Myofascial Pain Syndrome can be defined as chronic muscle pain. This pain originates around certain points of pain and sensitivity in your muscles called trigger points. A recent study was published in the Journal of Manipulative and Physiological Therapeutics that sought to identify and review the most common treatments for myofascial pain syndrome.

This study identified many different types of treatment used, and some of them are as follows:

• Spray and Stretch - vapo-coolant spray followed by muscle stretch
• Soft Tissue Massage
• Ischemic Compression - compressing the trigger point in the muscle
• Occipital Release Exercises - a form of massage and mobilization for the occiput (base of skull)
• Strain/Counter-strain - stretching a muscle and then having the patient contract that muscle
• Myofascial Release - compressing and tensioning the trigger point while stretching the muscle through its full range
• Chiropractic Spinal Adjustments

Immediate (after treatment) benefits were demonstrated with the chiropractic adjustments, spray and stretch, compression, massage and strain/counter-strain. The authors therefore concluded that there is moderately strong evidence to support the use of these manual therapies for the treatment of trigger point pain. These treatments, however, didn’t show as strong benefits as long term solutions.

Recommendations for other types of treatment for trigger points and myofascial pain syndrome can be drawn from this review.  They are as follows:

• There is strong evidence that laser therapy is effective.
• There is moderately strong evidence that electrical therapy is effective on a short term basis.
• There is moderately strong evidence that acupuncture is effective for up to 3 months after treatment.
• There is limited evidence for modalities such as muscle stimulation, interferential current, an other such stims.

Dr. Debbie Wright is a practicing Vancouver Chiropractor.

New Zealand readers will recognise the origins of the heading for this post - a few years ago, Wellington used that phrase to promote visiting that wild and windy place (don’t worry Wellingtonians, I’ve lived there for a few years - and among the wild and windy days are those gloriously balmy sunny days that take your breath away!).

The theme for this week has been resilience, or taking a look at how people who are living ‘well’ with their pain manage to do so.  So a couple of links today to resources for those who would like to learn more about positive psychology.

The first is a 2008 paper by Martin Seligman (my hero!) who reviews the concept of healthiness, returning to the origins of the WHO definition of health ‘not merely the absence of disease’…

Health is a state of complete positive physical, mental, and social well-being and not merely the absence of disease or infirmity. (Preamble to the Constitution of the World Health Organization, 1946)

He suggests in this paper called Positive Health that identifying and encouraging features of life that promote optimism and resilience will have direct benefits on health.  I couldn’t agree more.

As he points out in the introduction of this paper, psychology and psychiatry have been working on mental illness for a long time - and there have been some great advances in this field over the past century.  But the field of mental wellbeing is embryonic.  Hence the development of positive psychology sited at Pennsylvania University.

The Positive Psychology Center has a load of resources for therapists and researchers - well worth a tour.

One of the best resources for individuals who want to apply positive psychology to their own life is the Authentic Happiness site, which is associated with Positive Psychology Center.  Head there for plenty of applied concepts to enrich your life, and those of your patients.

New Zealand has its own Positive Psychology Association (NZAPP) - take a look at their website for some further resource links, and perhaps consider signing up for membership.

Take a quiz to see what you know about resilience here... There is a lot of information about stress and stress management also available on WebMD, so plan on spending some time there!

The final link today is from the APA Help Centre: this link can also be downloaded as a pdf, so you can use it as a handout.

From the FMS Global News Desk of Jeanne Hambleton (UK)

SEATTLE–(BUSINESS WIRE)

Patients suffering from post-traumatic peripheral nerve pain treated with Lyrica® (pregabalin) capsules CV experienced significantly reduced pain compared to those taking placebo, according to new data presented today at the American Academy of Neurology annual meeting. The data also showed that patients treated with Lyrica reported less pain interference with sleep and were significantly more likely to report feeling better overall at the end of the study compared with placebo.

