Stubborn trigger points (Ramana's Case)

[ramana]

I am confused on if it is worth doing ab strengthening exercises. A physical therapist to whom I go for cervical pain is adamant that cervical pain would not improve unless I did overall improvement in fitness which also includes ab strengthening. The exercise is not crunches - rather lifting up the leg and making sure the back does not rise from the ground. I get some pain when I do that but it subsides. He says it is worthwhile to bear the pain. At Stanford, we were just told to do the stretching exercises and any other gentle exercise. But that was 2 years ago for me and I am wondering if I should go ahead.

[webslave]

If you have spinal issues then go ahead with the strengthening exercises for the abs, and I recommend this one in particular:

Lie on your back with knees bent and feet flat on floor. Deliberately flatten your lower back against the floor. Slowly raise your head and shoulders off the floor and reach with both hands toward your knees. Count to 10. Repeat five times.

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[ramana]

Once again thanks webslave. The exercise that you suggested is almost the reverse of what I have been asked to do i.e raise the leg instead of the neck. Anyway, right now I have begun to have more pain in the lower ab. It is the same pain that I was having earlier but over the years got reduced. So should I continue or not?

[webslave]

I don't believe these exercise could be harming you. May simply be very weak muscles complaining. Continue.

[ramana]

I did MR neurography at UCSF. After I spent tons of money for the test, the doctor says that he cannot understand the report. So I defer to the gurus over here for some insight.
This is the impression
'Evaluation of the pudendal neurovascular bundle demonstrates mild increased signal intensity within the rectal branches on the right distal to Alcock's canal which may reflect intraneural edema.'

Does this give clue to any diagnosis and/or treatment option

[Jay]

Hi,

Firstly, I am surprised that someone would refer you for this test if they can't interpret the findings. I'd be filing a complaint and taking my records to someone with more experience in this department, if I were you.

Unfortunately, I am in no way qualified to interpret this report. The same is probably true of our other posters (unless Ralph happens along, maybe?). Edema usually refers to the accumulation of fluid for various reasons, which leads to swelling. However, I have no idea what the situation would be for intraneural edema.

If I had to hazard a guess (which is what this is, since I'm an uneducated layman), it says that the test showed mild but increased activity within the right-sided rectal branches of the pudendal nerve. It might reflect nerve swelling(?).

That's just a wild guess, unfortunately. Maybe Webslave will have some thoughts.

[webslave]

Sounds like a nerve problem, maybe a form of CRPS?
http://en.wikipedia.org/wiki/Complex_Re ... n_Syndrome

Your long-standing and intractable problem is unlike anyone else here, Ramana, so we need to look further than the usual things we consider for CPPS. In your case, this points to a nerve problem rather than a nerve-mind-muscle-prostate problem.

• Nerve infection? (viruses can damage nerves)
• Nerve trauma (any impact/trauma or operation near these nerves?)
• Congenital nerve malformation (any indications of this when you were very young?)

Have a look at the causes for another nerve condition, peripheral neuropathy. This will give you an idea of the wide range of things that could be behind this nerve swelling seen on imaging.

[ramana]

Thanks webslave for your post.
The Fentanyl patch that you suggested did not find favor with the doctor because it causes constipation plus I am not in that much of pain as earlier (he reserves fentanyl patches for cancer patients it seems).
I have had CRPS diganosed earlier by doctors by beyond Lyrica nobody had any ideas. I already took Lyrica but after a few months it does not help that much. I did have an anal fissure operation in 2000 but there were no problems until the fissure resurfaced in 2006 and the pain started in 2007.

[ramana]

My pain has plateaued in the last few months. I started Effexor in late Oct to see if I it will help. For 20 days I was on 37.5 * 3 and then upped it to 150 mg. After 27 days the pain has increased appreciably and am back in bed. I can't see any reason except pure chance or Effexor. I searched the forum but did not find that Effexor can increase pain. The side effects were a problem though (not in my case).

Is there a possibility that antidepressants (I have to try wellbutrin also) can actually cause increase in pain?

[webslave]

Yes. We all react differently to chemicals and drugs. For instance, I tried Lexapro a few years ago experimentally (I have a relative who takes it under prescription) and I experienced myalgia (muscle pain), arthralgia (joint pain), laryngitis (hoarse voice), decreased libido, flatulence, diarrhoea, urticarial vasculitis on chest, and boils on skin. I absolutely can't take it. Others take it with no problem at all.

Always listen to your body. It will tell you if you cannot tolerate something. Try another drug in that class. You could react completely differently.

[Sherradin]

SSRI most definitely increased my bladder pain and this is the case with people with salicylate sensitivity. I dont know how it works but my muscles were so over contracted that my bladder was irritated and everything chemical (natural or other wise irritated it) Worm pills, SSRI's - Cipramil, Effexor and one other all killed and gave me bladder pain..now my sphincter muscles are relaxed and all my trigger points in the psoas and glute and adductors are under control I can tolerate alcohol again- this is a miracle. If the bladder nerves are inflamed then you react to all sorts of things. I ate the most bland diet for years trying to control the symptoms. It was only when I relaxed the pelvic musculature that things went back to normal.

The head of the pain clinic who prescribed the anti depressants was sure I was making it up. I am sure the added anxiety over experimenting with these drugs added to the whole neural wind up I was experiencing and amplified the symptoms. There is no doubt you can react to SSRI from a food intolerance perspective. There used to be a website Plant Poisons and Rotten Stuff that was from the Royal Prince Alfred Hospital Allergy Unit that listed reactions to SSRIs but I can't find it now.

[webslave]

There used to be a website Plant Poisons and Rotten Stuff that was from the Royal Prince Alfred Hospital Allergy Unit that listed reactions to SSRIs but I can't find it now.

Is this the site?
http://failsafediet.wordpress.com/

[Sherradin]

No Webslave it was a very comprehensive site that the Salicylate Sensitivity Network site says no longer exisits. Its a pity because it was very detailed on the diet and many things related to it. Not sure why its not there any more. The site was actually called Plant Poisons and Rotten Stuff. Maybe we get Julian from Wikileaks to find it for us in the digital records somewhere.

[webslave]

That's odd, because the person who owns that site says they used to own the Plant Poisons and Rotten Stuff site and that the info is all there.

[Sherradin]

YOU'RE RIGHT> That person is Sue Dengate who wrote the book Friendly Food. She helped me a lot in the beginning when I only had diet as a tool. I spent more time looking around the site it is the old Plant Poisons and Rotten Stuff. You're right, its all been upgraded.

You are a demon on the PC to find it. Its a very good diet for me as it seems to lower nerve irritation. But like anything you have to work out if you really are salicylate intolerant. I react to blood thinners (NSAIDs) and high sal foods like licorice so I knew it was a part of the equation, others react to gluten. Its all so idiosyncratic.