A: I don't know. We do tend to have an overactive sensitivity. We can feel things others can't. Devin
Q: I feel better since i've been off the paxil. A: I would stay off it then. It is easier on your system if you are taking 20 mg Paxil to taper, by taking half a pill for a week, and then every other day a half tab for a week before stopping. Devin
MENSTRUATION Q: I am unable to find any answers in all my research as to the connection of my monthly period and incredible pain from my fibromyalgia. I have been suffering with terrible periods for seven plus years and now the pain, fatigue, etc. is just too much. A: This is often due to myofascial trigger points. the myofascial congestion tightens around normal fluid passages, such as blood vessels and lymph vessels. Before your period, try some tennis ball acupressure-- lie on your belly on a sofa or other soft area, and work the trigger points using a tennis ball under your belly. Work the area where the leg and trunk joins. There will be a lot of pain when you go over the trigger points. Groin stretches are helpful for the trigger points in the pelvic muscles. Work on the low back as well. This won;t take care of all the problems, because some are due to FMS. Blood clots and membraneous flow are common. The TrP work will lighten the pain load, however. Devin
METABOLIC Q: What is a metabolic disease? I am having laser surgery on my eyes in Jan and the list of candidates who should not have this surgery includes those with metabolic diseases. A: Ask your surgeon what is covered here. Usually this term means conditions like diabetes or hypothyroid. We often have metabolic perpetuating factors. Talk this one over with the doctor in question. Q: FM appears increasingly to be connected to an imbalance of several hormones, most but not all of them brain chemicals. Since all of our body chemicals come from the foods we eat, FM could therefore be seen as a metabolic disorder. CFS appears increasingly to be connected to faulty energy metabolism at the cellular level. Thus, it, too, can be seen as a metabolic disorder. That, I have come to believe, is the connection between FM and CFS. It would explain, for one thing, why there is such a significant overlap between the two syndromes. Further, I believe that the fatigue experienced by PWF is the result of lack of restorative sleep while the fatigue experienced by PWC is the result of faulty energy metabolism.
A: I think you have it. Both FMS and CFS seem to me to be
neurotransmitter dysfunctions. there is probably a whole family of
neurotransmitter dysfunctions out there. Devin |
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| MULTIPLE SYMPTOMS
Q: ALL of our symptoms, migraine, trigger points, irritable bowel symdrome, weight gain, panic attacks, sleeplessness, etc., etc. are symptoms of FM.
A: Not so. The headaches are usually from MPS trigger points.
IBS can be from both FMS and MPS, and the weight gain and panic attacks can
be from reactive hypoglycemia. If you have RH, are you on the diet for it?
Dr. St. Amand will get you on it, but you should be on it right away. Reactive
hypoglycemia perpetuates both FMS and MPS. Work on as many aspects
MUSCLE SPASMS Q: I have had severe muscle spasms for the past few weeks- everywhere, neck (sides, back, under jaw,) hands, ribs, back, legs, feet... Could this be strictly from the FMS, or could the albuterol be the culprit? A: This is probably from trigger points. Physicians (and everybody elese) often get FMS and MPS (myofascial pain syndrome) confused. This should not be allowed to go on, as the treatments are quite different. So are the symptoms.
MYOFACIAL PAIN SYNDROME Q: My docs insist that MPS is nothing more than "localized FM," and since I have a FM dx, they refuse to treat it. (I've brought them Devin's book, only my neuro seemed even remotely interested). A: In spite of the excellant medical texts of Travell and Simons, MPS is not known enough. Today I listened to a tape from the Bethesda conference I went to last March. It was wonderful to be in a room with all those doctors who knew that FMS and MPS were different! The tape concerned ways to spread the news about MPS. Each of you are teachers of FMS and MPS, and will form your own network of teachers. We're gaining on the ignorance, but it's a big job. Devin
