Stubborn trigger points (Ramana's Case)

[ramana]

I have a couple in transverse perineum that refer pain to testicular and abdominal region. My PT and I have pressed on them....nothing happens. Milking - no response. Stretched the muscle and removed other trigger points. Still they are there.
Going for a diagnostic lidocaine injection tomorrow. However, am wondering if there is some way to make those specific trigger points go away. Now the thinking is that they constitute 80% of the pain.

The theory of trigger points is cool. However, there is a definite need for improval of methods to remove them

[mbaker]

Assuming you are pressing on them for 60-90s with appropriate pressure, stubborn ones can take a few weeks or so to go away. And that's working them every day. But you are correct in that after pressing them, you should gently milk them (Thiele massage). This will stimulate blood flow to the area. But be patient. If they're stubborn, you've likely had them a long time.

--mb

[ramana]

PT started doing Thiele massage today. It is a bit more than milking though. She is sweeping the entire area with her finger. Incredibly painful.

[mbaker]

As long as she continues to hold the Trps for 60-90s first, followed by Thiele when she's done, the pain is a good sign. It's likely the blood and nutrients flowing into the area of muscle that's been deprived of this for some time. The Clair Trigger Point Manual also says to use a stroking motion rather than constant pressure on Trps - different opinions abound on the correct technique, but I don't think you can go wrong with constant pressure + Thiele afterwards. It's what I do and it works for me.

--mb

[ramana]

I have had same TrPs at the same location for 4 months. Sometimes they will go away and then reappear. At other times (now) they just don't go away (with professional PT or me or relaxation breathing etc). Even after 100 units of Botox in those specific muscles (transverse perineum / external anal sphincter) and dry needling. What else can I do? Any ideas appreciated.

[mbaker]

I've mentioned this before, but Dr. Travell in her books on myofascial pain indicates that key vitamins B1, B6, B12, Folic Acid and C are sometimes deficient in people with chronic pain. Only way to know for sure if via blood tests your doctor can order for you. My doc also included B5, B7, Iron, A and E. B5 and B7 were low, B7 was nearly nonexistent. He ordered me to start on a b-complex immediately. I did so in August 07 and I firmly believe it's one of the reasons my symptoms are nearly gone. Another std test the doc can ask for is a CBC test. In that test is a value called MCV which indicates the size of the red blood cells. If the number is high normal this means the red cells are likely suffering from low B12 levels or a combo of low B12/low Folic acid levels.

It takes about 4-6 mos of proper vitamin therapy (if deficient) to see full results. The red blood cells live for up to 4 mos before they are replaced. So over time, the old cells created when levels of vitamins were lower, slowly die off and are replaced with hopefully healthier ones.

I'd start with this as soon as possible. But get the tests before you just start popping pills and hoping. You need to know where you're at now so you can track progress. Your doc should be happy to order these tests for you.

Hope this helps,
-mb

[ramana]

Hi mbaker
Thanks for your post. This is a very important point IMHO. I did do tests for deficiencies (vitamin D, vitamin B12 iron, magnesium and a couple of others). I am pretty sure that vitamin A, vitamin B6 and MCV was not included.

Which of the books of Dr Travell are your referring to. I am looking at the Travells and Simons; Myofascial Pain and Dysfunction Trigger point manual and I don't see MCV. Part of the information is also here at books.google.com

[ramana]

Hi again mbaker
In case you have a ready list of all the tests that you did it would be great. If not, then I am anyway going to look into this in more detail and will post whatever I can find

[mbaker]

Go to Travell's Volume 1 book, Chapter 4. The whole chapter discusses issues around nutition and myofascial pain.

--mb

[ramana]

Thanks again. The chapter is partially there on google books. The list of tests however is available here.
Pgs 227 and 228. Essentially it is hematologic profile + blood chemistry profile + thyroid test.

[ramana]

In this thread viewtopic.php?f=37&t=5335&st=0&sk=t&sd=a&hilit=saliva, it is mentioned that home based saliva tests can be ordered at sites like www.canaryclub.org.

I wanted to get them done - but not sure if it is useful to contact a doctor for this.
I had a osteopath take my saliva test last year - but for reasons best know to her she refused to divulge the actual levels - just whether they were good or bad. My PCP is not gonna order this I am sure.
Is this a reliable thing to get done at home or should I look around for some doctor who is willing to order them.

[ramana]

Hello everyone
Here are multiple perplexing symptoms that have defied treatment from any doc so far:

a) I had chronic prostatitis / chronic pelvic pain syndrome symptoms appear (quite disabling and still continuing) in April 2007

b) In Nov 2007 I had massive armpit swellings (reddish) accompanied by high fever. The fever subsided in a couple of days after treatment with antibiotics. The swellings subsided after 10 days then returned after 5 days. And so on .I was on antibiotics for 36 days. The swellings were big(I could not put my arms down) in the beginning but then started reducing with each episode. By mid December, I was too sick (stomach problems) to take antibiotics.They were going to put me on antibiotics IV but I refused. Miraculously the swellings went away on their own and I am of antibiotics ever since Now they keep on reappearing every fortnight or so. They are much smaller but continue to be painful. Dermatologist did nasal swab for various bacterial infections. No bacterial infection. They never oozed pus so they could not take a culture. Last week the dermatologist just gave up. Said he can do nothing since they are mostly under the skin (now) and just asked me to use mupriocin / hibiclens for several months.

c) I had severe headache episode in early April immediately after Botox. That lasted 2 days and I was unable to do anything.Then again last week which lasted 4 days. No ideas why it appeared. Putting cold packs on neck afforded some relief

d) My right hand now has suddenly developed lot of pain. Chiropractor says trigger points on the muscle and starting of carpal tunnel (I don't have numbness or tingling as yet)


So far all docs are looking at this separately and don't see any connection. I am wondering if there is. The only explanation that I have is for the migraine and hand pain and that is probably because I am bed ridden for a year which leads to musculoskeletal weakness. For armpit swelling, I can't think of any explanation.

Any guesses? Or any tests that I should get done? My history is in my signature. Thanks guys.

[webslave]

As far as I know, you are one of the few other cases with lymph adenitis (adenitis is a general term for an inflammation of a gland or lymph node). I had it too, and I was also bedridden, as you are. I also had exhaustion (chronic fatigue). Do you have that?

[BrettP]

Maybe an allergic reaction to the antibiotics? Sometimes I get an armpit rash from amoxicillin, which usually feels like large pimples, and red surrounding areas (but the knots are in the skin very deep). However, they go away when i stop taking them (had an ear infection about 9 months ago). Maybe you are allergic to a deodorant or something? Anything is possible, but in my case, it seemed to be an allergic reaction.

[webslave]

The swollen lymph glands denote an immune reaction. It is quite common in CFS. My doctors told me my immune system was so revved up that the glands were swollen and painful. The cause was given as stress.