Post-traumatic peripheral nerve pain is a difficult to treat condition that occurs after nerve damage due to trauma from accidental injury or surgery. It can be a chronic condition, affecting the injured area with pain persisting long after the initial injury has healed. Traumatic injury causing long-lasting changes to the peripheral nervous system – the communications network that transmits information to and from the central nervous system (the brain and spinal cord) and every other part of the body – is believed to be the cause of this persistent pain.

Post-traumatic peripheral nerve pain can have a wide array of symptoms, including numbness, tingling and prickling sensations, sensitivity to touch or more extreme symptoms including burning pain.

“The findings of the study are good news for the many patients who suffer from this painful and debilitating condition,” said Robert van Seventer, MD, Chair of the Department of Anesthesiology and Director of Amphia Pain Clinic and Research Centre, Amphia Hospital, the Netherlands.

“Post-traumatic peripheral neuropathic pain has historically been a challenging condition to treat so this data demonstrating the ability of pregabalin to provide relief for patients is encouraging.”

The study found patients treated with Lyrica experienced significantly reduced pain compared to those taking placebo. At the end of the study, patients receiving Lyrica had, on average, a pain score that was 0.62 points lower on an 11-point scale compared to placebo.

Patients receiving Lyrica reported less pain interference with sleep compared to placebo. At the end of the study, patients receiving Lyrica had an average self-reported weekly pain-related sleep interference score of 2.73 (from a baseline of 4.1) on an 11-point scale measuring how much pain had interfered with sleep during the past 24 hours, compared to 4.13 for placebo (from a baseline of 4.8). Additionally, at the end of the study, significantly more patients receiving Lyrica (64 percent) reported feeling “improved” compared to placebo (41 percent).

About the Study

The multi-center, double-blind, placebo controlled study of Lyrica in 254 adult patients with post-traumatic peripheral neuropathic pain randomized patients to receive flexible dose Lyrica 150 mg to 600 mg daily for four weeks of dose optimization, followed by fixed dosing for four weeks.

The study was conducted at 60 sites across Canada and Europe. The average Lyrica dose was 326 mg daily. Patients had to experience persisting, neuropathic pain for at least three months following a traumatic event such as an accident, surgery, amputation or a nerve injury and have a pain score greater than or equal to 4 on an 11-point scale. Patients remained on existing treatments during the study.

Patients were asked to measure their pain on a scale of zero to 10; the average baseline scores for study participants were 6.0 in the pregabalin group and 6.3 in the placebo group on this 11-point scale. A score of 4.0 to 7.0 is considered moderate pain and a score of greater than 7.0 is considered severe pain.

The primary endpoint was the difference in average self-reported pain score at the study’s conclusion between patients treated with Lyrica and placebo. Secondary endpoints included the effects of Lyrica compared to placebo on co-morbid symptoms of post-traumatic peripheral neuropathic pain including anxiety, patients’ self-reported pain-related sleep and patients’ self-reported overall improvements.

The most common side effects in the study versus placebo were dizziness (43.3 percent vs. 9.4%) and somnolence (15.7 percent vs. 6.3%), followed by headache (11.8 percent vs. 11.0%), fatigue (11.8 percent vs. 7.9%) and dry mouth (11.0 percent vs. 4.7%). The study was funded by Pfizer Inc.

About Lyrica

In the United States, Lyrica is approved for the management of fibromyalgia. Lyrica is also indicated for the management of painful diabetic peripheral neuropathy, postherpetic neuralgia (pain after shingles), and for the adjunctive treatment of partial onset seizures (a type of epilepsy) in adults.

Outside of the United States, Lyrica is indicated in adults for the management of peripheral and central neuropathic pain (NeP), treatment of generalized anxiety disorder, and adjunctive therapy for partial seizures with or without secondary generalization.

Important Safety Information

Treatment with Lyrica may cause dizziness, somnolence, peripheral edema or blurred vision. Other most common adverse reactions include dry mouth, weight gain, constipation, euphoric mood, balance disorder, increased appetite and thinking abnormally. There have been post-marketing reports of angioedema and hypersensitivity.

