Saturday, September 25, 2010

Lymphatic Massage


The lymph system collects and cleans up cellular garbage, which is then returned to circulation as plasma. Lymph fluid movement requires exercise, deep breathing, body movement, and properly functioning organ activity. If movement is disrupted, excessive lymph accumulates in the lymph system and causes swelling. Lymphatic Massage/Drainage opens lymphatic ducts aids in reducing generalized swelling.


Book Excerpt ©

There are three types of swelling. Diffuse swelling occurs with interstitial edema, localized swelling takes place around a lymph node from chronic infection, and there is swelling from myofascial entrapment of lymph and blood vessels.

… Idiopathic edema, a form of fluid retention found in FM, occurs more frequently in women. Interstitial edema is caused by abnormal biochemicals that cause fluid to be retained in the spaces between tissues. These spaces, called interstitial spaces, are part of the ground substance in the myofascia. … You haveto figure out why the edema is building up in the interstitial spaces, and remedy that perpetuating factor. “Treating the cause is the best way to treat the effect.”

The second type of swelling is that caused by obstructed lymph flow. Swelling that occurs around a lymph node is the result of accumulated dead cellular matter and bacteria in the node as a response to chronic infection. Lymph nodes act like filters. The filter—the lymph node—can get stopped up from excessive accumulation of unwanted organisms, like a shower drain clogs with hair. When this happens, the lymph fluid backs up in the lymph vessels causing localized swelling. People with FM, CFID, and CMP can have this kind of swelling; however, it is more commonly seen in CFID patients.

… The third kind of swelling is that seen in CMP patients. This is swelling caused by blood or lymph vessel entrapment by taut bands of muscle fiber, as discussed in chapter 1. Trigger points (TrPs) that occur near lymph nodes may be mistaken for swollen nodes when they are actually TrPs. Lymph fluid, unlike blood, which is moved along by specific vessel mechanics, requires modalities such as exercise, deep breathing, body movement, and properly functioning organ activity to keep it moving. When any of these are disrupted, excessive lymph accumulates in the lymph system and
causes swelling. [In this case, the trigger points must be treated to release the flow of lymph].

I hope you have found this helpful in understanding swelling/edema.

~ • ~ • ~ • ~ • ~ • ~

All answers and blogs are based on the author's opinions and writing and are not meant to replace medical advice.  

Celeste Cooper is a retired RN, educator, fibromyalgia patient, and lead author of the Broken Body Wounded Spirit: Balancing the See Saw of Chronic Pain devotional series (coauthor, Jeff Miller PhD), and Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome and Myofascial Pain: The Mind-Body Connection (coauthor, Jeff Miller PhD) She is a fibromyalgia expert for Dr. Oz, et al., at Sharecare.com, here, and she advocates for all chronic pain patients as a participant in the Pain Action Alliance to Implement a National Strategy, here. You can read more educational information and about her books on her website, http://TheseThree.com


Friday, September 24, 2010

Letter Regarding Concern over the Proposed FM Criteria

Letter sent to:
International Myopain Society
http://www.myopain.org/ContactUs.aspx

Dear Doctors Russell Gerwin, Bennett, and Fellow Advocates,

Please let me preface this letter by saying thank you for your dedication to making a difference in neuroimmune disorders such as fibromyalgia (FM).

As a patient with FM and CFS and chronic myofascial pain (CMP) from myofascial trigger points, an RN educator, and an author on the subject, I am greatly concerned that not enough attention is being given to studies such as yours and:

Ge HY, Wang Y, Danneskiold-Sams√łe B, Graven-Nielsen T, Arendt-Nielsen L.The Predetermined Sites of Examination for Tender Points in Fibromyalgia Syndrome Are Frequently Associated With Myofascial Trigger Points.J Pain.2009 Nov 13. [Epub ahead of print]

I clearly understand from years of reviewing the research that this is not new to you Dr. Gerwin, Dr. Russell, or Dr. Bennett. So I ask, can we continue on for another decade of by guess and by golly, or take the bull by the horns and get it right this time?

