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  • WHAT HAPPENS TO OUR PAIN CIRCUITS WHEN THE NERVES CONNECTING MUSCLES AND THE SPINAL CORD GET INJURED?

    In 1984, while I was studying the effects of a nerve injury where an injured nerve was unable to repair itself and reestablish its former connections inside of muscles, it became apparent that, in addition to the injured nerve cells, the nerve cells that they connected to inside the spinal cord were also getting injured. This discovery indicated that the effects of nerve injury were much more serious and widespread than previously appreciated because they extended to the entire pain circuit of the injured nerve. This finding in part provides an explanation for why so often a chronic pain experience will long outlast an initial injury or traumatic event. 

    Since that time, many other changes in pain circuits following nerve injuries have been discovered. For example, injured nerve cells release several different chemicals like substance p and nerve growth factor into their affected muscles as well as from their endings in the spinal cord. In addition, the environment surrounding pain neurons in the spinal cord that transmit pain messages to the brain also changes. For example, glial cells surrounding injured spinal cord neurons start releasing chemicals around these neurons that increase their activity. All of these effects contribute to the continuation of the activity of nerve cells in pain pathways that contribute to the sustained, unrelenting quality of the chronic pain experience.

    After nerves have been injured, there are two kinds of activities that contribute to this relentless quality of chronic pain. First, the nerve cells inside of the injured nerves begin to respond to events that were previously not considered painful, like light touch or pressure. They also begin to respond to new areas of the body that previously lied beyond the more limited areas that they used to respond to. These changes fall under what scientists call allodynia, i.e., injured nerve cells that now respond to events that were not previously painful but now are.

    The second activity involves nerve cells inside the spinal cord and brain pain pathways that receive inputs from the injured nerves. These nerve cells now maintain their activity longer than they used to. They will often exhibit a behavior called windup where they will respond to successive inputs with higher and higher firing rates. Such changes are referred to as neuropathic pain by scientists, i.e., sustained activity in brain and spinal cord pain pathways that long outlast the injurious event that caused them.

    Such sustained activities in altered pain pathways have a disastrous effect on the muscles of the body that they activate. What happens is that the sustained activity in the pain pathways  is also maintained by the nerve cells exiting the spinal cord (motor nerve cells) that control these muscles. Because of the sustained activity, the affected muscles cells cannot fully relax. They develop contraction spots, shorten, are placed under excessive tension and cannot move comfortably through their normal, full range of motion. The result is chronic pain that comes from these muscles. If it goes on long enough, the joints that they are attached to will also get damaged and also become sources of chronic pain. At this point, all the elements of a full blown chronic pain experience are now in place. Without confronting such a chronic pain situation and taking some kind of corrective action, the chronic pain will continue for months and many times for years.

    Is there a way out of this dilemma? There is. It involves a two part solution; first, stopping the affected muscles from continually sending painful messages along their nerves into the spinal cord and second, altering the pain circuits in the spinal cord and brain so that they stop firing continuously.

    The first part involves identifying the muscles that have been affected, applying sustained pressure to all of the contraction spots in those muscles using the trapped ball method (detailed in The Book [https://store.bookbaby.com/book/A-Way-Out-Of-Chronic-Pain]) and applying sustained stretches of the affected muscles to relieve excess tension in them and recapture their lost range of motion. The second part involves returning each day to confront the contraction spots for at least two to four weeks to get them to stop their destructive effects on the brain and spinal cord pain pathways. If this can be accomplished, it will give them a chance to change their activity patterns and allow them to heal. Along with their healing, will come relief from the chronic pain.


  • THE RELATIONSHIP BETWEEN POSTURE AND CHRONIC PAIN-PART 2

    HOW TO RELIEVE CHRONIC LOW BACK AND UPPER BACK PAIN BY ADDRESSING POSTURAL DEFORMITIES

    The March 2022 blog explained how postural deformities can be  underlying causes of back and shoulder chronic pain. The figure illustrates the two most common postural deformities that can affect us as we get older; one affects the lower back and the other affects the upper back.

