Tag Archives: Trigger point

Fibromyalgia/CMP

I was just wondering if any of you are suffering from FM or CMPS?
I have been getting anywhere from 36-42 trigger point injections a week for about 2 1/2 months now, and am preparing to have the botox injections in my lower back, up my spine, across my shoulders and the back of my neck. Has anyone here had these botox injections? I am scared to death about the pain being worse than the injections I get now 🙁
Thanks for any responses you may give me whether it be positive or negative.

LaTrecia

Prolotherapy

Nonsurgical reconstructive therapy ó also referred to as “prolotherapy” or “proliferative therapy” ó evolved out of a treatment pioneered by H. I. Biegeleisen called “sclerotherapy,” which was originally (and still is) used to treat varicose veins. Prolotherapy involves the injection of an “irritant” solution into the area where ligaments are weak and/or damaged. Over the next few days, cells called “macrophages,” literally big eaters, are attracted into the area by the presence of this irritant solution. Once they arrive, these macrophages pick up the irritant solution and carry it away for disposal (they are the garbage men of the body). As the macrophages are finishing their job, the body sends in “fibroblasts,” literally connective tissue builders, to lay down fibrous tissue wherever they detect damage to connective tissue such as ligaments.

Of course, prolotherapy can be used on any weakened ligament or tendon in the body. The determining factor is the doctor’s skill in introducing the needle to exactly the right locaiton. Knees, hips, elbows, shoulders, in fact every joint in the body can develop problems which can be addressed with prolotherapy.

The doctor’s job is to introduce the irritant solution into the places where ligaments are weak or damaged. If properly placed, this causes the repair of ligaments. This new supporting structure pulls the vertebrae back into close relationship with each other correcting instability and therefore putting an end to inflammation. When inflammation disappears, so does pain! Stability is restored along with mobility.

A single treatment with prolotherapy will cost around $200. Usually not more than ten to fifteen treatments are necessary to bring a typical back pain or neck pain syndrome under control.

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The term “prolotherapy” is a derivation of “proliferative injection therapy” and is also known as sclerotherapy. The practice of prolotherapy is used by doctors of osteopathy and other physicians to treat a number of different types of chronic pain. Prolotherapy consists of a series of intraligamentous and intratendinous injections of solutions in trigger points near the pained area to induce the proliferation of new cells.

Proponents of this treatment suggest that looseness in the supporting ligaments and tendons around the joints causes the pain, inducing the muscles to contract against the ligament and irritate the nerve endings. The physicians using this treatment method for low back pain believe the ligament laxity to be concentrated in the sacroiliac joint. During a physical examination a physician will identify trigger points generally in the muscles overlying the sacroiliac joint. The physician then may inject proliferant substances into the supporting ligament and tendon tissue.

The practice of sclerotherapy or prolotherapy to produce dense fibrous tissue in an effort to strengthen the attachment of ligaments and tendons is not new. Forms of this therapy apparently date back to Hippocrates, however, prolotherapy recently found favor with osteopaths following the teachings of George Hackett, MD, who in 1939 began using a local injectable irritant to initiate the healing process. It was Dr. Hackett who coined the term “prolotherapy” because sclerotherapy implied scar formation, which, according to Dr. Hackett, did not occur with prolotherapy. Nevertheless, both processes use trigger point injections to form new cells in an effort to support weakened muscles. Although the method has been in use for some time, to date there is no strong clinical evidence to support the efficacy of the treatment.

Prolotherapy injections are intended to mimic the natural healing process by causing an influx of fibroblasts that synthesize collagen at the injection site, leading to the formation of new ligament and tendon tissue. The newly produced collagen is intended to support the injured or loosened ligaments, creating a more stable and strong muscle base, in the process, alleviating pain.

There are three classes of proliferant solutions used to initiate inflammation: chemical irritants (e.g. phenol), osmotic shock agents (e.g. hypertonic dextrose and glycerin), and chemotactic agents (e.g. morrhuate sodium, a fatty acid derivative of cod liver oil). The two studies supplied by the requestor used a dextrose-glycerine-phenol solution.

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What is known about prolotherapy outcomes for back pain?
Reported success rates range from 80%-90% when performed by a physician trained in the prolotherapy procedure. Many of these reports are based on anecdotal evidence from the physicians themselves. Studies have not yet connected positive outcomes for back pain and healing to prolotherapy.