Pfizer Inc: Working together for a healthier world™

Founded in 1849, Pfizer is the world’s premier biopharmaceutical company taking new approaches to better health. We discover, develop, manufacture and deliver quality, safe and effective prescription medicines to treat and help prevent disease for both people and animals. We also partner with healthcare providers, governments and local communities around the world to expand access to our medicines and to provide better quality health care and health system support. At Pfizer, more than 80,000 colleagues in more than 90 countries work every day to help people stay happier and healthier longer and to reduce the human and economic burden of disease worldwide.

Contacts Pfizer Inc
Media:
Sally Beatty, 212-733-6566

Investor:
Jennifer Davis, 212-733-0717
Permalink: http://www.businesswire.com/news/home/20090429006303/en

FOR MORE HEALTH STORIES SEE http://jeannehambleton77.wordpress.com

Every month the best of pain blogging is gathered together and published by How to Cope with Pain. This month is a little different - instead of us sending in posts, the best posts have been selected and included in the carnival.  Take a look here for this month’s round-up. In the mix is a post on mirror therapy from Neurotopian, and for a little more, you can go here to view a video of mirror box treatment for stroke - the principles are the same for complex regional pain syndrome (CRPS).

My post about using attention management for coping with chronic pain is included - yay!

And my personal favourite is this one by Kerrie from The Daily Headache - scheduling in an ‘off’ day, or pushing yourself to do something knowing that a ‘bad day’ will ensue - but it’s worth it every now and then.

Pain management is all about choices really - and the power of pain management to me is helping people who have chronic pain recognise that they do have choices available, that pain does not need to dictate everything.

From the FMS Global News Desk of Jeanne Hambleton (UK)

Press Release from ENFA - 29.04.2009

Brussels, (29.04.2009)

Last week was high on activities for the Fibromyalgia community, on one hand the European Network of Fibromyalgia Associations (ENFA) met with the European Health Commissioner Ms Androulla Vassiliou1. And on the other hand the European Medicines Agency (EMEA) gave another negative decision for a treatment for fibromyalgia in Europe2.

Ms. Pam Stewart, Vice-President of European Network of Fibromyalgia Associations (ENFA) and chairman of the trustees of Fibromyalgia Association UK, said one of the biggest challenges that the patients have been facing is the lack of officially recognised medical treatment options in the European Union.

By comparison there are three drugs in the United States of America approved by the Food and Drug Administration: Cymbalta from Eli Lilly, Lyrica from Pfizer and recently authorised Savella from Forest and Cypress (Pierre Fabre).

Last October, Cymbalta received a negative decision from the EMEA and last week was the turn of Lyrica said Ms Stewart. One dossier is still remaining to be evaluated by the EMEA: Savella. Each of these drugs has a limited success and judged alone leads to their failure to get approval.

However with a full range of treatment options, more people with fibromyalgia could have reduced levels of pain. This could enable them to embark on a management programme to significantly improve their quality of life said the Vice President.

“We are constantly hearing from people diagnosed with fibromyalgia that their doctor tells them there is no treatment because no approved guidelines or medications are available. Medical professionals that do not have time to research treatment options should have clearly signposted guidelines for effective treatment options. No one should be sentenced to a life of pain, she said.

“Patients across Europe are currently using these medicines off label. However, the European Medicines Agency told European Network of Fibromyalgia Associations that this is a common situation already faced in other disease areas such as cancer, and the situation with off label use cannot be taken into consideration in the assessment of medicines for which a marketing authorisation is sought.

“The difference with Fibromyalgia is that patients in the UK, for example, are unlikely to be prescribed any of these effective drugs because they have not been officially approved for Fibromyalgia. Patients are left with inadequate treatment options and although these drugs can be purchased over the Internet, this means their use is not monitored and people could be at the mercy of unscrupulous suppliers, which could put their lives at risk,” said Ms. Stewart.

Another example, coming from Germany, concerns the social status of patients since they are labeled as “depressive patient” for their life insurance or health insurance in order to have their drugs fully reimbursed by the National Health Insurance. In order to get any effective medicines, doctors should not diagnose fibromyalgia at all because the medicines are not indicated for fibromyalgia.