    When we see someone with such deformities, our first reaction typically is, “Oh, this is someone who has spine problems”. There are indeed  problems with the spine. However, what caused them was not the spine per se, but the muscles acting on the spine.

    In the case of the lower back deformity at the base of the spine, the lumbar curvature has been flattened out and the whole upper body has been pulled forward. The culprits are the abdominal muscles (arrow 1) which have become severely shortened and the victims are the back extensor muscles (arrow 2) which have been put under excessive tension and weakened so that they can no longer fully perform their antigravity function. Existing in this state, the back extensors at arrow 2 are probably full of contraction spots and may have been hurting for some time. 

    It is easy to see how the act of simply bending forward at the waist to pick something up off the floor would place the back extensors under additional tension and could lead to a sharp pain in the lower back. The way out of this postural dilemma is to lengthen the abdominal muscles at arrow 1 while simultaneously relieving the excessive tension in the back extensors at arrow 2. Eliminating any contraction spots inside the back extensors by using the trapped ball method is explained in detail in The Book. If this, along with lengthening the abdominal muscles, can be achieved, the lumbar curvature can be restored and the potential danger to the joints and disks between the vertebrae of the lumbar spine will be greatly diminished.

    There are three ways to lengthen the abdominal muscles. The first way involves lying on your back and placing a rolled up towel under the back of your waist at the level of the belly button. The second way involves lying on your stomach and placing pillows under your chest. The third way involves lying on your stomach, but this time placing the pillows under the tops of your thighs. In each of these stretches, the abdominal muscles are being lengthened while the back extensor muscles are simultaneously unloaded and relieved of excessive tension. The details of these highly effective stretches are shown in The Book.

    The second postural deformity shown in the figure involves the neck, upper back and shoulders. The shoulders droop excessively, curl forward and, along with the head, are held too far forward over the chest.  In this position, the pectoral muscles (arrow 3) which flex the arms and shoulders forward have become shortened and the neck and upper back extensors (arrow 4) are under excessive tension and full of contraction spots.

    Putting any additional demands on these extensors as we do, for example, when we reach forward or try to lift something heavy over our head makes us susceptible to neck, shoulder or upper back injury and pain. The keys to reducing these risks and improving this postural deformity is to lengthen the pectoral muscles, reduce the excessive tension in the neck and upper back extensors and use the trapped ball method to eliminate contraction spots inside these muscles.

    A very effective way to stretch the powerful pectoral muscles is to sit on a chair that has been placed inside an open doorway and place both arms on the door frame. The amount of stretch is determined by how far inside the doorway the chair has been placed. While sitting in this position, the pectoral muscles are being stretched while at the same time the neck and upper back extensors have been unloaded and their excessive tension has been relieved. The Book illustrates three variations of this pectoral stretch along with detailed instructions on how to perform them.

    By working on the muscles at the levels of arrows 1-4 that are causing these two destructive postural deformities, you can dramatically reduce the risk of a painful injury and relieve any existing neck, shoulder, upper and lower back chronic pain.


  • IS IT REASONABLE TO EXPECT THAT A THREE PART APPROACH FOR CONFRONTING CHRONIC PAIN WILL BE ACCEPTED BY THE PUBLIC? YES!!! WHY?

    This question was at the heart of a dialog I recently had with a trusted colleague about the approach I have presented in my recently published Book entitled, “A Way Out Of Chronic Pain, How It Happened and What To Do About It”.

    Her: “The average person will not embrace a three part approach because first, they will not be interested in the neurobiological explanations about the sensation of pain, and second, you are asking too much of them. People want either a simple one-step, one-repetition approach or they want to be told what pill they can take that will immediately cure their chronic pain”.

    Me: “I agree that this is exactly what most people want. This is precisely what i would want if I was in the middle of a chronic pain episode. 

    Me: “However, the problem is, neither one exists!”. 

