My doctor told me today that he thinks I have myofascial pain syndrome in addition to my nerve pain. I have read a little about this, but I am curious if any of you have experience with this and can tell me what works, what doesn't work, etc. I am interested in conventional and alternative treatments. Also, does this ever go away?
I'm semi-familiar with the syndrome. According to conventional definitions, the condition calls for "combinations of physical therapy, trigger point injections, and massage are needed." This is where a good PM Doc can really earn his/her money. PM Docs can do "procedures" such as injections and epidurals. At my PM clinic, 2 or 3 days per week are set aside specifically for "procedures." The lead PM Doc, anesthesiologist, does procedures almost all day. I learned this the hard way....The clinic will squeeze a couple appts in between the procedures and once I had to wait over two hours because the Doc was caught in a procedure(s).
I also think it's important for the patient to really trust and follow the Doc's lead. Those who don't submit to at least conventional therapy can be discharged, or at the very least, not taken seriously. I think in some cases, they suspect these patients to be drug seekers. Please know that I'm not in ANY WAY suggesting you fit into this category, but I've heard stories of people in my clinic. So, just be careful how you go about things and be sure to at least appear that you are 100% committed to what he/she recommends.
Thanks for your response. When I saw my doc today, I actually told him that tramadol was working for me, so I don't think he believes I am drug seeking. I do appreciate the heads-up, though. I am very sensitive to that issue, as I have been treated with suspicion on a number of occasions when I was in intense pain. I am post spinal fusion, and my doc said the only NSAID I could take was Celebrex. He gave me some samples, so I'll try that, but if this persists, I am going to look into other treatments.
I also wanted to mention that this goes for ANY CP patient. We have to be fairly receptive to treatments or suggestions to improve, regardless of our condition. I think most Docs get suspicious if all we want are meds.
Hi Toonces: I have chronic myofascial pain. I have had it for several years and Ex is on the correct path. Previous conceptions of CMP were that it was considered one of the "waste basket" diagnisis', as was Fibromyalgia. They share some symptoms, but not all. Some people are diagnosed woth both.
Not a lot of doctors really know much about it. They know what they've read on the internet and also in medical literature. But most of the literature is out-dated. It has recently been "upgraded" from a syndrome to a "disease". The really interesting thing is that many people who have chronic pain, develop CMP after a while because the best known cause is "untreated or undertreated injury or ilness and pain." I had an injury to my lower back that went untreated for quite a while and that was what started me on the CMP path.
I have run the gamit of therapies, meds, etc. and am currently on a med regimine along with myofascial release therapy and aquatherapy. I see a physiatrist for PM. He is an MD, who specializes in physical medicine and rehabilitation. (PM&R)
I have found, over the years that trigger point injections did not help me, however, there are many people who get relief from them. I think it depends on the person and the extent of the disease. As of right now, there is no one "cure" for CMP. If treated early and correctly, some people can have lasting relief. In my case, because I had no treatment, let alone a diagnosis, my pain gateways are wide open and I am what my doc refers to as "hard-wired".
I hope this explains it a little for you. Please feel free to ask any questions you have. I'd be glad to answer whatever I can. Take care, cmpgirl
Thanks. Can you tell me what medications you are taking, and other ones that you have tried? I'm sure you have posted it before, but I won't know where to look. I'm currently taking Lyrica, tramadol and tylenol.
Sure thing...I started out with my first PM who didn't believe in prescribing narcotics for chronic pain. He treated me like it was all in my head, anyway. What a jerk. Anyway...I found a new PM and have been going to him ever since. I started out on low doses of short acting meds (vicodin 5 mg, 4 or 5x/day and Soma 350mg, 3x/day (muscle relaxer).
I have since increased in increments over the years, adding oxycontin 20mg, 2x/day with the same vicodin for breakthrough pain, and the same dose of Soma. This was at a time when oxycontin and other long acting narcotics were just starting to be used widely in pain management.
I am now taking 20mg oxy, 3x/day, 7.5mg vicodin for BT (up to 6 max/day) and I go back and forth between Soma and Flexaril as muscle relaxer. The Soma has always worked best, but I build up a tolerance every now and then and take the flexaril for a while to get the tolerance down.
