MYOFASCIAL PAIN -v- DISC PAIN…

As most of my readers know I suffer from chronic back pain after four previous spinal fusion surgeries only alleviated the pain for a matter of years before it came back.

Nowadays spinal fusion is not used as the first choice for prolapsed discs with pain management being the first treatment and only if nerves are compressed is it used as another option.

The problem with spinal fusion especially if you have more than one surgery is the pressure it puts on the disc below and above your fusion.

Another condition which you can also suffer from after any type of surgery is Myofascial Pain Syndrome which is a chronic painful muscle disorder and is common if you have experienced a muscle injury. Over time these myofascial restrictions can lead to poor biomechanics, altered structural alignment, compromised blood supply and pain. Other causes of myofascial pain are injuries to an intervertebral disc, general fatigue, repetitive motions, and some medical conditions.

It is characterised by the myofascial trigger points and the symptoms include persistent or worsening pain, deep and aching muscle pain, tender knots located in the muscles and pain after exercise or sporting activity.

Myofascial Pain Syndrome (MPS) is the name given to pain caused by trigger points and fascia (connective tissue) adhesions in the body, usually in muscle tissue, and inflammation in the body’s soft tissues.

Myo = muscle
Fascia = the main connective tissue in the body
Release = to let go, ease pressure

Treatments include anti-inflammatory medication, pain killers, physical therapy, stretching, massage therapy and trigger point injections.

A trigger point injection is either a cortisone injection or dry needling. Pain relief is quick and helps in continuing physical therapy. Trigger point injections can also be used for people suffering from degenerative disc disease.

Understanding the cause of your pain is an important step to finding an effective solution. It may involve a series of sessions and an at home program to keep the area strong.

Disc pain can come from a disc bulge or prolapse but you can also get myofascial pain which could be treated conservatively instead of surgery. Fibromyalgia patients can also suffer from myofascial pain. According to history, Sir William Gowers introduced the term fibrositis for a common, but idiopathic, localized form of muscular rheumatism that is now recognised as myofascial pain syndrome in 1904. And, despite the intervening years, it still constitutes the largest group of unrecognised and undertreated acute and chronic pain problems. Some people (like myself) have also been told they could have Fibromyalgia, previously named ‘fibrositis’.

My neck and arm pain have been giving me a lot of problems since last summer and after extensive tests, MRI’s, ct scans and more it was decided that a nerve block would help with the pain. There is never any guarantee with any injection but they hope to give the patient a few months of pain relief.

Nerve block injections into your neck for a disc bulge can be quite dangerous as they are quite tricky to do and they go through the front of your neck. I had this injection about six weeks ago. It’s not a very nice injection (if any are) but I knew the pain consultant had hit the spot and soon felt total relief. Unfortunately, it was short lived and only gave me pain relief for a few weeks. Not all the pain has come back but most of it as did the pins and needles.

I then had another appointment at the pain clinic and after looking at my MRI’s etc I was given a quick check where my pain consultant felt that the pain I now have could well be myofascial and not from the bulging disc so he has booked me in for a series of steroid injections in my shoulders.

I guess with any spinal pain after you have had all the tests it’s then worth trying alternative treatments well before you resort to surgery which is something I have always said I would avoid having.

 

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ACUPUNCTURE THE LATEST TREATMENT FOR FIBROMYALGIA…

The theory and practice of acupuncture originated in China. It was first mentioned and recorded in documents dating a few hundred years before the Common Era. Earlier instead of needles sharpened stones and long sharp bones were used around 6000 BCE for acupuncture treatment.

The word “acupuncture” means “needle piercing”. It is a traditional Chinese medical treatment using very fine needles, which are inserted into the skin at any of the 800 specially-designated points. It originated from a Dutch physician, William Ten Rhyne, who had been living in Japan during the latter part of the 17th century and it was he who introduced it to Europe.

A study conducted at Sheffield University in the UK looked at the long-term symptom reduction and economic benefits of acupuncture for persistent pain, An average of 8 acupuncture treatments was given to 159 people, while 80 received usual care instead.

After one year, people receiving acupuncture had reduced pain and reported significant reduction in worry about their pain compared to the usual care group. After two years, the acupuncture group was significantly more likely to report that the past year had been pain free. They were less likely to use medication for pain.

A scientific explanation is that acupuncture releases natural pain-relieving opioids, sends signals that calm the sympathetic nervous system, and releases neurochemicals and hormones.

Dove Press wrote that ‘A Systematic Review and Meta-analysis of Randomised Controlled Trials’, showed that ‘Acupuncture therapy is an effective and safe treatment for patients with FM, and this treatment can be recommended for the management of FM.’

Without balance in our bodies, there are many health-related problems we can encounter and having an Acupuncture treatment can help to restore your body systems to the right balance. They are quite often referred to as Yin (which is negative) and Yang (which is positive).

The Acupuncture Association of Chartered Physiotherapist’s explains how Acupuncture works. The acupuncture needle will stimulate the flow of QI [pronounced ‘chee’], which circulates in channels or meridians within the body. The QI circulates within the deeper organs of the body but connects to the superficial skin. In the state of a normal healthy body, a balance exists between these systems. Both the superficial energy and the deeper energy can be influenced by the stimulation of specific acupuncture points. If injury, disease, emotional trauma or infection occurs, the natural flow of QI within the meridians and organs may well be affected and the result is an altered flow, either a slowing or stagnation of QI causing pain and inflammation, or a deficit of QI, which may cause weakness, exhaustion and longer debilitating disease. The stimulation of relevant acupuncture points may free stagnation, reduce excess or indeed, increase QI to the specific area or organ and thus help to restore normal QI flow and balance.