    As you may have already discovered in trying to deal with either an ongoing or past episode of chronic pain, it can be very stubborn and persistent. Here is the reason. Any ongoing chronic pain involves much more than what is going on in the affected body part. For example, when there is long standing pain that is coming from a knee, there is much more involved than just the knee. What is also involved is at least one of the muscles that is attached to the knee, the nerves that send information from the knee muscle(s) to the nerve cells in the spinal cord, the nerve cells in the spinal cord that receive this information and the nerve cells in the brain that receive the information from the spinal cord nerve cells. As a result of your long standing knee pain, all of these nerve cells have been altered from the normal way they handle pain inputs coming from the affected knee. My own research has documented some of the ways in which spinal cord nerve cells get damaged when there is a long standing nerve injury. Recent research has documented the many changes that brain nerve cells and their associated glial cells undergo that result in persistent activity in pain pathways from a body part affected with chronic pain. It is these changes in the altered nerve cells that maintain the chronic pain despite what corrective measures we may take at the site of the knee pain. 

    These neurobiological changes explain why attempts that are directed only at the affected knee can at best only provide temporary relief because they do not address the nerve cell changes that are sustaining the chronic pain. For example, today there are several substances that can be injected into a painful knee or other joint like steroids, hyaluronic acid, platelet-rich plasma or stem cells and these can provide some symptomatic pain relief. However, relief with such injections is usually temporary, typically lasting a few weeks or, if one is fortunate, a few months before they need to be repeated.

    In order to have any chance to break the viscious cycle of chronic pain and for an approach to be successful, it has to address the affected joint, the affected muscles as well as the altered nerve cells. This is why a three part approach is needed. The three part approach involves eliminating sites of contraction inside of affected muscles, static stretches to lengthen these muscles and moving these muscles under load through their full range of motion. The details of the approach are presented in The Book [https://store.bookbaby.com/book/A-Way-Out-Of-Chronic-Pain]. For these reasons, once you come to the realization that there is no simple one-step solution to chronic pain, I hope you will embrace that approach because if you do, you at least have  a chance for a long lasting solution to a chronic pain episode.

    Know this!


  • THE THREE HEADED MONSTER OF CHRONIC PAIN – WHERE IS THE HOPE?

    Blog # 5 June 2022 If you have been suffering from chronic pain for sometime, you have undoubtedly asked yourself two questions many times. Why is it that no matter what I do, the pain persists? And is there any hope for it to ever go away?

    The answer to the first question is that if the pain has been going on for several months, it now most likely has three separate but interrelated sources. These are 1) muscles, 2) nerves and the brain and 3) joints They make up a Three Headed Monster of Chronic Pain. The reason that the pain has persisted, is that no matter what corrective action you may have tried to get relief, it probably has addressed only one of these three sources.

    The answer to the second question is that something can definitely be done about the muscle and nerve and brain sources of the pain and maybe even the joint source of the pain. 

    If you can chop off even one head of this Three-Headed Monster of Chronic Pain even while the other two heads may still continue to breathe some of the fire of chronic pain, you can reasonably expect to see some relief in your chronic pain. This may be enough to significantly improve the quality of your life, see some improvements in your sleep, in your ability to move and to be more active, in your ability to sit more comfortably and in your posture. 

    The best place to start corrective steps is with your affected muscles. With daily effort, it is definitely possible to lengthen shortened muscles, relieve overly tensed muscles and to re-teach muscles to contract under load throughout their range of motion again. The first step is to try to eliminate sites of shortening inside of muscles. These sites have been called contraction spots, sore spots, knots or trigger points. Previous generations of scientists like Travell and Simmons have achieved dramatic reductions in patients’ chronic pain by eliminating these spots by either injecting them with local anesthetics or by applying coolant sprays to them, so there is reason to be hopeful. If some of them can be eliminated, then it will be possible to lengthen any shortened muscles using static stretches. Details about how to find, confront and eliminate contraction spots at home and lengthen shortened muscles with static stretches are presented in the Book. I highly recommend that you consult the Book https://store.bookbaby.com/book/A-Way-Out-Of-Chronic-Pain and attempt the approaches to confront and eliminate your contractions spots.

