Category Archives: pain

How Do I Find a Chronic Pain Specialist?

Which type of medical provider specializes in trigger point (TrP) therapy and other therapies, such as FSM therapy, that are presented on this site and which provider should you choose to treat your chronic pain? The first rule is that you should see either a medical doctor or doctor of Osteopathic to determine or diagnose the cause of your pain.

Once you have a diagnosis of your condition, that will determine who you should see next.

Medical Doctor

Medical doctors will perform invasive procedures such as trigger point needling or injections. They will also diagnose the cause of your pain, if possible, and can legally prescribe medications too. Physical therapists, doctors of acupuncture and chiropractors cannot prescribe medications unless they are also medical or osteopathic physicians.

A handful of medical doctors currently perform FSM therapy, but only a handful. Medical doctors generally will prescribe for one or more therapies and then will refer the patient to a physical therapist who would perform whatever prescribed therapies the doctor requested. Only recently have medical doctors begun to refer patients to either acupuncturists or chiropractors.

Doctor of Osteopathic or Osteopathy

The scope of practice for osteopaths includes diagnostic and therapeutic techniques (including musculoskeletal manipulations as well as prescriptions and other therapies) and preventive measures.” (1)

Like M.D.s Osteopaths earn a four year under graduate degree and a four year medical school degree, plus they also endure internships and residencies the same as a medical doctor does. They specialize in any specialty area of medicine-such as pediatrics, family practice, psychiatry, surgery, obstetrics, etc. (2)

Osteopaths complete the same amount of education, internship and residency as a medical doctor; however, osteopathic physicians also receive an additional 300 – 500 hours in the study of hands-on manual medicine and the body’s musculoskeletal system. (3)

“Osteopathic medicine is dedicated to treating and healing the patient as a whole, rather than focusing on one system or body part. An osteopathic physician will often use a treatment method called osteopathic manipulative treatment (also called OMT or manipulation) — a hands-on approach to make sure that the body is moving freely.” (4)

Some doctors of osteopathy will practice in the field of chronic pain relief and some have expertise in Trigger Point therapy and FSM therapy.

Physical Therapist

“Physical therapists provide services that help restore function, improve mobility, relieve pain, and prevent or limit permanent physical disabilities of patients suffering from injuries or disease. They restore, maintain, and promote overall fitness and health. Their patients include accident victims and individuals with disabling conditions such as low-back pain, arthritis, heart disease, fractures, head injuries, and cerebral palsy.” (5)

“Treatment often includes exercise, especially for patients who have been immobilized or who lack flexibility, strength, or endurance. Physical therapists encourage patients to use their muscles to increase their flexibility and range of motion. More advanced exercises focus on improving strength, balance, coordination, and endurance. The goal is to improve how an individual functions at work and at home.” (6)

Physical therapists may also employ many sorts of electrical stimulation including Frequency Specific Microcurrent (FSM), Electrical Muscle Stimulation or EMS, Alpha Stim microcurrent, Electro Therapeutic Point Stimulation (ETPS) which is a form of microcurrent therapy and other similar microcurrent therapies. (7)

Physical therapists also use hot packs or cold compresses including ice massage and ultrasound therapies to relieve pain and reduce swelling and inflammation. Traction or deep-tissue massage are commonly used to relieve pain and improve circulation and flexibility. (8)

Physical therapists specializing in the treatment of chronic pain as the primary focus of their practice will often implement trigger point and acupuncture point therapy as a frequent method of pain relief. A physical therapist who specializes in chronic pain would be one type of provider you will want to seek.

Pain specializing physical therapists will frequently work together with medical doctors because some health insurance companies require a medical doctor’s prescription before they will compensate the physical therapists. The general rule is see your medical doctor first to be treated by the physical therapist; however, some insurance companies will allow PT visits without a doctor referral. It is usually wisest to contact your health insurance company first to learn its requirements. Then you may proceed to see either your medical doctor or a physical therapist depending upon your medical insurance policy requirements.

In any event, if you are private pay, then you do not need a medical doctor’s prescription to be treated by a physical therapist. If you know that your health insurance allows physical therapy treatment without a medical doctor’s okay, then physical therapists will be happy to treat you and get reimbursed by your health insurance. Most insurance policies do have a maximum number of physical therapy visits per year that the insurance company will reimburse, so if you exceed the maximum number you will be required to pay the physical therapist yourself.