As I move about the various Facebook groups much of the pain and neuralgia described by fellow survivors can be attributed to myofascial trigger points. On investigation, after explaining proper technique for locating these knotted up pieces of muscle fiber in a taut band of muscle, people report back to me that they have them. This is significant anecdotal evidence that can be defined by the patient. Why are our clinicians and those writing the new criteria missing this?

My greatest desire is that new criteria for the diagnosis of fibromyalgia include the prevalence of myofasical trigger points. A physician trained in assessment and effective treatment will provide objective measureable criterion. Yet, I see in the proposed criteria by Dr. Katz , which I might add is right on cue with the central sensitization aspects of FM, does not include the presence of myofascial trigger points, or even suggest that the FM patient be screened for their presence.

The peripheral, nerve to muscle dysfunction of multiple TrPs in multiple layers of muscle tissue has bombarded my CNS already in perptual central sensitization. So many of us with FM also have, insomnia, disordered sleep IBS, irritable bladder, SIBO and other autonomic effects. We also have migraine headaches, some of which can be explained by myofascial trigger points, bruxism, restless leg syndrome, and TMD/TMJ, which can also be attributed at least in part to myofascial trigger points. Why are we missing this? It dumbfounds me as to why this connection is not being made.

I look forward to hearing what you have to say about this most important issue not only to me, but to the health of so many others. If we can feel one morsel of control over what is happening, we can take back some feeling of empowerment. I don’t expect that addressing myofascial trigger points is a cure for FM, but to know that we have a specific treatment for one aggravating factor to our pain is helpful.

Thank you in advance for your continued dedication to unraveling the mysteries of fibromyalgia.

Sincerely,

Celeste www.TheseThree.com (Find links to my blog, twitter, and Facebook)
Author, Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection

Tuesday, September 14, 2010

My Life in the Fibro Lane - For Fibromyalgia Network News

Fibromyalgia Network News, “My Life in the Fibro Lane,” Submit yours at groups@fmnetnews.com


My Life in the Fibro Lane

Though the scenario may be different, my story is typical. In the mid 80’s an ICU patient, through no fault of his own (unaware of his intentions), grabbed my hair and tossed me about like a rag doll, quite literally. That was the beginning, only escalated by other physical trauma. I have also had torn rotator cuffs of each shoulder and one complete reconstruction as a result of my work as an emergency nurse. Anatomically, some of the muscles that support the shoulders also support the neck (cervical spine) and these injuries exacerbate my coexisting spinal problems and migraine headaches. These are the stage props of my not so loving affair with fibromyalgia.

I have been diagnosed with three disorders; fibromyalgia, chronic fatigue syndrome and chronic myofascial pain (CMP) from myofascial trigger points. As more recent research suggests and as I have suspected from years of research and writing all FM patients have myofasical trigger points (TrPs). In many cases a tragedy has occurred, they have gone undetected. It is unfortunate that clinicians do not recognize the presence of TrPs, since they can be a great aggravator of our fibromyalgia pain, and they can be objectively measured and treated. Another story for another day, and yes, I am an advocate for change.

Since this is my story on FM, I will make the gory details of chronic fatigue syndrome (CFS) short. Some think the two are interchangeable, but after researching, I do not believe that FM and CFS are the same. I personally have suspicions that my chronic fatigue is related to the Hashimoto’s Thyroiditis that went undetected for a long period of time, though I do not heal well and have many of the other symptoms of CFS. A test, I hope with the discovery and connection of XMRV to CFS, will finally lay this question to rest for myself and many others in my position.