    If your chronic pain has been going on for some time, it means that your nerve cells that carry information back and forth between your affected muscles and the spinal cord and brain as well as your nerve cells in the pain pathways inside your brain have been altered from their normal pain-free state to a hypersensitive, painful state. These alterations comprise the second head of the Three Headed Monster of Chronic Pain and are responsible for its persistent, ongoing quality. These changes are a big part of the reason that so many times, no matter what you do to address the pain at the site of the affected body part, the pain usually persists. Addressing this Second Head of the Monster of Chronic Pain is challenging because it requires multiple repetitions over an extended period of time. However, there is definitely hope for progress. Since these neuroplastic changes occurred in response to the destructive chronic pain inputs coming from the muscles in the affected body part, if they can be changed or eliminated, there is good reason to expect that the patterns of nerve activity in the altered pain pathways inside the spinal cord and brain can once again be changed back to their normal, pain-free state.

    The best approach we have today to make these neuroplastic changes is by reducing or eliminating the ongoing neural inputs coming from the contraction spots inside the affected muscles. We know that these inputs can be changed because when scientists injected painful contraction spots with local anesthetics, they were able to shut them down with the patients often reporting dramatic improvements in their pain.

    Most people over the age of fifty will show some osteoarthritic changes in their joints on x ray or MRI images. Yet many experience no pain. However, if these changes proceed far enough, the joints can certainly become sources of pain independent of any pain coming from the adjoining muscles and nerves. This is especially true if the joint cartilages and discs have been damaged to the point where adjacent bones are rubbing against each other and being abraded. 

    This is the third head of the Three Headed Monster of Chronic Pain. If the damage has progressed to this point, it may not be possible to completely eliminate this source of pain without a surgical intervention. However, short of this point, lengthening any shortened muscles around an affected joint, reducing their tension level and eliminating their contraction spots may be able to relieve the stresses on the affected joint enough to reduce the overall level of pain to the point where it becomes more tolerable and increases the overall quality of life. 

    So, while it may not always be possible to slay the Three Headed Monster of Chronic Pain, it is still possible to chop off its first head (muscles) and second head (nerves and brain) and sufficiently quiet its third head (joints) to the point of greatly reducing the amount of pain you are experiencing to the point of making significant improvements in the quality of your life. Give it a try!


  • WHAT IS THE MOST NEGLECTED MUSCLE IN THE BODY AND WHAT IS ITS ROLE IN KNEE AND HIP PAIN?

    Blog #4 May 2022

    We live in a very health conscious society. We spend a great deal of time, effort and money taking care of our various body parts, for example, our skin, hair, nails and teeth. We run, we swim and we carefully watch our diet in order to take good care of our heart. However, for that part of the body that makes up half our body weight, most of us take it for granted and hardly give it a second thought. I am talking about our skeletal muscles. There are about 640 of them. About half of our brain and spinal cord are devoted to controlling them. If you are suffering from chronic pain, it is highly likely that at least one or more muscles are not healthy and have been neglected for a long time.

    This brings us to trying to appreciate the difference between healthy and unhealthy muscles. A healthy muscle contracts smoothly to one end of its range of motion. It can do this under a load without any pain. After a contraction, it can relax fully to the other end of its range of motion. In comparison, an unhealthy muscle only contracts through a limited portion of its range of motion, experiences pain or discomfort when asked to contract under load and does not completely relax after a contraction. It is susceptible to “pull” type injuries especially while contracting under load. 

    Probably the most neglected muscle of the body is the rectus femoris. This muscle runs across the front of the hip joint, down the entire front of the thigh and ends in a strong tendon that enters the knee joint. it is part of the quad group of muscles and is shown in front view in figure A.

    It serves two main purposes. It flexes the hip by lifting the thigh off the floor and extends the knee by straightening it from a bent position. If there is pain around the front of the thigh or in front of the knee, the rectus femoris is a prime suspect as a cause. Physical therapists will tell you that this muscle is shortened and tight in most adults that are referred for therapy.

    The explanation for this is that no matter what exercise regimen we might follow, in any typical day, this muscle is never moved throughout is full range of motion. For example, when we sit in a chair with our feet on the floor, the knee is typically bent at ninety degrees so that the rectus femoris is being held at about the midpoint of its range of motion. Even worse, when we sit in recliner-type chair or when we lie in bed, the rectus femoris is held at its shortest length. So for the better part of every single day, this is how we hold this muscle. It is the unfortunate reality of our sedentary existence.

