Muscles as Pain Generators

Pain can be caused by many things. It can stem from an organ such as the pancreas, stomach or bladder. These pains are usually best treated by attending to the dysfunction in the organ itself. There is also neuropathic pain and musculoskeletal pain. These are the types of pain that I deal with most effectively in my practice. Neuropathic pain is pain that originates from the nervous tissue. It is often caused by irritation of the nerves themselves, either within the central nervous system (brain and spinal cord) or the peripheral nervous system (nerves and nerve roots). Most often people seek treatment for pain in the peripheral nervous system. This can be caused by a herniated disc, which "pinches" a nerve root as it exits the spinal cord. There may also be entrapment of a nerve at a variety of sites throughout the body, most commonly where the nerve comes into close proximity with a nearby bone and is either repeatedly stretched or pressed against during certain activities (carpal tunnel syndrome). Often "nerve" pain is experienced as a burning, electric or tingling sensation. Sometimes it is possible to "release" the nerve entrapment either surgically, with splinting, with injections or exercises. Many times the best treatment is to avoid the repetitive maneuver or pressure that causes the nerve to be irritated and make judicious use of medications that can reduce the discomfort while waiting for the nerve to recover.

In my practice, the largest portion of chronic pain problems originate from the musculoskeletal tissue. Arthritis and bony degenerative changes are often treated with anti-inflammatory agents and can also benefit significantly from exercises usually started in water to strengthen the muscles. Muscles are "shock absorbers" for the bone and can displace forces that are otherwise directed towards the bone itself. Joint injections can also prove helpful and sometimes bracing or assistive devices may be necessary especially when arthritis flares.

Under our skin, the bulk of tissue that supports the bone and often surrounds and works in harmony with the nerves, lies the muscle and its fascial covering. Muscles can be sprained or strained with strenuous activity. This can cause micro hemorrhage and bleeding that then needs to be resorbed by the body and may leave small areas of calcified blood or inflammatory "junk" between the muscle fibers once healing has been completed. These small areas of debris can, over time, form "trigger points" within the muscle fibers themselves and lead to a myofascial (muscle) type pain syndrome. Usually, such a syndrome is experienced in the axial plane (cervical, thoracic or lumbosacral region). Muscle has great memory and it likes to recoil (spasm). These small trigger points can cause stretch of the muscle fiber which, in turn create irritation and pain, such as a small amount of debris under the skin on the face, known as a pimple, causes pain until it is "popped".

Muscles are often overlooked and considered unimportant from the standpoint of pain generators. One need only think of how we all came into this world, via the uterus, a muscle, as to the strength and importance of muscles in our body.

The Importance of Trigger Points