Conjecture Over TPs

[Rufus]

ABSTRACT

The terms myofascial pain, fibromyalgia and fibrositis are critically examined. They constitute diagnostic labels for non-specific musculoskeletal aches and pains. Analysis of the evidence shows that none of these labels is substantiated by hard physical signs or by laboratory evidence of consistent pathological or biochemical abnormality. What is the objective evidence for disorder(s) of muscle, fascia or fibrous tissues, so clearly indicated by these diagnostic names? Alternative terms such as 'regional pain syndrome' or 'chronic pain syndrome' merely redefine the clinical problem without providing a mechanism or basis for diagnosis. Despite different diagnostic criteria, these conditions, along with chronic fatigue syndrome, have many demographic and clinical similarities, most notably tender trigger points. Indeed, the terms are often used interchangeably. There are few differences in the symptoms, physical findings, laboratory tests, functional status, psychosocial features and psychiatric disorders. This paper seeks not to deny the existence of aches and pains, but to critically examine the utility of these terms. The only claimed physical sign is the presence of tender trigger points over muscles or muscle attachments. Research suggests that tender points are a measure of general distress related to pain complaints but separately associated with fatigue and depression. They are present in some normal subjects and are variable in occurrence in time in the same individual. They reflect no demonstrable pathology. It is therefore argued that none of these commonly used diagnoses represent distinct disease entities. A possible but unproven alternative hypothesis is that such symptoms relate to neural pain with both peripheral and central components, and in some instances psychological or wilful embellishment.

Full paper here

[webslave]

The author of that article Dr John Pearce ("J.M.S. Pearce") sees himself as a debunker of myths. One of his other masterpieces was "Migraine: A Psychosomatic Disorder" (migraine is not seen as psychosomatic or stress-related today, with a recent study failing to detect any objective evidence for a biological stress response before or during migraine attacks, and other breakthrough work on controlling migraine with brain implants like Onstim). He is a man of advanced age: "Dr John Pearce was Senior Consultant Neurologist at Hull Royal Infirmary from 1967 until 1992. He has been Emeritus Consultant Neurologist since 1992. He has written a variety of books on Dementia, Headache,Migraine, Parkinson's disease, and Medical History."

[alprost]

There is plenty of evidence related to the 'reality' of trigger points including intramuscular EMG. My experience with this condition has taught me that few people really analyse anything rigorously, especially when they are not in pain themselves.

Some of the points I've heard used to de-bunk trigger points:
- 'There is no reliable measure of TP's'. Yes TP's are difficult to measure, but this doesn't mean that they don’t exist. Until relatively recent advances in technology, we had no way of analysing gasses and proving that oxygen was part of the earth's atmosphere. By the same logic, was there no oxygen there until we had developed the technology to measure it?!!
- 'There is a low level of inter-observer agreement in the identification of trigger points'. Again, this proves that some people are better than others at palpating them, not that they don't exist, but it doesn't stop people from jumping to this completely illogical conclusion. Again, inadequate rigour of thought and analysis.

Scientists like this guy are the pits. They have no personal knowledge or experience of pain, and their points are made purely from a textbook study only. As patients we are forced to examine all possible treatments with an open mind if we want to get better, whereas an academic doesn't have to (although there are some excellent and sincere researchers grappling with CPPS) . If this guy had chronic prostatitis / chronic pelvic pain syndrome and went to see a decent PT because his pain forced him to, he'd soon change his mind.

Its a bit like the old story of the difference between commitment and dedication being like the difference between bacon and eggs - the pig is committed to the plate, the chicken isn't - it's only dedicated to laying eggs.

[Clay]

Back when I grew up, doctors like him told us that homosexuality and autism were both the products of bad parenting.

It isn't that these people are just idiots, it's that they make their proclamations with such authority and certainty, and it does such damage to the innocent victims - like parents of gays and autistic children.

[Edinburgh94]

Completly agree with the points made by Alprost and Clay.

Don't read stuff like this it will only make you doubt the treatment.

[bshaw99]

He can say what he wants and he can call it what he wants but until medical science comes up with a single pill that duplicates the empirical results of trigger-point release for some of us, he can stick his finger up his own trigger-point :)

[damien6]

Hey,

Both my parents are "classically" trained scientists and both believe this Prostatitis/CPPS is bullshit. Not that they've done any research on the matter at all, literally. Generally speaking they're pissed when they see me on the web, "oh no not that again". According to Mum I'm a hypochondriac and there's absolutely nothing wrong with me, just an excuse etc. My Dad is a bit more open minded and thinks it will just go away over time, he suggested I should take up meditation a couple of months ago but thats about as far as he's been interested in looking at it, (which I'm sure I would have done immediately if he suggested it years back) he's also suggested exercise which is one I like (but I get very anxious if I do too much of it) but that's it, duty done.

Apparently my mum had some sort of IC years ago, which was only mentioned to me very recently and not by her, and procedures and things didn't help but it did get better with time. She's very fierce about this thing, its bullshit etc.

They're scientists who won't read a book let alone look at a web page.

But this is not that unusual. My last shrink was very keen on telling me there was nothing wrong with me, ie his way of saying I should just ignore it and things will get better. And I remember the smirk on my Urologists face when I said I was going to look online for more info about the thing.

On another point when it comes to muscle clenching I make a conscious effort never to do it, because I know that it will potentially cause pain, but it seems the anxiety causes the pain (unconscious clenching? if so must be very slight) rather than actual clenching. Or else the pain is still wired into the region and hasn't been worked out by actual PT or paradoxical relaxation. Does that sound about right?

Damien

[Please don't send any messages saying I shouldn't worry about what my parents think]

[Sleeper Service]

CPPS is an acknowledged illness, it's not bullshit. The Stanford/Wise-Anderson Protocol now has peer reviewed studies that validate it as a treatment. I'm not saying it's perfect because in medical terms it's still in its infancy, however, it appears to give demonstrable results although double blind tests need to be conducted.

Similarly, quercetin treatment has given results in double blind tests that show that is significantly more effective than a placebo. In fact, it's results are better than those demonstrated by more traditional monotherapies.

The bottom line is this:

Prostatitis/CPPS isn't given a lot of attention by those outside the urological field - and, frankly, it's not given that much attention by some of those within it - because:

a) It's not fatal.
b) Most cases do clear up with the passage of time (although some persist until action is taken).
c) It's not 'sexy' in terms of research and funding.

Since the advent of the Internet a lot of men have managed to band together and go "Hey, wait a minute! It's not just me!" and the profile of the condition has been raised. I think it is no coincidence that the increase in chronic prostatitis / chronic pelvic pain syndrome research and the production of effective means of treatment occurrs over the same period of time as the rise of the net.

It is up to each of us to investigate the possible solutions and find one or more that work for us, record the results and pass on the knowledge to others in the same situation.

Of course, it is possible that some of those who 'got better' using methods X and Y merely improved with time, but what are you going to do: wait patiently on the offchance it may resove or work on treatment that might be essential to your recovery?

The choice is yours.

[damien6]

Thanks man,

Its not that I don't think its real (I don't have a choice in the matter because I feel it) but it just sucks getting rolled over, especially when apathy and anxiety are the likely results.

Damien