At the same time, an ENFA delegation was meeting with the European Health Commissioner Ms. Vassiliou. The meeting was only a natural step, concluding ENFA’s activities on the ‘European Institutions Fibromyalgia Awareness Campaign’ launched in 2008 on World Fibromyalgia Day.

Since the commencement of the campaign last May, with the support from 418 Members of the European Parliament, the Written Declaration on Fibromyalgia was adopted by the European Parliament in December 2008. The written declaration was necessary to raise awareness to all the European politicians from the 27 member states. It also helps create a mapping of the disease status disparity across Europe and increase awareness of better diagnosis and treatment.

“However, we realised that without any officially approved treatment options available, it was almost impossible to properly raise awareness of Fibromyalgia. The patient petition with over 27,000 signatures from all over Europe that MEP Adamou voluntarily hand delivered to the Health Commissioner, clearly demonstrates the frustration from the fibromyalgia community and strong and urgent needs to have treatment options to be officially available. The Fibromyalgia community is left with one hope to see maybe Savella drug approved before the summer. But unfortunately, the hope for a multiple choice of treatment in Europe seems to be lost.

“The European Network of Fibromyalgia Associations and all its associations have for years raised awareness on Fibromyalgia among national and European politicians, health professionals and the general public, and will keep on being active as long as it is necessary,” the Vice President.

About ENFA

ENFA is a network of patient association and support groups working in close consultation with the national association in the relevant country. Our joint missions are to conquer the myths and misunderstandings around Fibromyalgia. The network will help collectively push forward the boundaries which currently exist in understanding, experiencing and treatment of Fibromyalgia. Our main goal is to see Fibromyalgia receiving the recognition it deserves across Europe as an illness in its own right.

About Fibromyalgia

Fibromyalgia is a complex disease with chronic widespread pain as the defining symptom and various additional symptoms including fatigue, non-restorative sleep, morning stiffness, irritable bowel and bladder, restless legs, depression, anxiety and cognitive dysfunction often referred to as “fibro fog.” All of these symptoms cause serious limitations in patients’ ability to perform ordinary daily chores and work and severely affect their quality of life. Fibromyalgia imposes a large economic burden on society as well as on affected individuals. A study shows that an average patient in Europe consults up to 7 physicians and takes multiple medications over 5-7 years before receiving the correct diagnosis. The debilitating symptoms often result in lost work days, lost income and disability payments.

In fact, a Dutch study in 2005 estimated that the average annual cost of fibromyalgia was €980 million in the Netherlands. Research in the UK has shown that diagnosis and positive management of Fibromyalgia reduce healthcare cost by avoiding unnecessary investigations and consultations.

For more information on the European Network of Fibromyalgia Associations (ENFA) contact Ms. Pam Stewart Vice-President of ENFA Brussels@enfa-europe.eu; www.enfa-europe.eu.
1 On Wednesday 22 April in Strasbourg, for more information visit www.enfa-europe.eu; 2 On Thursday 23 April in London, for more information visit www.emea.europa.eu

Those with chronic pain/illness have much to grieve. Often this is a topic that is not discussed very often.

What is grief all about? Grieving is a disorderly process, unpredictable in appearance and manifestations. It is hard work and the steps to and the time it takes to processing it are individual for each woman. It differs in expression, intensity, and time.

Because our society hasn’t (as a whole) taught us about the grief process . . .

• it’s wide array of feelings,
• its impact on our behaviors and body,
• and the fact that grieving is normal . . .

 . . . many women struggle needlessly and far longer than necessary.

People are also afraid of the intense feelings of others. So they change the subject, minimize the feelings and intellectualize the situation. This is done by saying something that appeals to the intellect instead of the emotions.

To grieve well, a woman in pain needs to first acknowledge those losses. Some of these losses could include . . .