Physical therapists, like medical doctors and osteopaths must complete a four year college degree program. In addition, physical therapists must also complete a regimen of post graduate education and training to obtain the physical therapy license. That regimen will soon include three years of post graduate study.

Chiropractor

Chiropractors, also known as doctors of chiropractic or chiropractic physicians, “are medical professionals who diagnose and treat disorders of the musculoskeletal and nervous systems. They use traditional diagnostic testing methods (such as x-rays, MRI, and lab work) along with specific chiropractic techniques that involve hands-on manipulation of the articulations (joints) of the body.” (9)

The chiropractic philosophy is based on the belief that bodily functions are connected and healing involves the entire body. Chiropractic philosophy hinges upon the thesis that the spine and the human nervous system is responsible for proper health. (10)

The spinal cord is responsible for both voluntary movements and involuntary functions such as breathing and one’s heartbeat. Homeostasis is the state when all bodily systems are in balance. If the body falls out of balance, chiropractors will manipulate the body and especially the spinal chord to promote healing. (11)

Chiropractors employ many of the therapies that the physical therapist does including heat and cold therapy, ultrasound, electrical muscle stimulation and relaxation, traction, massage, and exercise programs. Some chiropractors additionally may utilize acupuncture, trigger point therapy and FSM, or frequency specific microcurrent. (12)

Applicants for Chiropractic college “must have at least 90 semester hours of undergraduate study leading toward a bachelor’s degree.” Curiously, an applicant for Chiropractic school is not currently required to have a bachelor’s degree. However, “many applicants have a bachelor’s degree, which may eventually become the minimum entry requirement” according to the US Bureau of Labor Statistics. (13)

Chiropractic doctoral “programs require a minimum of 4,200 hours of combined classroom, laboratory, and clinical experience.” Chiropractic programs stress anatomy, physiology, public health, microbiology, pathology, and biochemistry in the first two years of study. Manipulation and spinal adjustment along with physical and laboratory diagnosis, neurology, orthopedics, geriatrics, physiotherapy, and nutrition make up the final two years of education. (14)

Upon graduation students are granted a degree of Dotor of Chiropractic. After graduation some chiropractors continue to study pursuing a post doctoral education in either orthopedics, neurology, sports injuries, nutrition, rehabilitation, radiology, industrial consulting, family practice, pediatrics, and applied chiropractic sciences earning a diplomate in their given specialty. (15)

For whatever reason there has been a history of animosity between doctors of chiropractic and doctors of medicine through the years. However, that animosity has lessened somewhat in recent years and some medical doctors will now refer patients to chiropractors, and vice versa.

Acupuncturist

“Acupuncture is a component of traditional Chinese medicine that originated in China over 5,000 years ago. It is based on the belief that living beings have a vital energy, called “qi” (or chi), that circulates through twelve invisible energy lines known as meridians on the body. Each meridian is associated with a different organ system. An imbalance in the flow of qi throughout a meridian is how disease begins.” (16)

Dorland’s Pocket Medical Dictionary states that acupuncture is “the Chinese practice of piercing specific areas of the body along peripheral nerves with fine needles to relieve pain, induce surgical anesthesia, and for therapeutic purposes.” (17) Pain is reduced by restoring the balance of qi (or sometimes pronounced chi) in the body.

In 1997 the US Food and Drug Administration (FDA) reclassified acupuncture needles from “experimental” to “medical device.” That same year the National Institutes of Health endorsed acupuncture for a variety of conditions. (18) Since that time numerous medical professionals from other fields, such as doctors of chiropractic, have taken up the practice of acupuncture and begun to offer it as a part of their practice.

Doctors of acupuncture will often enhance the needling procedure with moxibustion, which is the “heating of acupuncture needles with dried herb sticks to activate and warm the acupuncture point.” The process is also known as “moxa.” (19)

They may also perform electrostimulation, which “provides electrical stimulation to two to four acupuncture needles,” by attaching electrodes to the needles and running minute electrical charges through the needles.This is primarily for pain relief. (20)

Another form of acupuncture is Chinese cupping in which glass or plastic cups are placed over acupuncture points on the skin. Through various means a vacuum is created under the cup drawing the skin upward into the cup thereby relieving qi and stagnation of the blood and relieving pain. (21)