The anecdotal reports suggest improvements such as:

* Reduction or elimination of back pain
* Increased strength of the ligament, tendon or joint capsule
* Reduced recurrence of injury to the treated site
* Improved or return to normal function

Factors that may be key for a successful outcome include:

* Proper diagnosis of the location of the sprain or strain
* Willingness of the patient to complete follow-up therapy
* Clinical skill of the physician in performing the injection

Finally, it is important to note that nobody knows exactly what happens in prolotherapy. There is no objective medical evidence, and no histology has been published as to what goes on when injection is placed into the painful soft tissues.

Angie’s Pain

It all started as a normal TMJ problem. My jaws would pop & click w/ wide opening, yawning, etc.
Over about 2 years it progressed very quickly into “internal derangement w/out reduction”. I’ve done physical therapy, bite splints ( soft & hard ), biofeedback, imagery, soft diet, liquid diet, Advil, Tylenol, Aleve, about 10 different RX NSAID’s. After all the O-T-C Nsaid’s & Rx Nsaid’s, I now have an ulcer. Then I moved onto trigger point injections weekly, occipital nerve blocks weekly. Percocet 10’s, 3/day.
OxyContin 20mgs, 2/day, Duragesic Patches, 75mcg’s, one patch/ 72 hrs., MS Contin 30mgs, 2/day.
And now currently I take Methadone 15mgs, 2/day, w/ 60 Lortab 10/500mgs for breakthrough pain.

Trigger point injection

Trigger point injection (TPI) is used to treat extremely painful areas of muscle. Normal muscle contracts and relaxes when it is active. A trigger point is a knot or tight, ropy band of muscle that forms when muscle fails to relax. The knot often can be felt under the skin and may twitch involuntarily when touched (called a jump sign).

The trigger point can trap or irritate surrounding nerves and cause referred pain – pain felt in another part of the body. Scar tissue, loss of range of motion, and weakness may develop over time.

TPI is used to alleviate myofascial pain syndrome (chronic pain involving tissue that surrounds muscle) that does not respond to other treatment, although there is some debate over its effectiveness. Many muscle groups, especially those in the arms, legs, lower back, and neck, are treated by this method. TPI also can be used to treat Fibromyalgia and tension headaches.

Procedure

Medical specialists such as an orthopedist, physiatrist, pain specialist, or neurologist can administer TPI. Injections are given in the physician’s office and takes approximately 30 minutes. Before performing TPI, the physician may give the patient a nerve block to prevent pain from needle penetration.

A small needle is inserted into the trigger point and a local anesthetic (e.g., lidocaine, procaine) with or without a corticosteroid is injected. Injection of medication inactivates the trigger point and thus alleviates pain. Sustained relief usually is achieved with a brief course of treatment. The injection may cause a twitch or pain that lasts a few seconds to a few minutes.

Aftercare

Numbness from the anesthetic may last about an hour and a bruise may form at the injection site. Pain can be relieved by alternately applying moist heat and ice for a day or two. In most cases, stretching exercises and physical therapy are performed following TPI.

Complications

The patient should contact the physician if redness or swelling develops. There is some risk for puncturing a lung or the membrane that surrounds the lung (called the pleura), when a muscle near the ribcage receives a trigger point injection.

NY – Pain and Headache Treatment Center

http://www.lij.edu/lijh/phtc/phtc.html

Pain and Headache Treatment Center
1554 Northern Blvd. – 4th Floor
Manhasset, NY 11030
IF YOU ARE SUFFERING FROM CHRONIC PAIN
One in five Americans suffers from some form of chronic pain. Generally, pain is viewed as a symptom of underlying disease that will end after healing takes place. But, when pain does not subside, quality of life may become diminished by conditions such as: headache, migraine, low back pain, sciatica, facial pain, neck and shoulder pain, post-surgical pain, shingles, nerve injuries, myofascial pain, fibromyalgia, cancer pain, carpal tunnel syndrome or repetitive stress injury.