I haven't worked since 2000. I didn't know what was wrong with me when I finally handed in the towel, I only knew that my brain was slipping away, the pain was unbearable and interfering with my ability to critically think. Sleep deprivation and non-restorative sleep was reaching a point of constant worry and anxiety that I might inadvertently harm a patient. This cognitive deficit was eventually confirmed by neuropsychological testing and evaluation by a forensic psychologist. So here I was, at what should have been the height of my career, alone and afraid to do the work I sacrificed and trained to do, care for others. Confused as to what was happening, after all, my training was as a hospital nurse and educator (I had zilch experience with any rheumatic condition), and persistence, I was finally diagnosed (over a year after I quit work). And found I fit the mold to a T. Five years earlier I had cut my hours back to part time in an effort to cope with the pain and fatigue. Five years, the average time from symptoms to diagnosis, though I suspect many of us would admit the symptoms quite possibly went unnoticed for a lifetime. I was now forced to care for myself. A feeble attempt at best, by both my healthcare providers and myself, I was totally ignorant. A new mission presented itself.

Through it all, and psychotherapy with a psychologist that specializes in treating patients with chronic pain, I learned that I had something to contribute and have been able to maintain forward momentum since. I have written a book on my three disorders as a way of personal coping and reaching out to help others (I had always told my students, if you really want to learn something, teach it, little did I know at the time how much more that would mean to me).

That is what I wish for everyone on this path with me, find an outlet, find YOUR contribution, we all have it in us. It was never easy, it still isn’t, but understanding and appreciating that there is more to being alive and well than physical being, that we all have something unique to share, is inspirational to me. The trials and triumphs of others are what keep me up on my down days.

I have followed my own advice on finding constructive ways of coping, and have fallen in love with writing poetry. Following is a poem that pretty much sums up the past two decades of my life. So I leave you with this:

MY CAP OF MANY USES

A woman struggling to style her thin hair,
Why should I grieve what was once there?

Fingers of condition apologize for that,
So, I strive to coordinate my life with a cap.

Success bloomed many caps in my time
Lately, they are scented by a different kind.

Words dot my life, push, strive and hope,
Corrupted by illness, change, endure, cope.

But fear not my friend though my cap is askew,
This woman is learning, bring meaning anew.

These fingers have taught me about myself,
My caps are as peacemaker, caretaker, health.

So I leave you with this, my caps they were sent,
A schoolhouse of words, pure, sturdy and meant.

As I fondle this wisp of thin hair that remains,
My caps, though different, they stay the same.

Written by Celeste Cooper, author
Integrative Therapies for Fibromyalgia, Chronic Fatigue syndrome, and Myofascial Pain: The Mind-Body Connection (co-author Jeff Miller, PhD) Healing Arts Press, Imprint of Inner Traditions, Bear and Company

Sunday, September 12, 2010

Implantable Neurostimulator - "To Have or Not to Have"

Well my friends, though I am 60, my neck is 80. It seems in addition to severe arthritis, my discs have severely degenerated at all levels and it is "inoperable.”An implantable neurostimulator has been suggested by two doctors I respect. If you know anyone who has tried this, I would sure like to hear about it.

My history with neck problems.

My issues started after working in the ICU. A post anesthesia encephalopathy patient was on a tall air bed. He literally lifted me into the bed with him by my hair and tossed me about like a rag doll. It took several doctors and nurses to release his grasp. That was the beginning, only escalated by other accidents where I was expected to lift and assist patients that were too large for one person of any size. I have also had torn rotator cuffs of each shoulder and one complete reconstruction as a result of emergency nursing care. Anatomically, some of the muscles that support the shoulders also support the neck (cervical spine).

I have total respect for bedside nurses that care for us, they literally confront battle grounds every day. I have walked in their shoes.

Physical trauma can be a trigger to the onset of FM (discussed in the book), and I speak of this first hand.

Preventative Measures and Alternative Interventions.

I sleep with either a cervical collar or an ice pack. Because of the FM and chronic myofascial trigger points, I pay particular attention to stress on the muscles of the neck. Posture of course is a great aggravator and even with the best of intentions ones head starts to drift forward when in a stationary position. This adds greatly to the pain for those of us with these two co-existing conditions.

