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Trigger Point Therapy Part Two

March 9, 2012 Written by JP       [Font too small?]

Those living with chronic pain frequently turn to over-the-counter NSAIDs or nonsteroidal antiinflammatory drugs for acute or long term symptom management. As expected, this approach generally makes day to day living more tolerable. However, there can be steep consequences to pay for the temporary relief these medications provide. Adverse reactions ranging from compromised bone healing to damage to the gastrointestinal tract have been attributed to regular NSAID use. In fact, the concern about the side effect profiles of NSAIDs is so profound that drug companies themselves are scrambling to find ways to minimize the downsides of this popular class of drugs. Some pharmaceutical manufacturers are even going so far as to combine NSAIDs with natural agents (dietary fiber, lactoferrin and probiotics) that may allow for these synthetic antiinflammatory agents to work in a safer manner.

It’s plausible that one day there will be a more benign class of pain relievers that is suitable for long term use. But, that still begs the question: Wouldn’t it better to address the underlying cause of pain, rather than simply interfere with some of the chemicals involved in the inflammatory process? The former philosophy is largely espoused by allopathic or conventional medicine. The latter point of view typically finds its home in the alternative, complementary and integrative medicine camps. In practical terms, this might mean foregoing or limiting the use of acetaminophen (Tylenol), aspirin or ibuprofen (Advil), and treating trigger points that are referring the pain itself instead.

JP - Is trigger point therapy supported by scientific studies published in the medical literature? If so, what are a few of the most impressive trials to date?

Valerie - Trigger point therapy is well-supported in scientific literature, and has been researched around the world for decades. Doctors Travell and Simons published a two-volume set in the 1980’s and 1990’s, and both volumes have since been revised and expanded. There is absolutely no doubt that trigger points exist and that they can be palpated; what we still don’t know is the physiological mechanism that causes trigger points.

Note: Here’s a partial list of Valerie DeLaune’s favorite trigger point studies:

Study 1 - Current Studies on Myofascial Pain Syndrome (link)

Study 2 - Brain Manifestation and Modulation of Pain from Myofascial (link)

Study 3 - Myofascial Syndrome and Pain: A Neurophysiological Approach (link)

Study 4 - Biochemicals Associated With Pain and Inflammation are Elevated (link)

Study 5 - New Views of Myofascial Trigger Points: Etiology and Diagnosis (link)

JP - Your latest book, Pain Relief with Trigger Point Self-Help, focuses on self administration of trigger point therapy. Is this form of personal care appropriate for most people?

Valerie - Self-care is appropriate for most people. My self-help books are a good adjunct for someone receiving professional treatments, or someone who doesn’t have access to a practitioner for some reason. People who do self-care get better at least five times faster than patients who only have me treat them in the office. As noted above, it can be difficult to find a practitioner who is well-trained in trigger points, and not everyone can afford treatments.

There are a couple of things to keep in mind: one is that not everyone is good at locating their own muscles. It is a process of figuring out which muscles contain the offending trigger points and identifying and treating the trigger points, and it is not a “quick fix.” The second is that there are another 25% causes of pain that are not trigger points, and someone may come to the conclusion that trigger point therapy doesn’t work when their pain doesn’t resolve. I can guarantee you that if trigger points are the source of the pain, and you are able to locate the trigger points, take the time to treat them per the instructions, follow the general guidelines for treatment, and identify and treat the underlying causes of the trigger points, you will be successful in relieving pain.

Note: The book-on-CD ROM version of Pain Relief with Trigger Point Self-Help originally came out in 2004, and is available through Amazon and TriggerPointRelief.com. The print version was just released.

JP - Does trigger point therapy work best when used in conjunction with other healing modalities such as exercise, dietary modification and nutritional supplementation?

Valerie - For treating the underlying causes of trigger points, known as “perpetuating factors,” I do recommend exercise, dietary modification, and nutritional supplementation (among other things) as appropriate for the patient’s particular set of trigger points and perpetuating factors. Exercises may need to be stopped or modified until the trigger points are inactivated, so I can’t make a blanket statement about that. Poor diet, high caffeine and alcohol intake, and smoking will all cause and aggravate trigger points, for example. Each individual may have something they need to change about their particular diet/supplementation.

Common initiating and perpetuating factors are mechanical stresses, injuries, nutritional problems, emotional factors, sleep problems, acute or chronic infections, and organ dysfunction and disease. Large sections of each of my books are dedicated to perpetuating factors, which must be resolved for long-term relief from pain and other symptoms.