Traditional medical interventions may fail to remedy the problem because the pain has “taken on a life of its own.” Often in desperation, sufferers look for relief from many sources, a process that may be frustrating as well as costly.
A TEAM THAT IS SENSITIVE TO PAIN
The Pain and Headache Treatment Center of Long Island Jewish Medical Center (LIJ) is a collaborative program of the departments of Neurology, Anesthesiology and Rehabilitation Medicine. Both the body and mind must be taken into consideration for treatment to be effective. This is why the Pain and Headache Treatment Center has a multi-disciplinary team that includes:

* Anesthesiologists
* Dental and Facial Pain Specialists
* Neurologists
* Nurses
* Orthopaedic Surgeons
* Physiatrists
* Physical Therapists
* Psychologists

COORDINATING TREATMENT
The Pain and Headache Treatment Center offers a full range of treatments, all under one roof, in a comfortable and attractive setting. Our Board Certified specialists have years of experience in caring for individuals with all types of pain problems. A nurse coordinator acts as liaison and our trained staff helps patients with coordination of appointments, scheduling and assistance with insurance coverage.

The process begins with a comprehensive evaluation so that patients can receive the most effective treatment or combination of treatments. This includes a review of the patient’s medical records and tests. Individual treatment programs are then structured. Weekly staff meetings are held to discuss and review progress.
WHO CAN BENEFIT FROM SPECIALIZED PAIN CARE?

* Patients who have not responded to initial medical interventions aimed at their pain
* Patients with pain conditions that may respond to nerve block procedures: conditions such as acute back pain, sciatica, shingles, reflex sympathetic dystrophy (RSD or CRPS), myofascial pain or neck and arm pain
* Patients with pain that cannot be attributed to a clear cause
* Patients who want to learn more effective coping strategies for managing their pain
* Patients whose personal physicians would like a second opinion or additional treatment suggestions
* Patients who desire a comprehensive and coordinated treatment program

TREATING THE WHOLE PERSON
The best treatment for pain is to eliminate the underlying cause. Sometimes this is not possible and treatment must concentrate on the symptom and its effects. A customized plan helps each patient learn to utilize medications more effectively and practice techniques that can increase coping skills and promote a return to a more normal lifestyle. The goal of our multi-disciplinary approach is to:

* Manage the pain through medication trials and/or nerve block procedures
* Strengthen the body with a wide variety of physical rehabilitation techniques
* Empower the patient’s spirit with psychological help for dealing with the devastating consequences of chronic pain

TREATMENT APPROACHES
Medication Trials
Many medications are available for the treatment of pain. We have the expertise to employ many types of medications safely and efficaciously, paying great attention to individual sensitivity and responses.

Anesthetic Nerve Blocks and Other Procedures
Experienced anesthesiologists can perform nerve blocks and use steroid injections to interrupt pain transmission and reduce inflammation. Some pain syndromes such as RSD, shingles pain, radiculopathy (sciatica and other nerve compressions), nerve entrapment, joint pain and myofascial (muscular) pains may respond to these blocks. Neurolysis or permanent nerve blocks can also be performed to treat some chronic pains.

Rehabilitation
Physiatrists and physical and/or occupational therapists tailor programs, including hydrotherapy, massage and electrical nerve stimulation, to meet the conditioning and strengthening needs of individual patients.

Psychotherapy and Behavioral Medicine
The mind and body are intimately linked in pain. The psychological impact of pain may overwhelm the mind’s ability to deal with it. Our approach is to empower patients to take control of the pain through biofeedback, relaxation techniques, hypnotherapy and behavioral modification.

Trigger Point Therapy
Local muscle spasms sometimes cause severe regional pain. Long-lasting relief can be achieved by simple techniques such as massage/release or trigger point injections into these area. Post-traumatic injuries, myofascial pain and fibromyalgia are some of the syndromes treated in these ways.

Orofacial Pain Treatment
Specialized treatments are available for trigeminal neuralgia, temporomandibular joint disorders (TMJ), phantom tooth pain, mouth and facial pain. Dental and orofacial pain experts use medication, nerve or muscle injections, occlusal splints or surgical procedures to treat these conditions.

Additional Therapies

* Acupuncture
* Transcutaneous electrical nerve stimulation (TENS)

ADVANTAGES OF THE MEDICAL CENTER SETTING
In addition to the core team, the Pain and Headache Treatment Center draws from the vast resources of the North Shore – Long Island Jewish Health Systems. As an academic institution affiliated with the Albert Einstein College of Medicine, LIJ is dedicated to the integration of clinical services, teaching professional staff and remaining at the forefront of research. These commitments help ensure that our program provides the best and most up-to-date services.
ARRANGING FOR TREATMENT
The LIJ Pain and Headache Treatment Center is an LIJ-based private practice facility. Our physicians participate in a number of managed health care programs. As specialists in job-related injuries, our health professionals work with patients to obtain authorization for treatment from Worker’s Compensation or private insurance carriers. For added convenience, credit cards are accepted.