    In a typical sedentary person, the upper end of the rectus femoris which lies across the front of the hip is also shortened. When we sit in a chair, the thigh is bent at a right angle so that the rectus femoris is held somewhere near the middle of its range of motion. Just like its lower end, in a typical day it rarely is fully flexed or fully extended to the ends of its range of motion. For example, to fully extend its upper end, either the thigh or the upper body needs to bent backward at about a thirty degree angle. 

    Without a conscious effort, the upper and lower ends of this muscle can spend years just existing in the middle of its range of motion. The end result of this existence is that the entire rectus femoris muscle becomes shortened, filled with contraction spots and is no longer capable of comfortably moving to the endpoints of its range of motion. In this unhealthy state, whenever it is put under load, it is highly susceptible to “pull” type injuries. And it is a leading suspect when there is chronic pain at the front of either the knee or the hip. 

    If there is chronic knee or hip pain, there is a way out of it! It involves working to eliminate the contraction spots and performing static stretches on both the lower and upper ends of the muscle so that the muscle can once again comfortably function throughout its normal range of motion. The Book clearly explains exactly how to comfortably do the stretches and how to eliminate the contraction spots by applying sustained pressure to them. Once the muscle has been successfully lengthened, the Book also illustrates dynamic movements that can be performed under load. 


  • WHY IT IS SO IMPORTANT TO CONFRONT CHRONIC PAIN AND NOT JUST LIVE WITH IT

    BLOG # 3 APRIL 2022

    When someone is suffering with chronic pain, a natural reaction is to cut back on physical activity. This is understandable because it often hurts to move and there is a fear of making it worse. However, this is the worst thing you can do for six reasons.

    1) If you do nothing, nothing good will happen and the pain will continue.

    2) If you are suffering with chronic pain, it is highly likely that some key muscles have lost a good part of their range of motion. Such muscles are highly vulnerable to further injuries and we certainly have plenty of names for such injuries like pulls, twists, turns, strains, sprains, cricks, yanks, wrenches and tears. A typical scenario is one moment you are fine and a simple movement like bending over to pick something up off the floor or reaching overhead for something on a shelf and the next moment you are in excruciating pain. Sometimes it does not even require a movement to go from a pain-free state into a state of pain. For example, a very common experience is going to sleep without pain and waking up with low back pain.

    3) When there is chronic pain, not only have muscles been adversely affected, but several harmful things have happened to the nerve cells (primary neurons) that connect them to the spinal cord and brain. These cells become sensitized. They begin to fire more intensely and frequently, they continue to fire long after the activity that started them firing has ended, and they begin to respond to stimuli that previously were not painful like touch and pressure. In addition, they release several chemicals from their endings into the muscles that keep the nerve cells firing. They also activate motor nerve cells in the spinal cord and brain that keep the muscles in a shortened state and under tension. In this state, the brain sends messages back out to the affected muscles that result in inflammation and swelling. Now all of the conditions are in place for a self-sustaining, vicious cycle of chronic pain that is not easily broken. 

    4) Once primary neurons become sensitized, they in turn sensitize the nerve cells that they connect with in the spinal cord and brain so that entire pain pathways become altered. Once such changes are in place, many nerve cells in pain pathways will have increased their firing rates and enlarged the areas of the body that they respond to. Interneurons that normally slow down or stop normal transmission in pain pathways become damaged and no longer perform their inhibitory role. Once such changes have occurred, all of the ingredients of a chronic pain state are in place Unfortunately, once such changes have occurred, there is no single drug or exercise that will undo them.

    5) The longer muscles remain shortened and under excessive tension, the greater the possibility that they will damage the bones and cartilages of joints and, in the case of back and neck muscles, the disks that lie between the vertebrae of the spinal column. Once such osteoarthritic damage has occurred, it may not be possible to reverse them.

    6) And most importantly, if you can regain lost range of motion and eliminate sites of contraction in affected muscles, the pain will lessen and you will feel better!