Citations

(1) Medline Plus, http://www.nlm.nih.gov/medlineplus/ency/imagepages/9713.htm; Retrieved 11/12/2009.
(2) American Osteopathic Association, http://www.osteopathic.org/index.cfm?PageID=ado_whatis; Retrieved 11/12/2009.
(3, 4) Medline Plus, http://www.nlm.nih.gov/medlineplus/ency/article/002020.htm; Retrived 11/12/2009.
(5, 6, 7, 8) Bureau of Labor Statistics, Occupational Outlook Handbook, 2008-09 Edition. http://www.bls.gov/oco/ocos080.htm. Retrieved 11/13/2009.
(9, 10, 11, 12) What is Chirpractic?, by Ron Grassi, DC, MS, FACFEI and Mary Claire Walsh, staff writer, http://www.spineuniverse.com/displayarticle.php/article800.html. Retrieved 11/15/2009.
(13, 14, 15) Bureau of Labor Statistics, Occupational Outlook Handbook, 2008-09 Edition. http://www.bls.gov/oco/ocos071.htm#earnings. Retrieved 11/15/2009.
(16, 18, 19, 20, 21) What is Acupuncture? by Cathy Wong, ND, CNS. From About.com. January 31, 2005, http://altmedicine.about.com/cs/treatmentsad/a/acupuncture.htm. Retrieved 11/15/2009.
(17) Dorland’s Pocket Medical Dictionary, 25th ed. W. B. Saunders Co., 1995. ISBN 0-7216-5738-9

FSM Ushers in New Era of Medical Treatment for Chronic Pain

Since the mid 1990’s FSM, or Frequency Specific Microcurrent, has been gradually altering the landscape of the chronic pain treatment community and is beginning to affect quite profoundly the way chronic pain and numerous other medical conditions are being treated worldwide. Raphael J. D’Angelo, M.D., of Aurora, Colorado, is among the proponents in the medical community who advocates the merits of FSM and administers FSM therapy to his patients in his everyday practice. Dr. D’Angelo defines FSM as follows: “FSM is the application of specific frequencies of electrical current to the human body. The current is in millionths of an ampere called micro amps, which is below the threshold of sensation. In other words, the current is so tiny that the person receiving a treatment can’t feel it.” (1)

Lay people often confuse FSM with EMS, Electrical Muscle Stimulation, which is an electrical device that stimulates the muscles and can usually be found in a physical therapist or chiropractor’s office. Other people confuse FSM with a TENS unit, or transcutaneous electrical nerve stimulation, which most people with chronic pain are familiar with or have at least heard of.

“A “TENS unit” is a pocket size, portable, battery-operated device that sends electrical impulses to certain parts of the body to block pain signals. The electrical currents produced are mild, but can prevent pain messages from being transmitted to the brain and may raise the level of endorphins (natural pain killers produced by the brain).” (2)

Although FSM is neither an EMS or a TENS unit, an FSM device is licensed and approved by the FDA, Food and Drug Administration, as a form of a TENS unit as are all microcurrent devices. However, both EMS and TENS units carry an electrical charge which is thousands of times greater than an FSM unit. (3)

Dr. James Oschman, Ph.D., a biophysicist, states in his book, Energy Medicine, the Scientific Basis, that science has proven that the human cell is organized as a liquid crystal which conveys and stores current, electrical charge and vibrational information. “Every part of the body, including all of the molecules so thoroughly studied by modern science…form a continuously interconnected semiconductor electronic network. Each component of the organism, even the smallest part, is immersed in and generates a constant stream of vibratory information.” (4)

In 1991 German scientists Erwin Neher and Bert Sakmann earned the Nobel Prize for physiology and medicine “for their discoveries concerning the function of single ion channels in cells.” (5) They developed the “patch clamp technique” for measuring electrical current in living cells. (6)

Once the ability to measure electrical current in cells was discovered, it was learned that diseased or injured cells carry a different current than healthy cells. Either disease or trauma may affect human cells, altering their electrical makeup and frequencies. David G. Young, N.D., explains that “when an injury occurs to a tissue, the electrons in the affected tissue take on a different vibrational characteristic, unique to that injury or other abnormal condition. As the vibrations of the electrons change, it is believed the electrons concurrently may also change to a different “orbit” from what was normal for that tissue type.” (7) Sometimes such cell alteration produces chronic pain.