My next visit he wants to increase the oxy to 30mg and hopefully reduce the BT meds. Just the change to 3x/day made such a difference that I was able to take fewer BT meds. Hopefully, the oxy increase will mean even less BT meds. That is the goal anyway. The less tylenol, the better.
I have also had all types of other modalities, like phys. therapy, TENS unit, injections, aqua therapy, ultrasound therapy, myofascial release, etc. The 2 things that have actually helped are the myofascial release and the aqua therapy. The others just seemed to make it worse.
I tried the tramadol, but had a reaction to it. I have also tried nortryptaline, neurontin (I have nerve pain too) zanaflex, and many others I can't remember right now.
I think it is a trial and error thing. Not all people have the same reaction to all meds. Our chemistry is different and so is the pain. Is your current doc a pain management doc? If so, has he suggested other meds or therapies? I know I've probably left things out. I've been doing this for so long. But if you have other questions, I'd be more than happy to dust off the cobwebs and answer what I can. Take care, cmpgirl
PS: I also have my story posted up at the top in the sub-board, if you want to take a look. It may give more info than I have here.
Last edited by cmpgirl; 04-25-2008 at 04:50 PM.
Reason: added text
cmpgirl - Thanks for the additional info. I have a few more questions. How often do you get the myofascial release treatments? I am looking for someone in my area that does this, and I think I'll ask my chiropractor and PT if either can refer me to someone. Also, does the "cloudiness" from the Soma go away? I have a prescription for it, but I don't take it at work unless my pain gets really bad because it really makes me feel light-headed. I have tried flexeril, but it doesn't seen to help much.
Hey Toonces and Pepper...I used to get the myofascial release as often as 2x/week, but my insurance decided that a liscensed massage therapist was not covered. I now go a couple of times a month. There are registered physical therapists who do this type of massage therapy and they are considered covered under my insurance, but there is only one in my area who offers it and I'm sad to say he's not very good at it. So, I pay out of pocket to see an LMT. It is so worth it. You should ask if a provider has had specific training in myofascial release. If they haven't, many don't do it right. It should start out very light, like butterfly wings. And then it gets more into the tissue as you can tolerate it. Don't let someone push you farther than you are ready for.
About the Soma, I have taken it, on and off for 8 years and in the beginning, I had the brain fog and drowsiness, but I wasn't working any more, so it wasn't as much of a problem. It really is the one that has worked the best for me. I would think that Pepper's idea would be a good one. I've never thought of splitting them before, but why not? Just make sure you have some chocolate on hand. It really is the only thing I've ever found that gets rid of that bitter taste! (I know, sounds crazy, but trust me!)
Good luck finding a therapist. It is a very good tool for dealing with the spasms. It takes a few sessions, but once you get started it's a big help. Take care, and thanks for the tip, Pepper. I might try that sometime to stretch it out a little.
Okay cmpgirl, I've got another question. Here's the situation: I went in for a myofascial release treatment, and in general it felt good, although I have very sore muscles along my shoulder blades, and the treatment wasn't deep enough to get at those. So, at the end of the treatment, I asked the therapist if she could tell if the fascia was restricted (I have read that they can feel it) and she said yes, and pointed to my lower back and said that's where it felt "a little restricted." The problem is that I don't have any pain in my lower back! All of the pain is in my shoulders and neck and upper back, and it is very severe. So now I am left wondering if this is what I even have. I guess my question is would the therapist be able to feel it? Or is it possible that my pain is still myofascial in nature, and she just couldn't tell. I am really confused now and want to go back to the doctor. Can you therapist tell that your fascia is restricted?
Toonces: Myofascial pain is what is called referred pain. I know it sounds nuts, but the "trigger point" for the pain, isn't in the same spot as the actual pain. That is why she pointed to your lower back. I know it sounds wierd, but that's just another one of the maddening complexities of CMP.
Trust me, she will get deeper into your muscles as time goes by. If she were to start any heavier, you'd go right off the table! It's a process, but well worth it in the long run. She obviously knows how to properly do myofascial release. You're lucky you found someone who does. Not all that claim to know it, really do.
Take care and I hope you get as much benefit out of this as I have. cmpgirl