    These six reasons point out why it is so important not to let chronic pain persist and go untreated. Left untreated, not only will the pain persist and diminish the quality of your life, but it will cause changes in your body that will not be easily reversed. To avoid this, the pain will have to be confronted by doing the work needed to regain lost range of motion in all of the muscles that have become either shortened or are existing under excessive tension.

    Be assured that there is a way out of this. The steps are presented in  detail in The Book and also will be presented in upcoming blogs.


  • POSTURE, CHAIRS AND PAIN

    BLOG # 2 MARCH 2022

    This blog will examine what in our daily lifestyle could be setting up conditions that lead to chronic pain. A good place to start is to look at our posture because it shows very dramatically the health of so many of the muscles that are involved in chronic pain. 

    Posture is the relationship of our body parts to each other. Panel A in the drawing shows what the normal, healthy posture should look like. A line drawn perpendicular (dotted line) to the floor should pass through the ears, the hip and knee joints and the arch of the foot. In this position, the muscle are perfectly aligned. None are excessively shortened or stretched. Panel B in the drawing, shows the early stages of a deformed posture. The head is being held too far forward.  The pelvis is tipped back and the natural curvature of the lower back is flattened out. In this position, it may not even be possible to fully straighten the knees. 

    You can very easily tell what your posture looks like by standing in front of a mirror and turning to the side. There are only two choices. You are either in good alignment as shown in Panel A or you are showing postural deformities like those in Panel B. If you are showing postural deformities, you are well along the road to developing chronic pain if not already experiencing it. You can very easily tell what your posture looks like. Just stand in front of a mirror, turn to the side and take a look.

    If there are postural deformities, what does that mean for our muscles? It means that some muscles are shortened while others are being excessively stretched and held under tension. In the abdominal area, the abs and the hip flexors are shortened and, by bending the body at the waist, are pulling the upper body and head forward. At the same time the back extensors which are located along the back of the spine are being continuously held under tension. Living in this state, is it any wonder that so many of us experience low back pain? With the head and shoulders tipped forward, it means that our chest muscles (the pecs) and the muscles in the front of the neck are shortened. At the same time, the muscles along the back of the shoulders and neck are being excessively stretched and under tension. This situation sets up ideal conditions for developing upper back, shoulder, neck and jaw chronic pain as well as a variety of headaches. 

    How do such postural deformities develop? Our sedentary lifestyle customs come into play at this point. For example, whenever we sit, our abs, hip flexors, pecs, quads which are located along the front of the thigh and the muscles along the front of the neck are all held in shortened positions. Over time, this shortening will become permanent.

    The design of most of the chairs we routinely sit in are major contributors to the problem. They are designed for style and esthetics but not for the human anatomy. The typical car seat design, which is also found in airplanes, buses, trains as well as in many household chairs, is shown in the photograph. It clearly illustrates three parts of the posture problem. First, the seat back joins the seat at a sharp angle making it impossible to comfortably place the curved buttocks  against the seat back. Second, the bump at the bottom of the seat back is too low and pushes the pelvis forward forcing us to sit in a slouched position from the moment we sit down and for the entire time that we sit in the chair. Third, the head rest is too far forward and forces us to bend our neck and hold our head too far forward. While sitting, we so often lean forward and hunch over a computer or reading material which further adds to the development of postural deformities. These are only a few examples that show how the events in a typical sedentary lifestyle inevitably lead to postural deformities and predispose us to developing chromic pain.

    The big question here is what can be done about it? There is unfortunately no simple, one step answer. That we all basically lead sedentary existences is part of our daily lives and although we can certainly make changes around the edges like using a stand-up desk and standing up frequently, that lifestyle cannot be realistically changed or eliminated. 

    Admonishing ourselves to “sit up straight” or “stand up straight” will not work. Sitting in poorly designed chairs for long periods of time inevitably leads to slouching and continued shortening of muscles. Once  muscles have shortened or have been placed under excessive tension, they will sustain any existing postural deformities and continue to further their development. Such deformities and the loss of range of motion in the affected muscles makes us susceptible to the development of chronic pain. Unfortunately engaging in many of our healthy activities like walking, jogging, swimming, bicycle riding and resistance training cannot by themselves solve the problem. 