FSM applies minute frequencies of electrical charge to the human body to correct those alterations, thereby relieving the pain. FSM advocate Raphael J. D’Angelo, M.D., of Aurora, Colorado, states that “Frequency Specific Microcurrent is an energy that supplies informational frequencies to our cells and tissues that will eliminate dysfunctional energies and  restore vibrational normality.” (8)

Dr. D’Angelo further states “Dr. Albert Abrams in the early 1900s found very specific frequencies that had predictable therapeutic effects and is given the credit for the start of frequency specific microcurrent. Today, the Abrams Frequencies are still in use and selected frequencies have been validated in modern research studies.” (9) Those frequencies discovered by Dr. Abrams and other frequencies detected by many other doctors and osteopaths of the early 20th century are the basis for modern FSM therapy.

Dr. Carolyn McMakin, D.C., who is recognized as the founder of modern day FSM and the leading world authority on FSM, (10) is probably more responsible than any other medical practitioner for motivating medical providers to employ modern FSM therapy to relieve chronic pain. Dr. McMakin has traveled the globe presenting to her medical colleagues her re-discovery of these same electrical frequencies and the application of these frequencies in FSM medical devices thereby making the new FSM therapy possible.

In the following paragraphs Raphael J. D’Angelo, M.D., explains how he was introduced to FSM:

“I was introduced to this cutting edge technology at a medical conference in 2002.  Dr. Carolyn McMakin of Portland, Oregon, the leading world authority on FSM, was demonstrating its capacity to heal injured tissues.  Her subject was a doctor who had a torn rotator cuff of the right shoulder that had been surgically repaired three months earlier.  He had been in rehabilitation and still could not get his right arm past horizontal.”

“She put on electrically conductive gloves attached by wires to a machine that allowed her to change the frequency and current to each glove.  Dr. McMakin then proceeded to place her gloved hands over his right shoulder directly in contact with the skin.  She worked on different muscles, tendons and nerves over twenty minutes and at the conclusion she had his right arm easily over his head without pain!  As a physician that deals with sports injuries and pain syndromes, I was convinced that this revolutionary technology needed to be offered to my patients.” (11)

The following video about FSM is produced by Dr. McMakin:

Dr. McMakin is the one who applied the discoveries of all of the doctors and scientists who came before her into the science of FSM therapy thereby enabling medical treatments of countless chronic pain syndromes and other medical conditions. In our next article we will discuss many of the conditions that may be successfully treated with trigger point therapy, acupuncture point therapy and FSM therapy.

Citations

(1, 3) Frequency Specific Microcurrent Theory, by Raphael J. D’Angelo, M.D.,  http://www.fsm4u.com/page3.html; Retrieved 11/3/2009.
(2) “What Are TENS Units?” From About.com; http://arthritis.about.com/od/assistivedevicesgadgets/g/tensunit.htm; Retrieved 11/03/2009.
(4) Energy Medicine, The Scientific Basis; by James Oschman, Ph.D.,
(5) The Nobel Prize in Physiology or Medicine 1991, http://nobelprize.org/nobel_prizes/medicine/laureates/1991/. Retrieved 11/05/2009.
(6) Ervin Neher and Bert Sakmann, 1991 Nobel Prize laureates for physiology and med, http://www.ionchannels.org/showabstract.php?pmid=1373344&redirect=yes&terms=1991+nobel+prize+winners, Retrieved 11/5/2009.
(7) Frequency Specific Micro current – What is it and how does it work?, by David G. Young, N.D. (Doctor of Naturopathy), http://pages.prodigy.net/naturedoctor/microcurrent.html, Retrieved 11/4/2009.
(8) Frequency Specific Microcurrent Theory, Raphael J. D’Angelo, M.D.,  http://www.fsm4u.com/page4.html; Retrieved 11/4/2009.
(9) Frequency Specific Microcurrent Theory, by Raphael J. D’Angelo, M.D., http://www.fsm4u.com/page2.html; Retrieved 11/4/2009.
(10, 11) Frequency Specific Microcurrent Theory, by Raphael J. D’Angelo, M.D., http://www.fsm4u.com/page6.html; Retrieved 11/4/2009

Trigger Point Needling to Alleviate Pain

http://pain6.blogspot.com/2009/10/chronic-pain-referral.html
Trigger Point Needling is a commonly used method to alleviate pain from trigger points, which are knots or hardening of muscle fiber. The procedure is generally performed by a medical doctor or osteopath and can be either in the form of dry needling or the doctor may inject a pain killer such as lidocaine or even botox into the trigger point to ease the patient’s pain.