Thanks to a good friend here on FB, who brought up the importance of proper neck alignment and her use of a cervical pillow, I saw this as an important teaching opportunity. You obviously have cervical degeneration and stenosis or you wouldn’t be reading this discussion. Positioning is important. Of course, as we sleep, if we get it, which is rare for most of us, we are not in control of how our neck is positioned. Even if we do sleep, it is non-restorative, and we miss out on the healing phase. We definitely need help. If you have found a particular device that helps, please share. I think we are all up for hearing about it. We also know this won’t cure our degeneration, but anything that might retard further degeneration and help curb some of the pain is like a bright star.


I currently use a TENs unit, which helps divert the pain some.

I have tried the many FDA approved (and off label) medications for neuropathic pain and could not tolerate the side effects. I am fogged enough without being a zombie. Pain or not, I want to be present in my own life. I understand that it works for some, but many FMers have sensitivity to these meds. The goal of any medication or treatment is to improve function.

I am desperately trying to find a myofascial therapist, one that has been trained in Travell and Simons, here in the East KC area, but to no avail. I have had some help with active release therapy from a chiropractor and a physical therapist, but the effects are short lived. (See other discussions on myofascial trigger points).

So much has not been researched to my scientifically minded satisfaction, and I find anecdotal accounts of the utmost importance. Prolotherapy has also been mentioned. If anyone here has had it, or knows someone who has had it, I am all ears.

Harmony and Hope.

Friday, September 3, 2010

Defining Myofascial Trigger Points (MTrPs)

Myofascial trigger points can mimic many things and cause pain, dysfunction, and shortening of the muscle affected by this knotted up muscle fiber in a taut band of muscle. Such things as paresthesias (numbness and tingling), burning, or a needles and pins sensation if the TrP is entrapping the a nerve, circulation/temp changes (if located next to a blood vessel) and swelling (if located next to a blood or lymph vessel) may also be present. (Helpful treatment links following).

The following ook excerpts, protected by copyright, you must ask permission from Healing Arts Press to reuse this content

Common Abbreviations ©

MPS: myofascial pain syndrome
CMP: chronic myofascial pain
MTP: myofascial trigger point
TrP: trigger point


Myofascial Trigger Point ©

A myofascial trigger point (TrP) is a self-sustaining, irritable area in the muscle that can be felt as a nodule in a taut band. This irritated spot causes the muscle to gradually shorten, interfering with the motion function of the muscle and causing weakness and pain. Trigger points differ from tender points in that generally they refer pain to other parts of the body and can usually be felt with the hand (palpated) unless the muscle is too rigid from intense muscle involvement, or the trigger point is in a deep muscle or under bone. The tender points of FM or myalgias associated with CFID do not restrict motion or cause localized muscle weakness. If they do, the patient should also be evaluated for the presence of CMP. Trigger points in CMP are well defined and often radiating—the pain radiates out to other parts of the body.

Active Trigger Point ©

An active TrP is a myofascial trigger point that causes pain at rest. It is always tender, causes shortening of the muscle, weakens the muscle, and causes patient complaints of referred pain on direct compression. An active trigger point can elicit a visible local twitch response when adequately stimulated by compression or needle insertion. It can produce referred motor and autonomic phenomena, generally occurring in the TrP referral zone. An active TrP can also cause the referral zone to become tender.