    However, there is definitely hope! The solution is to start a program that counteracts the destructive effects of our sedentary lifestyles that will restore the affected muscles to their normal, healthy state and recapture their lost range of motion. First, sites of contraction inside of muscles will have to be eliminated. Second, shortened muscles will have to be lengthened. Third, shortened muscles will have to be put through movements that will restore their strength and their ability to function properly throughout their range of motion.

    How to do this is covered in detail in The Book and will be discussed in future Blogs. 


  • THE FRUSTRATION OF CHRONIC PAIN

    BLOG #1 FEBRUARY 2022

    The most frustrating part of having chronic pain is how unrelenting it feels. It hurts all the time. It just doesn’t let up no matter what you do or, for that matter, what you avoid doing. It disturbs your sleep. You can’t sit comfortably. You can’t walk normally. It prevents you from doing so many of the physical things you used to enjoy. Worst of all it makes you feel trapped with no way to escape it. It pulls you down emotionally and robs you of your joie de vivre.

    I know that you would like to get to the “what to do” immediately.  However, in order to succeed with the “what to do” it is critical to first understand the “why” of it all. Or put another way, exactly what I’m up against here? If you buy the Book now, I would strongly urge you to first read the first few sections which deal with the “why” questions before proceeding to the “what to do” sections.

    So why is it that no matter what we do, it does not seem to bring relief, or at best, provides only temporary relief with the pain only to return, sometimes worse than ever? The Book lists 31 things that are routinely tried in chronic pain situations which offer little or very limited relief including powerful drugs. Even opiates don’t seem to be able to stop it. As an orthopedic nurse practitioner once said to me, “the only thing opiates are good for is getting the brain to think that they are reducing the pain”.

    The answer to many of these “why” questions is that when there is chronic pain in a body part, there are always two potential sources of it. They are 1) muscles and 2) their associated bones and joints. No matter what intervention we turn to, it will usually address only one of these sources. Therein lies the source of so much of the frustration when trying to confront chronic pain.

    For pain originating in muscles, there is definitely something that we can do to eliminate it or at least substantially reduce it. However, if there has been extensive osteoarthritic damage to bones and a joint, there may not much that that can be done to completely eliminate it. For example, inside a knee or hip joint, if the cartilage that caps the ends of bones has been destroyed and the joint space has been reduced to the point where the bones are grinding against each other without the intervening cartilage, it may not be possible to eliminate the pain without surgically replacing the joint. In the case of the lower back, if the disks that lie between the vertebrae have been damaged to the point where adjacent vertebrae are grinding against each other, complete elimination of the pain may not be possible. 

    However, the situation is far from hopeless. Even in the face of osteoarthritic joint damage, it is still possible to achieve much pain relief by confronting the pain originating from the associated muscles. Indeed most people over the age of fifty will have some osteoarthritic changes that can be seen in x rays; yet many of them have no pain at all. There are many reasons to treat the muscles of a body part with chronic pain. First, the number of nerve endings that transmit pain messages from muscles to the brain greatly outnumber those transmitting pain messages to the brain coming from joints. Second, eliminating muscles as sources of chronic pain, even if there is some pain coming from a nearby joint, the overall level of pain might be reduced enough to make it tolerable and greatly improve the overall quality of life. I hope these reasons are enough to get you to consider making a determined effort to confront chronic muscle pain. 

    Confronting chronic muscle pain can only make your life better. Even in the worst case scenario where surgery may be necessary, it will be necessary to confront chronic muscle pain to fully achieve a pain free existence. After joint surgery, you are routinely prescribed a regimen of rehabilitative physical therapy in which the remaining pain coming from muscles is systematically addressed. Should chronic pain occur in your life, the sooner it is addressed the better. If it is confronted early enough, you could end up avoiding the possibility of joint damage and the need for surgery. 

    The existence of chronic pain means that there are events going on inside of some of your muscles that need your attention. Neglecting them only means that they will get worse and increase the risk of joint damage. One of the surest things in life is that by doing nothing, the pain will continue. 

    Future blogs will provide more insights into chronic pain that may be bothering you and will provide approaches to confront it. 

    I hope you will continue to read them.