Injecting lidocaine into a trigger point is very similar to getting any type of injection, except that with a trigger point injection, the doctor wants the medicine to reach a specific area in a specific muscle as opposed to the medicine generally entering the patient’s system.

Lidocaine “is widely used for infiltration, nerve-block, and spinal anesthesia in a 0.5 to 2 percent aqueous or saline solution and is also applied to mucous membranes (2 to 4 percent) for mucosal anesthesia.” (1) Because lidocaine is a fast acting anesthetic, pain relief may be almost immediate depending upon the reason for the trigger point flareup.

According to Dr Janet Travell, “trigger point injection requires careful positioning of the patient and often needling at both the central and attachment trigger point regions to be successful.” (2) After trigger point injection the physician will also usually prescribe several visits to a physical therapist for “bimanual release of tightness in the vertical and diagonal muscle fibers” (3) of the muscle immediately surrounding the trigger point.

In addition the physical therapist will also prepare the trigger point for manipulation by either icing down the trigger point and surrounding muscle or applying a vapocoolant spray over the muscle and painful areas prior to manual manipulation.(4) The goal of both the injection and the physical therapy is to coax the trigger point to relax its tight grip on the muscle.

Figure 1 shows a perpendicular injection into a trigger point, which is the injection into the central area of the trigger point that was previously mentioned. Figure 1 also shows a similar injection into the trigger point at an angle in the inset picture. Many physicians will inject straight in and at angles to the right and to the left to insure reaching all areas of the trigger point needed to ease the patient’s pain.

Botox, or Botulinum Toxin Type A, is injected in a similar manner that lidocaine is injected. Botox is a drug developed from a toxin produced by the bacterium Clostridium botulinum, which is the same toxin that causes food poisoning or botulism. (5)

This is the same botox that dermatologists and plastic surgeons use to treat facial wrinkles to make their patients look younger. Doctors also use botox in small doses to treat “Cervical dystonia – a neurological disorder that causes severe neck and shoulder muscle contractions.” (6)

Cervical dystonia and the neck and shoulder muscle contractions are a fancy way of saying that the trigger points in those muscles are working overtime and causing the muscles to contract to the point of causing severe pain. If you can get the trigger points to relax their grip on the muscle, the pain will subside.

“Botox injections work by weakening or paralyzing certain muscles or by blocking certain nerves.” (7) A muscle that is weakened or cannot contract will also not be able to cause pain by overcontracting.

The negatives of botox are that its effect ony lasts from three to six months after which the needling procedure must be performed again to continue to ease the pain. Botox can also cause pain in the injection area and even worsen the symptoms that you are trying to eliminate.

When botox is used to treat cervical dystonia, the pain in the general area of the injection will increase somewhat for a week or ten days, after which the pain caused by the trigger points will ease or dissipate completely. However, the treatment can occasionally backfire by increasing pain in the injection area and never easing, leaving the patient in an even worse state of pain and never easing the pain.

Botox can also cause flu-like symptoms, headache and upset stomach. According to the Allegan, Inc. web site, which is the company manufacturing botox, other side effects may include: “dry mouth, discomfort or pain at the injection site, tiredness, headache, neck pain, and eye problems: double vision, blurred vision, decreased eyesight, drooping eyelids, swelling of your eyelids, and dry eyes,” problems swallowing, speaking, or breathing, or a spread of toxin effects to other areas of the body. (8)

Dry needling is performed in the same manner as injecting lidocaine or botox, however, no medicine is injected into the site. The needling itself is sometimes enough to induce the trigger point to relax. Dry needling can be performed by an acupuncturist or a medical doctor.

The following video is an example of how a doctor performs dry needling on the infraspinatus muscle:

The efficacy of any of the forms of needling will naturally depend upon the reason for the flare up of the trigger point. In the case of a trigger point flareup caused by trauma, such as an auto accident,the flareup may subside completely after treatment or may return because of permanent injury such as spinal cord injuries.

(1) Dictionary.com. http://dictionary.reference.com/browse/lidocaine, retrieved 10/25/2009.