Re: Dr. St. Amand's NEW Paper Q. To us, "systemic candidiasis" and "myofascial pain syndrome" are merely synonyms for fibromyalgia. A: Please be aware that Dr.St.Amand and I differ in this regard, The mother and father of myofascial pain syndrome, Janet G. Travell M.D. and David G.Simons M.D. have delineated carefully the differences between fibromyalgia and myofascial pain syndrome, both in their medical texts and many papers. These are entirely different conditions and should not be confused. There are a number of medical papers confirming this. Please see the bibliography on the physicians' side of my website This is not a matter of opinion, but of medical fact. It is possible for someone to have one and not the other. Trigger Points and Myofascial Pain Syndrome have been defined by Travell and Simons, and I believe we should accept that they know the difference between MPS and fibromyalgia. They defined the terms clearly in the first Trigger Point manual over a decade ago. FMS and MPS often occur together as FMS/MPS Complex, but not always. Most doctors have not read these medical texts, which is the main reason for the confusion about terms. This in no way detracts from my regard of Dr. St. Amand nor my respect for the work he has done with guaifenesin. Guai has redeemed too many lives, including mine, for me to think otherwise. "Systemic candidaisis" is a perpetuating factor, possibly an effect of reactive hypoglycemia, also a common perpetuating factor of both FMS and MPS. Devin
NEUROPATHIC PAIN Q: Is there anyone out there who has any experience with neuropathic pain (not specifically RSD) superimposed on FMS? A: I often see neuropraxia as a result of entrapped nerves from myofascial trigger points. Depending on the trigger point and the extent of the problem, this can be handled several ways--spray and stretch, galvanic stim, etc., but it is important to find the perpetuating factors. Entrapped nerves generally respond to ice for relief. Devin
NEUROTRANSMITTERS Dopamine is another neurotransmitter. The neurotransmitters should be in balance, but because we don't always get the deep sleep we need--where they are balanced and regulated--we have imbalances. FMS is among other things an imbalance in neurotransmitter and endocrine systems. Each patient is very different. Some of us may have too much of some neurotransmitters, such as histamine. That's why it is often trial by error to find the right meds that work for each of us. Devin
ONSET OF FM Q: What is the possible cause of Fibromyalgia? A: Any kind of physical or emotional stress, such as a virus or other infection, can spark FMS in a predisposed individual--one with the genetic trait. This can be Lyme disease, parasites, yeast overload, auto accident, etc. It is the straw that breaks the proverbial camel's back. Devin
PHANTOM PAIN Q #1: I have been having a problem with what I call Phantom pain (for lack of a better term). It is this sharp pain in various parts of my body, not aparently caused by anything (except FM of course). It is very intense and there seems to be nothing that I can do for it but wait for it to go away. I usually doesn't last very long, but the frequency has increased lately. It is becoming very unsettling. It seems as though it just picks a spot and makes it hurt! For instance last night watching tv, my left elbow just started to hurt. A sharp pain. The other night, my pinky finger on my right hand, same sharp pain, more intense. They just go away in time. Does anyone else have this? Am I going crazy? It hurts, but why? Q #2: I never thought of them as phantom pains -- someone called them zingers -- I like that one. Oh, I've been having them for years, and yes, I sometimes involuntarily yell out in pain because they come without warning and are so severe that they take my breath away. The real killer is when it happens in my knees or ankles or hips while I am walking. Well, that ends that -- I just have to stop and stay still until the pain goes away. A: This is possibly nerve entrapment by myofascial trigger points. Travell and Simons showed the phantom pain--TrP connection in their manuals. There are many things you can do to relieve these. The ankle problem would be from entrapment by peroneal TrPs, and the hip would be piriformis TrPs, probably with satellite and secondary TrPs. Devin
PILLOW - CERVICAL Q: Does anyone know where I can buy mail order a cervical pillow for my neck? I don't get out much to hunt one. A: There is some problems with this. We usually have to try several to find one that fits the curvature of the neck. just right. this varies with how tight the scaleni and sternocelidomastoid muscles are. You may find a chiropractor or physical therapist who will lend one out (plastic covered) before you buy. Devin
PROGRESSION OF FM Q: *Remitting-intermittent-disappear, reappear after initial onset *Fluctuating-periodically abates, never disappears *Progressive-persistent, increasingly intense ?