To Make An Appointment Telephone
THE PAIN AND HEADACHE
TREATMENT CENTER
516 719-PAIN (7246)
Monday through Friday, 8:30 am – 5 pm
LOCATION
The Pain and Headache Treatment Center is located on the fourth floor of LIJ’s Manhasset Ambulatory Pavilion, 1554 Northern Boulevard, Manhasset, NY 11030.

Abbie – Chronic Low Back Pain


On January of 1991, at the age of 24, I was in a car accident that changed my life. A few months after the accident a MRI showed I had a L5-S1 herniated disc with a displacement of the S1 nerve root. I had a lot of pain in my back and down my left leg. Chiropractic treatments and rest did very little to alleviate my pain. Because of leg pain and weakness I had a microscopic laminectomy and discectomy. A few days after that operation the pain that had subsided came back and even worsened. I tried physical therapy for months with no improvement and finally a CT confirmed that the disc herniated again.

At this point I had to move back to my father’s home in Israel (at the age of seven [1974] my parents moved us all to a Kibbutz in Israel). I was hospitalized for three weeks for conservative treatment that included steroid injections (not in the back but IM), confinement to bed, PT, and traction. It was a horrible experience. I felt completely helpless because I could not really move, so any thing I wanted or needed had to be brought to me I could no longer be an independent person. The hospital was terrible I shared a room with two other women and I shared a bathroom and shower with five other patients. There was no toilet paper in the bathroom I had to bring my own. On a good days, I got up early to take a shower right after it was cleaned and before anyone else used it.

The conservative treatments did not work and I had my second laminectomy discectomy in June of 92. I was pain free for a few months when slowly the symptoms came back. The orthopedic surgeon could not determine from a new CT whether scar tissue was the culprit or new or old disc tissue was causing all the symptoms. I was in and out of the emergency room a lot for the pain, since my doctors never gave me adequate painkillers.

My orthopedic surgeon gave me a treatment of several trigger point injections once a week for three weeks that gave me minimal relief. I went to another hospital for acupuncture. The treatments were done in the hospital basement, and along with 7 to 10 other patients the doctor went from each one and inserted the needles. After 15 or 20 minutes you would hear patients beg the nurse to come and take the needles out because they were hurting. It was ridiculous and no wonder it never worked.

I started to look for a really good doctor, one that I chose and not one that would be assigned to me. I made appointments with doctors in their private practice (Israel has socialized medicine in which doctors are assigned patients based on availability). I saw one doctor in his office and he suggested another operation maybe even fusion once I told him that I have no money to do it privately and needed to go through the ‘system’ he changed his tune. I tried to see him at the hospital clinic (he was recommended to me as the best neurosurgeon in the area) and he put me in a ridiculous ‘walking’ body cast. This cast started under my arms and ended at my knees, and I was supposed to walk around in it for 10 days. They put me in this body cast in July (93) one of the hottest months in Israel. I still canít believe I agreed to this I was still naive and with each new treatment I believed that I was going to get better. When the ten days were up I could not walk and I was ready to kill myself because of the pain.

During these years my family physician and the nurse practitioner only gave me 1 percodan a day, 10 percodan at a time, and I had to come back every ten days to get some more. I remember waiting all day dieing of pain until it was time to take the percodan. I still cannot believe I got through those years like that. I guess that because of the poor pain management I was unable to do any thing else but lie in bed and read books all day long.

After the body cast I never went back to that doctor (big surprise). I had another 2 CTs, a mylogram, 2 more MRIs, and two bone scans and still no one could tell me what was wrong. Of course since after the second operation the doctors insinuated that it was all in my head. I had no support from most of my family. My sister and twin brother were angry that I was so dependent on my father and believed that I was faking so that I could keep on living with him. And my stepsister and brother could not understand what I was going through and believed that I need to ignore the pain (as if I could) and get up and get on with your life and everything will be fine. My mother did not know what to believe. My father, despite everyone in the family telling him otherwise, was always there for me. It was hard to be dependent at 24 (and the next 5 years) on my 68-year-old father. It was very humiliating to endure people’s stares when he tied my shoes or carried the groceries and so on. But finally we got a break.