(2, 3, 4) Myofascial Pain and Dysfunction: The Trigger Point Manual; Authors: Janet Travell, MD and David Simons, MD. p 491.

(5, 6, 7) Medline Plus – Botox. http://www.nlm.nih.gov/medlineplus/botox.html. Retrieved 10/26/2009.

(8) Botox Cosmetic. http://www.botoxcosmetic.com/. Retrieved 10/26/2009.

Referred Pain? What’s That?

Experiencing referred pain means you are experiencing pain in one muscle or area of the body, but the source of the pain actually comes from a trigger point in an entirely different muscle. Sometimes this occurs in a body part lying a significant distance from the referring trigger point.


In another post in which we discussed “what are trigger points” we learned that the trapezius muscle has a trigger point about midway between the shoulder and the neck lying atop the torso. (See figure 1)

Two more trapezius trigger points lie next to each other at the juncture of the shoulder and the neck, indicated in yellow on figure 1, although the posterior point is the more frequent culprit causing referred pain.

These trigger points “will consistently refer pain above the trigger point into the neck – this is a major source of “tension neckache.” As the pain intensifies, it will extend to the side of head, centering around the temple and behind the eye. On occasion, pain will also flare up in the angle of the jaw. When referred pain from this trigger point is combined with other myofascial trigger points, this almost always results in extreme tension headaches.” (1)


The trapezius is probably the muscle most often beset by myofascial trigger points. It is a frequently overlooked source of temporal…headache. (2)

In Figure 2 note how the trigger points of the upper trapezius refer pain to the side and back of the neck, traveling up the neck, over the ear to the temple. In addition they also refer pain to the jaw.

If you were beset with fierce temporal headaches and you and your medical practitioner were both unaware that trapezius trigger points referred pain to the temple causing temporal headaches, you would constantly be misdiagnosed for the cause of your headaches.

That is why it is so important to visit with a medical practitioner who has been trained in the diagnosis and treatment of trigger points.

(1) Aid My Headache. http://www.aidmyheadache.com/pain-mappings.en_us.php. Retrieved 10/22/2009

(2) Myofascial Pain and Dysfunction: The Trigger Point Manual; Authors: Janet Travell, MD and David Simons, MD. p 279

What Are Trigger Points?

The term “trigger point” was coined by Dr Janet Travell and Dr David Simon in the 1950s. A trigger point is a local hardening of an area in a muscle that often hardens to such a degree that, when touched with your finger, or palpated, it feels almost solid, like something entirely separate from the muscle itself. (1)

But the trigger point is a real part of the muscle, not at all a separate entity. When the muscle is pressed upon the trigger point will slide slightly away from the point of touch, or palpation. In figure A we see the trigger point slide to the right.

Likewise, when you press the trigger point from the opposite side, it will slide away from the point of pressure, or in this case to the left as seen in Figure B.

Trigger points are also sometimes referred to as Trigger Zones, Trigger Spots and Trigger Areas. You will also see Myofascial Trigger Points frequently mentioned when discussing these devilish areas of your muscles. (2)

All of these terms refer to the same area, Trigger Points, which “are localized and sometimes extremely painful contractures (‘knots’) found in any skeletal muscle of the body.” (3)

“Trigger points…are described as hyper irritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers. Trigger point researchers believe that palpable nodules are small contraction knots and a common cause of pain.” (4)

That last sentence is probably one of the most telling of all. “Trigger point(s)…are…a common cause of pain.” All skeletal muscles of the body have trigger points, and each and every one of them is capable of causing pain.

The pain caused by trigger points may range from a minor annoyance to a pain that is so crippling and severe that it induces people to commit suicide to rid themselves of the agony caused by the trigger point.

One of the most recognizable trigger points lies in the upper trapezius muscle, which lies atop of the torso resting between one’s shoulder and neck.


The area in yellow in the diagram above shows a trigger point that lies in the upper trapezius muscle that most people will recognize. This area is one that frequently tightens up because of stress and is part of an area that people automatically massage to loosen the muscle up, especially when one is fatigued.

In addition to causing pain to the area immediately surrounding the trigger point, the trigger point will often cause referred pain to a completely different muscle. Trapezius trigger points will often refer pain to the sides (scalenes) of the neck, to the jaw and to the temple of the head, causing headaches. (5)

Despite the many areas of the body to which trigger points can refer pain, successful treatments are available assuming that one finds the proper medical professional.