SHORTNESS OF BREATH For those of you who have shortness of breath and pain in between your shoulder blades, there is an article in the recent Journal of Myofascial Pain called "Treating Subjective Shortness of Breath by Inactivating Trigger Points of Levator Scapula Muscles with Acupuncture Needles", by Neoh Choo Aun. The levator scap TrPs are located just above the inner top point of the shoulder blades. Shortness of breath can also be caused by TrPs in other respiratory muscles. Devin
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| SINUS PROBLEMS
Q: Awhile back it seems like people were talking about sinus and vision problems. The thing that drives me crazy about FM is the not knowing when to NOT blame something on it. A: These are part of MPS, not FMS. We must keep them straight when we can, so that confusion is minimized. See my handouts for ENT/Allergists and Eye Care Professionals on my web site at http://www.sover.net/~devstar Devin
A: No, but it could be MPS related. It is always wise to check out possible infections. But even sinus infections can set up trigger points. Do the eye exercises--looking up can be very painful if you have trigger points. Try pressure right under the ear--press on your neck there with the heel of your hand. There is a TrP there that often contributes to clogs. Check the pterygoid and masseter TrPs--cutaneous facial too. Whenever you have time, start doing some pressure point work on your face and head. If you feel sore spots, they are probably TrPs. Devin
SORE THROAT Q: Would appreciate hearing from anyone who has experienced a chronic sore throat as a symptom of FMS. What are your symptoms and what, if anything, has given relief? Also, any ideas about the relationship to FMS. A: Sore throat is often secondary to myofascial trigger points. As the TrPs tighten the myofascial constriction around normal drainage channels, the fluid can back up and the sinuses become clogged. During the night the post nasal drip causes sore throat. Also, sternocelidomastoid TrPs and a few other TrPs in the area can refer pain to the back of the throat. Devin
SWALLOWING PAIN Q: Hi, I was wondering if anyone on the newsgroup has had pain in the throat and chest (especially when swallowing, it feels like something is stuck in my throat all the time even though I drink liquids to try and clear this sensation, the sensation is no longer gone after I do this, it has continued for about a week. A: This is a sternocleidomastoid trigger point. The SCM TrPs refer pain differently depending on which portion of this divided muscle the TrP is. These muscles can be found moving diagonally along the side of the neck, and attaching both to the breastbone and the collar bone. Trigger points along the inner margin of the sternal portion (attached to the breastbone at the lower side) refer pain to the back of the throat and tongue during swallowing. Devin
TACHYCARDIA Q: I've recently been dx'd with "postural tachycardia." My resting pulse is about 120 beats per minute!!! Any connection with FM? Need I worry about Mitral Valve Prolapse? A: I don't think it is a cause for worry, but you should ask your doctor if he/she thinks you have it. You should also look for pectoralis major/minor and sternalis trigger points, especially close to the breastbone, because they are usually responsible for tachycardia when there is tachycardia, especially if myofascial pain syndrome is part of the picture. FMS can also contribute with adrenalin surges due to the dysrupted HPA-axis, and reactive hypoglycemia can cause these as well. Devin
TEMPERATURE Q: Greetings, I have good improvement with cool or even cold water as well as warm water. I swim laps. It might be different for water walkers. A: The water temperature is mostly a function of myofascial trigger points--the temperature has to be warm, in a very narrow range, from about 88 tp about 94 F, or the TrPs are often aggravated. FMS doesn't have that problem, but can be aggravated by heat and/or cold. Devin
TENDONITIS Q: This is the second time that my tendonitis has flared up. A: Do you often feel like you have a "toothache in your shoulder?" There is a trigger point that causes that feeling, as well as referring the pain to the wrist. Check the area behind your armpit, just under the rim of the shoulder blade. That is the subscapularis TrP. You can work at it by using a tennis ball and lying on your side on the floor. It will hurt. The ankles--are they weak and do they give out? Or do they hurt? If they hurt, is it both sides, around the ankles, or one side or another? This may also be TrPs. Or it could indeed be tendonitis. The symptoms may be similar. Devin
TINGLING & PAIN Q: my symptoms include: 1. Pain, tingling, and muscle fatigue in my right hand and arm . . we thought at first that it might be carpal tunnel syndrome. A: This is probably axillary artery entrapment by the subscapularis trigger point. Q: my doctor's just overlook it. It's not their feet that go numb and hurt and pins and needles. It's something with the nerves, maybe Devin or Dr Nye could explain why it happens. A: It could be neuropathy, which is a technical term for "something is going wrong with the nerves". Dr. Nye is our neurological expert, and I defer to him on that explanation. It could also be myofascial trigger points. These can be reversed. If I know the total condition of the body--FMS, MPS, and perpetuating factors, especially trigger points in the legs and feet, I can often figure out what the pattern is. Devin Q: I've been diagnosed with fibromyalgia and am doing reasonably well, but recently my skin has started tingling. A: This is not FMS, but myofascial pain syndrome and nerve entrapment by trigger points. Superficial TrPs can cause what has been called "The Skinache Syndrome". Devin
TENS UNIT Q: is using a tens unit on trigger points helpful at all? A: TENS can be helpful for some pain, but I have found it totally useless for trigger points, as it does not provide the contraction needed to flush the muscles. The NEMS units, some microstim units, and galvanis stim can provide muscle contraction. I use them myself. Devin
TRIGGER POINT INJECTIONS
Trigger point injections should NOT be done using cortisone. I
heard that
A: It has been shown that for people with
both MPS and FMS, TrP injections are not as effective and
don't last as long, and they hurt more. Check the article
by Dr. Hong on my website bibliography. At any rate, this
procedure is for when other methods, such as "Spray and stretch",
galvanic stim, etc have failed. Also, you must still find and deal
with the perpetuating factors. If you have reactive hypoglycemia,
for example, you must tend to that before any method of treatment
works well. Therwise, even the best of therapies won't last.