• The changed nature of relationships - roles (at home, work, social settings) are now different for the woman in pain. “I think I alienated a lot of people at work … because I was out sick so much …. and others [had to] cover for me” (LS).  Sometimes friendships are lost.
• Loss of present income and/or loss of future earning potential.
• Loss of youth, healthy body functions and physical abilities, including clear thinking and use of intellect.
• Spontaneity - Living with chronic pain is hard work and typically everything needs to be planned out in order to manage the symptoms.
• Loss of independence.
• Retirement dreams often must be changed, put on hold or deleted.
• Pleasure - Available time and effort are spent on coping so that fun is often neglected.
• Satisfying Sexual life - Low energy level and interest contribute to this loss. Also the fear of pain can contribute to lack of sexual intimacy.
• Positive future plans - often these are viewed with fear, when time is even given to thinking about the future.
• Self esteem.
• Identity.

Action Steps:

1. What is a loss you need to acknowledge?
2. How can this information help you be a better griever?
3. What is one thing you can do to help a woman in chronic pain grieve a little bit better? 
4. Use the above loss list as a prayer guide.

“Without question [there have been losses associated with my chronic pain]. I am not the woman I once was, I lack the stamina & strength I once had….check that…it is a DIFFERENT strength & stamina.” CS

Related Articles

Laura:This week my focus is on fitting in exercise as well as making lists of what I am going to eat as well as what I have eaten. Sounds like a cumbersome task, but I am actually looking forward to meal planning for a change! You know what it’s like when you get home hungry, searching for instant gratification…you stand in front of the fridge and eat things out of cartons .

Look Familiar??? So, let’s save ourselves the temptation by planning out our food. In the other key areas of my life, I believe that failing to plan is indeed planning to fail, so am again going to adopt that thought process in regards to my weight management program.

And on the exercise front. The biggest challenge I have here, is the current need for pain meds in my life, that have a 12 hour cycle. I am attempting to adjust the timing of them so I don’t go to sleep too early, but can actually get up and be coherent before noon . The place that seems easiest for me to include exercise time is before breakfast, so this week is all about balancing out the med schedule to allow for an earlier wake up…why do I feel like I am sounding like a really old woman about now?

Chronic Pain sufferers can probably relate to the fact that you really do need to schedule around your pain from time to time. The big thing is though, that you do it. Physical activity helps your main on a physical. mental and emotional level, so find the time to do it. I’ll let you know how I have fared.

Will catch up after I check in with Nicole tomorrow!

Cheers,

LA

I had to go to Harley St today to see a consultant that my solicitor arranged. It was made very clear to me that he won’t be giving advice, only to write a report. I got cab both ways, it was £50 in total.

Because I was so excited to get an appointment, I didn’t think about the time of it. Having to go into Central London at 930 in the morning was just stupid. Even though I’d been told no advice, I hoped he would have at least been able to give me a few pointers, maybe some form of exercise or treatment I may have missed.

When I got there, he first suggested stairs. I laughed at that and he showed me to a lift.

He took a basic history, and took the statement I had prepared talking about what I cannot do, then I had to put on a pair of shorts and then it started.

The poking and prodding

Moving my head to see how much my neck moves, then on my back to see how my legs moved. Then out came the little hammer, all reflexes ok. I think there were a few more moves he wanted to do, but at this point I was tearful so he stopped.

He said I definitely need a MRI scan, and he suggested I push as hard for that as I can. He was very scathing at the slow referral and how my case has been handled.

I then pleaded with him to give me more advice, and he told me I was doing everything I could do. He said I might benefit from another type of meds, and I said I’ll discuss it with my doctor. More pills? Deep bloody joy.

Changing out of the shorts took me ages, and he helped me back to the lift and I started crying. Everything hurt, and my little cotton bag that had in my shorts and my purse, keys and phone suddenly became really heavy.

The cabbie I had was lovely, and just kept a stream of jokes going all the way home.

My friend was due to come round for a catch up, so I dosed up on pills and I was still in pain so decided a bottle of wine would ‘assist’ the pain relief.

Just my luck it hasn’t worked.

Yeah mixing pills and drink is wrong, but right now I don’t care.