(1) Color Atlas of Acupuncture, Body Points, Ear Points, Trigger Points, 2nd Edition; Authors: Hans-Ulrich Hecker, MD, Angelika Steveling, MD; Elmar T Peuker, MD; Joerg Kastner, MD; Kay Liebchen, MD. P 168.

(2) Myofascial Pain and Dysfunction: The Trigger Point Manual; Authors: Janet Travell, MD and David Simons, MD. p 8.

(3) Wikipedia, Myofascial pain syndrome, http://en.wikipedia.org/wiki/Myofascial_pain_syndrome, retrieved 10-18-2009.

(4) (3) Wikipedia, Trigger point, http://en.wikipedia.org/wiki/Trigger_points, retrieved 10-18-2009.

(5) Myofascial Pain and Dysfunction: The Trigger Point Manual; Authors: Janet Travell, MD and David Simons, MD. p 279.

Managing Chronic Pain

The purpose of this site is to introduce chronic pain sufferers to a method of treatment and management of chronic pain through a combination of trigger point therapy and acupuncture point therapy.

This is a system of pain management with which even many medical doctors have little familiarization. Most folks are somewhat familiar with or have at least heard of acupuncture, but relatively few lay people are aware of the benefits of trigger point therapy.

Trigger Point Therapy was discovered and developed in the United States by Dr Janet Travell, a brilliant physician who “developed and popularized the diagnosis and treatment of myofascial pain syndrome secondary to trigger points.” (1)

In order to avoid tedious technical jargon which is difficult for most lay people to understand, care will be taken to avoid such lengthy medical terms whenever possible. However, in order to understand how Trigger Point Therapy works, you should have a basic understanding of what it is.

“Myofascial Pain Syndrome (or MPS) is a term used to describe one of the conditions characterized by chronic, and in some cases, severe, pain. It is associated with and caused by “trigger points” (TrPs), which are localized and sometimes extremely painful contractures (‘knots’) found in any skeletal muscle of the body.” (2)

“Trigger points or trigger sites are described as hyperirritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers. Trigger point researchers believe that palpable nodules are small contraction knots and a common cause of pain.” (3)

The basic tenet of Dr Travell’s is to locate the trigger point or points responsible for the patient’s pain, treat the irritability of the trigger point through various means, and the pain will often dissipate and even disappear completely.

Dr Travell, in association with Dr David Simons, wrote Myofascial Pain and Dysfunction: The Trigger Point Manual, which is the master reference book that medical providers worldwide use to treat pain related to irritated trigger points.

The following are some of the conditions that may be successfully treated with Trigger Point therapy: Abdmominal pain, achilles tendonitis, ankle sprain and pain, ankylosing spondylitis, lower and upper back pain, bell’s palsy, busitis, calf pain, carpal tunnel syndrome, cervical spondylosis, chronic fatigue syndrome, muscular chest pain, coccyx injury, costocondritis, dupuytren’s contracture, earache, elbow pain, facial neuralgia or tic, facial pain, fibromyalgia, finger pain, foot pain, ganglion, gout, groin injury, hamstring injury, hand pain and stiffness, head pain including headaches, heel pain, hernia, hip pain, intercostal Neuralgia, knee pain, runner’s knee, lower and upper leg pain, mandibular pain, menstrual cramps, metatarsalgia, migraine, muscle cramps, muscle sprains, strained muscle, pulled muscle, neck pain, pelvic pain, osteoarthritis, peripheral neuropathy in hands and feet, post operative pain, prolapsed disc in lower back, rheumatoid arthritis, sciatica, scoliosis, shin splints, shingles, frozen shoulder, shoulder pain, spondylosis, temporo-mandibular pain, tendonitis, thigh pain, thumb pain, trigger thumb, and wrist pain. (4)

(1) Wikipedia. Janet G Travell, http://en.wikipedia.org/wiki/Janet_G._Travell, retrieved 10-18-2009.

(2) Wikipedia, Myofascial pain syndrome, http://en.wikipedia.org/wiki/Myofascial_pain_syndrome, retrieved 10-18-2009.

(3) Wikipedia, Trigger point, http://en.wikipedia.org/wiki/Trigger_points, retrieved 10-18-2009.

(4) Natural Health, Pain Management in the 21st Century, pp 55-210, Bruce R Hocking.