Secondary Trigger Point ©

A secondary TrP is one that develops in a second compensating muscle. A compensating muscle is one that is trying to make up for the malfunction of the muscle affected by primary trigger points. In other words, when a primary trigger point causes muscle dysfunction, the opposing muscles become stressed. These opposing muscles become overloaded because they are attempting to carry the entire load of the muscle work needed to perform a task. When staring at a computer screen your head starts to drift forward after a while, particularly if you spend hours there. You may have primary TrPs in muscles on the front of your neck, which may or may not be making their presence known. As your head starts drifting forward, putting less stress on the primary TrPs because of the slackening, the muscles on the backside of your neck are being stretched and stressed in an effort to keep your face from falling onto your keyboard. The sustained overstretching of these muscles causes secondary trigger points to develop in the muscles on the back of your neck. (This is an important reason to pay attention to posture as an
aggravating factor, to be discussed in chapter 4.)

Satellite Trigger Point ©

A satellite trigger point is a type of secondary TrP that develops in a muscle
of the primary trigger point’s referred pain area.

Latent Trigger Point ©

This type of trigger point is painful only when there is pressure on it. A latent TrP can restrict muscle movement and cause stiffness and weakness that persist for years after apparent recovery. Unless restricted motion or weakness causes you to start rubbing around to find the source, a latent TrP may go unnoticed. When you stumble upon a sore, hypersensitive nodule in a muscle that does not refer pain anywhere, you have found a latent trigger point. Now you have discovered the source of your restricted motion and weakness. Dormant latent TrPs can be reactivated by overstretching, overuse, or injury. Treat TrPs when you discover them, because some seemingly minor event, such as chilling, can cause a latent TrP to transition to an active trigger point. Once the TrP transitions from latent to active it will be painful all the time and can cause referred pain. Treatment is discussed in chapter 4.

End Notes:

Chronic myofascial pain (CMP) from myofascial trigger points is a peripheral nerve to muscle problem. Fibromyalgia, CFID/ME, migraine, IBS, irritable bladder and several other common co-existing conditions have a strong central nervous system component. When any of these co-exist with chronic myofascial pain (CMP) from myofascial trigger points (TrPs), the peripheral message of painful trigger points to the brain keeps the brain in a hypersensitive state," causing a “wind up” phenomenon at the HPA-axis (dysfunctional in FM and thought to be dysfunction in CFID) is off an running.

The good news is there are specialized myofascial physical therapists and chiropractors trained in techniques specifically designed for treatment of the myofascia. They can do a proper assessment and offer treatments such as myofascial release and active release therapy (ART) and active release therapy (ART). There are also specially trained myofascial massage therapist trained specifically in the work of Travell and Simmons.

Myofascial Release
http://www.myofascialrelease.com/fascia_massage/public/default.asp

Active Release Therapy (ART):
http://www.qfac.com/pain_management/active_release_therapy.html

National Association of Myofascial Trigger Point Therapists
http://www.myofascialtherapy.org/

I hope you found this information helpful.


"Though our bodies are weak our determination is unbreakable, standing tall, standing strong, standing united, committing to a cure."

Celeste

Neck Pain, Migraines, and Myofascial Trigger Points

This question came up in the discussion at our Integrative Therapies page on Facebook, so I thought I would share it here.

It is important to understand that latent trigger points (those that you can feel and hurt when you touch or manipulate them, but don't cause pain otherwise) for some reason in the FM patient can be activated just by a chill. Of course paying close attention to aggravating postures and activity is important too. I talk about the do's and don'ts of exercise in the book. If you have a copy, you might check that part out again, as it is important not to exercise a muscle with TrPs (trigger points) until they have been treated, otherwise you will activate latent ones or cause rebound of active ones.

Remember, anywhere there is muscle (and attachment of muscle to bone) there can be a trigger point. Each trigger point has a specific pain/symptom referral pattern that does not change between patients. The neck is a big issue for many of us and I suspect that is why so many researchers initially thought FM could be cured with neck surgery, yes this is true. It is however, a direct avenue, so to speak, to the central nervous system and is part of the spine that is more subject to injury as there are very few supporting structures other than muscle, and it has to hold up our heavy cranium.

Each bone of the spine has tiny little muscles that connect each vertebra. Even these minute little muscles called intervertebrals, meaning between vertebrae, can develop trigger points. You can feel them as tiny bands when you move your finger across them. Normally you would not feel this taut little band unless it has a TrP.