Most doctors I have spoken with, including David Simons, suggest
that it is better to avoid botulism toxin. Some TrP
injections, such as the soleus, are extremely painful and
can be disabling for a time. Your doctor should be thoroughly
familiar with the Travell and Simons texts and methods for TrP
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| TRIGGER POINTS
Q: Trigger thumb in my left hand A: This is probably a trigger point in the long thumb flexor. According to Travell and Simons, " a bulbous enlargement of the flexor pollicis longus tendon becomes ensnared by a restricted flexor sheath at the head of the first metacarpal bone, where the tendon is firmly attached to the thumb after it has passed over the adductor pollicis and between the two heads of the flexor pollicis brevis muscle."
Check the base of the pad of the thumb, palmar side, close to the wrist.
As you press along the muscle, you will feel the trigger points.
On page 554 and 555 of "Myofscial Pain and Dysfunction: The
Trigger Point Manual" Vol I by Travell and Simons, your doctor
can find how to get rid of it for you, either by injection
or spray and stretch. Q: My mother was diagnosed yesterday with FM. She has had tension in her neck (constant stiffness) and achiness all over for about 2 months now.
A: The constant stiffness is probably due to levator scapulae
trigger points. Check an area just above the inner upper corner
of the shoulder blade. There may be a lump, and should be
a trigger point right there. That is what is causing the referred
pain. this can often be relieved by tennis ball acupressure,
but you have to figure out what is perpetuating it. Trigger
points are part of MPS, not FMS. Q: Will this go away?
A: Not by itself. You have to find the perpetuating
factors. Q: What what would be the difference in treatment for trigger points?
A: The trigger points of MPS are reversible, and can be
treated by "Spray and stretch" or galvanic stim, among other
modalities. These will do nothing for tender points of FMS.
The differences are covered in detail in my book and website,
and I have a two-hour video on TrPs. It is important that
your physical therapist knows the difference between FMS,
single trigger points, and chronic MPS, so that the treatment is
given in the proper order. For instance, the pectoral TrPs must
be released before the sternocleidomastoid TrPs. Furthermore, you
have to look for and eliminate perpetuating factors. Devin
Q: Devin, Do degenerative disc disease and osteo in the shoulders, clavicle, and scapula also cause trigger points? A: You bet. This is very well documented by Travell and Simons. {{{}}} Devin
VULVODYNIA Vulvodynia may be caused by a number of trigger points which can refer pain to the area. You need a trigger point expert to find out which one, although that can be done by elimination. I have them on the video, but many are in internal muscles. There are also many other possible causes. Devin Q: I have at times a sensation that appears to be in the perineal/vaginal area. It feels as if there is so much pressure it is almost painful and causes me to break out into a sweat and I have almost fainted because of this. Could this be caused by a trigger point? A: This is indeed probably a trigger point, although it could be caused by something going on internally. It could also be left over from a pelvic infection, a pregnancy or a painful period. Groin stretches, sitting on a warm heating pad, and electrical stim to the perineal area and area around pelvis are all helpful. These TrPs will be in the video, but are not in the book. Pelvic TrPs can cause all sorts of symptoms. There is also a TrP high in the adductor magnus area, where the thigh meets the trunk of the body, inner midleg. This TrP can cause symptoms mimicing a severe pelvic infection, or infection of the prostate. Devin
YEAST Q. I would like to have explained the link between high yeast/sugar craving/pain cycle. Is the yeast level increasing in the blood due to the sugar diet? A. This is often due to reactive hypoglycemia. I suggest that you check out the book "Mastering The Zone" by Barry Sears. Your library should have it. The carbocraving is due to the dysfunctional insulin/glucagon ratio in the blood. Reactive hypoglycemia can have similar symptoms to FMS, and these will go away with proper balanced diet. Devin
ZINGERS Q: Are you referring to the sharp jolt of pain that feels like an electrical shock and lasts about 3 seconds (if that long). I get them at the base of my head (where it connects to the neck). One was so bad I spilled a cup of hot, hot coffee all over. A: This can be due to nerve entrapment by myofascial trigger points. There are a number of small muscles that run along the spine that can do this, if they have TrPs. Other nerves can get entrapped too. Devin
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Devin Starlanyl
http://www.sover.net/~devstar
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