THE DIFFERENCE BETWEEN NERVE BLOCK AND FACET JOINT INJECTIONS…

As my readers will have read before I had great success with lumber facet joint injections for low back pain. I have never had facet joints injections in my cervical spine but nor have I had a nerve block in my lumber spine so it’s interesting to find out the difference between them both.

The cost is definitely different for these two injections with the facet joint ones coming out a lot more expensive.

To explain the difference with these two types of injections I will start with a facet joint injection which is a type of steroid injection that is administered to a very specific set of joints. Steroid injections directly into these joints of concern can help relieve both inflammation and pain in the neck or back. Several injections to different facet joints may be needed depending on the site of pain.

As explained by the Spine Institute of North America a nerve block injection can be done anywhere along the spine. This particular injection targets the sympathetic nervous system and helps to reduce inflammation in nerves that branch from the spinal cord and the ganglia that is present at a particular location. Nerve blocks are a form of pain management as the substance that is injected numbs the nerves and helps to block pain signals. This one can consist of a local anesthetics, steroid and lidocaine (a numbing agent).

In a facet injection procedure, a physician uses fluoroscopy (live X-ray) to guide the needle into the facet joint capsule to inject lidocaine (a numbing agent) and/or a steroid (an anti-inflammatory medication). If the patient’s pain goes away after the injection, it can be inferred that the pain generator is the specific facet joint capsule that has just been injected.

A nerve block injection is also done using Fluoroscopy (live X-ray) to ensure the medication is delivered to the correct location. If the patient’s pain goes away after the injection, it can be inferred that the back pain generator is the specific nerve root that has just been injected.

So, basically both injections administer similar drugs and both are done using live X-ray but they are put into different parts of the spine. Why they vary so much in price is something I cannot seem to find out about except that you seem to need more than one facet joint injection at each session. Let’s hope that nerve block injections funding doesn’t change to a postcode lottery like the facet joint ones have done.

IS LOW LEVEL LASER THERAPY SUITABLE FOR CHRONIC NECK AND BACK PAIN ?…

Low-level laser therapy is a red or near infra-red light, applied from a low power laser specifically for therapeutic usage, where the light penetrates deep into the tissues. But is it suitable for chronic neck and back pain? Clinical Trials say Low level laser light therapy, with its proven anti-inflammatory ability, offers a simple non-invasive option for the reduction of chronic neck and shoulder pain.

Apart from it being used for back pain, it is also employed to treat musculoskeletal injuries and disorders, as well as Fibromyalgia. A low-level laser differs in that it operates at very low levels of power and unlike high-power lasers, it does not heat or damage human tissue.

It can help back pain by reducing pain and inflammation. You would probably need several treatments before you notice much pain relief and combined with exercise can be more beneficial than exercise alone. They call it the cutting edge of nonsurgical pain relief and tissue repair. Laser therapy uses light waves to stimulate healing in soft tissues. It has a similar effect to ultrasound.

It is a low-level cold laser and is pain-free; it works from the infra-red spectrum which penetrates up to 3cm into the muscles tendons and ligaments of the body. The laser light then stimulates the cell body within muscles, tendons or ligaments causing them to oxidize and increase healing at twice the normal rate.

It can improve healing, pain reduction, increase circulation and decrease swellings. It is not available on the NHS, but there are a number of clinics throughout the UK which perform this type of pain relief.  There are a number of hospitals that do this type of treatment from the City Back Pain Clinic in London, the Orchard Clinic in Northants to The Secret Glowin Manchester, with lots more clinics throughout the UK.

Pain News Network wrote Positive results have been reported for a very broad range of conditions, including the following: 

  • Osteoarthritis 
  • Tendonitis
  • Wound healing
  • Back and neck pain
  • Muscle fatigue
  • Peripheral nerve injuries
  • Traumatic brain injuries
  • Spinal cord injuries
  • Stroke 
  • Postherpetic neuralgia (lingering pain after shingles) 

LLLT speeds up healing significantly in acute injuries and substantially reduces or eliminates chronic pain.  Effects are long lasting.  There are no negative effects.

CAN LONG TERM USE OF OPIOIDS CAUSE RESPIRATORY PROBLEMS AND IS IT TIME FOR A CHANGE…

Can long term use of opioids cause respiratory problems and is it time for a change?

The straight answer is ‘yes’, according to Desert Home Treatment who say that ‘ The long-term effects of opioids on the bowels are significant, but it is the damage they do to the respiratory system that is behind most of the overdoses and fatalities that are related to opioid use. As opioids depress the central nervous system, they directly interfere with the body’s breathing mechanisms.’

Science Daily pointed out that ‘ Opioids are highly effective at killing pain, but they can also kill people by depressing their breathing and at the same time sedating them so that it can be impossible for them to wake up from oxygen deprivation,” says Richard Horner, a professor in the departments of Medicine and Physiology.’

Most pain killers opioids or otherwise can cause side effects but they tend to improve shortly after starting the treatment or following an intended dose increase. The most common side effect being constipation and itching but a respiratory problem is feared by many. They say it is mostly a concern in acute pain management where patients have not developed tolerance.

So should we be right to be sceptical about taking opioids for long term pain when they keep appearing in the news as sceptical ? Drug Abuse has written a great article on a ‘Need for Change’ with a list of 10 opiate alternatives. They include –

Over-the-Counter Acetaminophen

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Cortiosteroids

Serotonin and Norephinephrine

Reuptake Inhibitors

Neurostimulators

Anticonvulsants

Injections

Physical Therapy Massage, Acupuncture and Chiropractic Care

Exercise

It’s certainly something to ponder about.