I use a tennis ball in a knee high hose and treat these every night and several times a day when I can.

Definitely this can be the source of a migraine, it certainly is mine. It is also important that you not miss any TrPs on your face, the temporal area, forehead all of it. I believe this is why so many with FM have migraines. We also have sinus problems which is an aggravator to facial TrPs and the whole cascade of events is off and running.

Sometimes the muscle with the TrP is well away from the pain area. Very basically put TrPs in any of the neck and head muscles, including the trapezius can contribute to migraine.

Often we develop satellite TrPs (TrPs in the referral area of the primary TrP) If you are treating only the satellite TrP and not the primary TrP, it will seem your therapy is not working when in fact, you have not treated the causative TrP. Also, the primary TrP could be latent (dormant), but still there. That is why it is so important to make sure you are treating all of your TrPs not just the ones that are screaming out at the time.

On 11/14/2010 I received word that the FDA has approved botox for treatment of migraine. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm229782.htm This makes sense, because many times one can find TrPs at the temples, and I read that serotonin release abnormalities may play a part in migraine like it does in FM. It it always good to have options. In my own personal experience, I had botox for TrPs in my neck (I have severe diffuse degenerative disc disease and stenosis). What happened was it paralysed the muscle involved, which put all the work load of the other muscles to keep my head erect. This resulted in activation of many latent TrPs in many layers of muscles in my neck and upper back, resulting in excrutiating pain and self treatment was minimally effective because of the continued stess on the muscles and no way to relieve the work load. I had to wait for the Botox to wear off, which seemed like an eternity. Having injections in the face would most likely not have this effect and is something to consider with caution.

Resources:

Clair Davies The Trigger Point Therapy Workbook - The illustrations are wonderful and he shows the referral patterns well. Sometimes the ONLY way you can locate a TrP is by tracing it back to by its referral pattern.


Valerie DeLaune's Trigger Point Therapy for Headaches and Migraineby , if you JUST want to look at myofascial TrPs in the head and neck and migraine.

Myofascial therapist that specializes Travell and Simons trigger point therapy. There is a listing of therapists that might be in your area.
http://www.myofascialtherapy.org/

Harmony and Hope, Celeste

Wednesday, September 1, 2010

September is Pain Awareness Month-My Letter for the "March on Pain"

In honor of pain awareness month, September, the American Pain Foundation is planning a virtual "march on pain" to Washington.

Following is my contribution letter:

I have fibromyalgia; chronic fatigue syndrome and chronic myofascial pain (CMP) from myofascial trigger points and have written a book as a way of personal coping and reaching out to help others that are ready and willing.

I do not abuse drugs, yet I find it difficult to find a doctor not terrified to treat my pain. It seems chronic pain patients are accused of overusing medical care, yet it is this same system that puts us in that position. Why should we endure painful procedures that do not help? Why should we be prescribed anything but a pain medication to treat pain? Other alternative medications have many life threatening side effects and interactions with medications that opioids do not.

Having my pain managed should be a basic human right, it should not be decided by others who do not walk in my shoes, nor should I be treated as a criminal. With proper education programs for patients regarding the risks, pain can be controlled and improve quality of life. Should we become addicted, not pseudo addiction, abusers, for which there is a predisposition in some individuals, THEN you can get us the proper help. Please do not assume that we will abuse our pain medications. In fact approximately 70% to 90% of us will have improved mobility without risk of abusing our medications.

Sincerely, Celeste Cooper, author
"Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection" (co-author, Jeff Miller, PhD)

Risk Evaluation Mitigation Strategies (REMS), the FDA and pain medications, what it means and the American Pain Foundation plan for using your voice.
http://www.painfoundation.org/take-action/natl-efforts/rems/

Celeste's Website

Celeste's Website
Click on the picture