JP - Are conventional, allopathic physicians typically receptive to including trigger point treatment in a comprehensive treatment protocol? If not, why do you think this is the case?

Valerie - I think the biggest problem here is that allopathic physicians are still not being exposed to trigger point information in school, and in fact, myofascial pain is one of the most under-diagnosed conditions in allopathic medicine. I see this as a huge problem, and I’m not certain of the reason for it, other than it really is more of a specialty, and it is far more likely that an allopathic practitioner who specializes in the treatment of pain would have been exposed to trigger points. It takes a minimum of 90 hours of training to get a basic understanding of trigger point therapy. Plus, physicians are probably not going to spend an hour in their office pressing on your trigger points. The typical treatment you are going to get in an allopathic office is some kind of medication. If the pain is severe and intractable, you might get a referral to a pain specialist.

Tension Type Headaches Have Been Linked to Head & Neck Trigger Points

Source: J Headache Pain. 2011 February; 12(1): 35–43. (link)

JP - What will it take to bring trigger point therapy into the mainstream of medicine? Additional funding and studies? More educational opportunities for medical professionals and students? A grassroots movement spearheaded by proactive patients?

Valerie - I’m mostly going for the grassroots-movement-spearheaded-by-proactive-patients approach. With the books I have published and the magazine articles I have written, I am trying to reach the public, who I am hoping in turn will start educating their practitioners, and the demand will create the need for their practitioners to seek training. When I write for professional journals, my goal is to expand their knowledge of trigger points, but I am more likely already preaching to the choir to some extent. More recently I’ve starting writing for lay publications such as Yoga Magazine, Fibromyalgia Magazine (UK), and Positive Health, in an attempt to reach an audience that may have never heard of trigger points before.

Another success I’ve recently had is that I have been accepted to speak at four professional conferences within the next 1.5 years. That is another way I hope to expand experience within the professions (see TriggerPointRelief.com for a list of upcoming professional conferences). I also teach seminars and distance learning courses for professionals (see http://triggerpointrelief.com/workshops.html for more information).

JP - How does someone find a qualified trigger point practitioner? What should one expect and look for when visiting this variety of health professional?

Valerie - One way is to go to http://myofascialtherapy.org/find-a-therapist/index.html, though this is a very small organization that only lists 102 practitioners, because they only list their members.

Probably the best way is to call your local massage therapist and physical therapist offices (perhaps do an internet search on “trigger point [town]” first) and ask them a few questions if they say they do trigger point therapy. I would briefly describe where you feel pain and see if they can name the muscles they would check off the bat as the most likely culprits. This is just to make sure they understand the concept of referred pain, and that there is a list of muscles to check. I wouldn’t write them off if they can’t give you the entire list accurately, because they may be taking certain facts you have already told them into consideration and eliminated some on the list from their mind. Some muscles are also far less likely to be the culprit than others, and they wouldn’t consider those until they had checked the most likely first.

I would also ask them to list some potential perpetuating factors to ensure they understand that the underlying causes need to be addressed to ensure long-term relief. Again, you are not looking for a comprehensive list since it would take hours to answer that question, and they won’t know what your specific perpetuating factors are until they have reviewed your medical history and treated you, but they should be able to list some general categories like mechanical problems, nutritional problems, organ dysfunction and disease, etc. You just want to make sure it sounds like they know what they are talking about.

Or you may live somewhere that you can’t find someone with a high level of training, and you may just want a massage therapist to help you locate muscles for your self-help techniques. Ask around with your friends, co-workers, and relatives to see if they know someone they would recommend. For example, I just referred a patient to a massage therapist in Reno because she was moving there, and I have a former patient who lives there, and I emailed her and asked her for a recommendation, successfully connecting my patient with an MT in her new home town.

In trigger point therapy, we find a holistic protocol used to address a little known, but prevalent cause of chronic disability and discomfort: myofascial pain. If you or someone you know has yet to find satisfactory relief using other approaches, including other natural treatments, consider sharing this interview with them. What’s more, if you regularly go to an acupuncturist, massage or physical therapist, let them know what you’ve learned here as well. Feel free to forward or print out this information for their review – it may just improve the quality of care they administer and you receive. And, finally, don’t hesitate to put family, friends and open-minded practitioners in touch with Valerie DeLaune. By doing so, you’ll be contributing to a much needed step forward in the field of sensible pain management.

Be well!

JP

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