We found a very good orthopedic surgeon about two hours away. My uncle in Miami recommended him to us, since the doctor worked for the Miami Dolphins and now moved back to Israel. He preformed a L4-S1 fusion with 4 screws and 3 rods. At my request a neurosurgeon (a colleague of the ortho dr) decompressed the S1 nerve root.

Waking up from this operation was hard to say the least. The pain hit me like a freight train, and I could hardly breath. I was hooked up to a PCA unit but that was not enough, and I got supplemental morphine and phenergen. I pushed the PCA button every 5 minutes because if I didn’t my back would spasm up and the pain would be too much to bear. At 4 in the morning the unit ran out of morphine.

My mother who was at my side told the nurse that it was empty, and she replied that it was the anesthesiologistís, on call, responsibility to replenish the unit. However, the anesthesiologist was in surgery and would not be out for a long time. My mother then asked if the doctor could prescribe something instead of the PAC for now. The nurse replied that she was not going to wake up the doctor for something like that. I had to wait until 8 for one of the anasthiologits to come and refill the unit. I was in agony tears were poring down my face I begged for someone to help me. I was weak and disoriented from the anesthesiology and because of the operation I could not scream so my pleads went unnoticed.

I was release on my 28th birthday. An ambulance took me to the kibbutz rehabilitation unit. There I met the male nurse on duty, little did either of us know that we would be married a year later!! I was confined to bed and was allowed to get up twice a day this lasted for three months. I got through it with a lot of support from friend, my father of course and this kind male nurse (Neal) who kept asking me if I want a cup of tea and I always said yes. When I was released we started dating, and married in 1995. I always wanted to return the States and we moved two years later.

After the third operation I needed very little pain medication such as vicodin, but gradually over the years my pain became stronger and I needed to take percocet once the twice then three and four times a day. I kept hearing reports about chronic pain and I read an article in the Times about chronic pain and realized that that was I. But I still looked for a treatment that would cure me, and went through the typical injections, PT, and medications. During this time I went back to college part time and worked teaching Hebrew two hours a day twice a week. Once I realized that the CP was not going away I started searching for a PM doctor.

I started treatment at a PM clinic last November. The doctor said that they had many different medications and treatments we could try. I started to take neurontin 300mgs x3 a day then we gradually increased the dosage until I got to 1200mg 3x a day. I was ordered to stop taking the percocet, and I gradually did. At the next visit I got a nerve block injection and pamalor 75 mg to add to the regime. I was in a lot of pain and nothing was working I called their service many times and all they did was up the Pamalor, and when I told them that that is not enough I need a stronger medication to help me the doctor on call replied that if I was in that much pain I should go to the ER. So I jumped through their hoops and went to the ER and spent half a day there.

At my next appointment we talked to our doctor and explained to her that the medications I am taking help with the burning but not the rest of my pain, which is considerably stronger. She replied that she does not practice that kind of PM that she does not prescribe narcotics. So my husband stated, “so you don’t really care about my wife’s pain” the doctor contorted “yes I care, I would not be working in PM if I did not care” so again we tried to explain what I needed. At one point my husband asked if she was only going to treat only a part of the pain and not all of it. And that convinced her to put me on 20mg oxycontin 3x a day. She made me sign a contract with two terms that I see an orthopedic surgeon (about removal or the hardware that she thinks is pressing on the S1 nerve) and another pain management doctor to consult with about the Spinal Cord Stimulator and make an appointment with her in two weeks.

At our last scheduled appointment I was late because I was coming from the other PM doctorís office she wanted mo to see. As I was coming into her office I met her in the hallway and she told me not to bother going in because she will not see me. I begged her to understand why I was late since both her clinic and the other PM clinic were over 1.5 ñ 2 hours away from my house and I wasnít very mobile as it is. But she just stood there drunk with her power and in a bitchy way said no.

I was in tears as my husband drove us home. Instead of going home I asked that he take me to my PCP. I told her what had happened (mind you I did not have an appointment and it was 4:30 when I got there) she could not believe it and we decided that I would not go back to that PM doctor. Now my PCP wants me to find a new PM doctor while she continues to prescribe the medications I was given.

I have decided that I am not going to have another operation even though it might be true that the S1 nerve is compressed (this is dangerous since one might loose urinary control ect.). I canít deal with another operation. For now I will continue with what I have with some adjustments perhaps.