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Back Pain| Discomfort| New Technology

Posted Apr 05 2011 7:22pm

I just read this article dated 4/5/11 in the LA Times “Back pain is a complicated issue” http://www.latimes.com/health/la-he-back-pain-20110404,0,4021531.st

In most articles one reads on back pain, the major thrust is on discussion of pain related to herniated disks, facet joints and nerve roots.  Thus, the tests (XRays, MRIs) and treatments performed revolve around using spinal surgery, injections into nerve roots or muscles, radiofrequency cauterization, medications etc. to use of alternative methods such as acupuncture, massage, yoga, biofeedback, meditation, etc.  Then, there will be mention that most lower back pain will disappear and that 10% will suffer from chronic pain.   If one considers that 80% of us in a nation of 300 million Americans suffer from low back pain at some point in time, and if 10% goes into chronic pain (regardless of the treatments and some more added on to suffer chronic pain because of the treatments themselves), just please do the math.  One will realize that the population suffering from chronic pain is in the many millions.  This is a huge number indeed.
 
There is yet even a larger number of people, and that is the majority of us without pain but living in discomfort.  The original pain had disappeared, but the discomfort remains and because we have no pain, we are not considered or diagnosed to be a statistic for pain and/or disability.  However, tightness, stiffness, soreness, aching and/or tenderness of muscles is disabling to many and becomes more serious depending on one’s occupation. Consider what those signs and symptoms leading to easy fatigue mean to a surgeon, ballerina, trapeze artist, airline pilot or professional athlete where movements need to be precise and well-timed? 
 
Please consider the person who is tight and stiff from shortened muscles due to chronic spasms from presence of long-standing irritable trigger points (neuromuscular junctions).  This is related to painless involvement of the spinal nerve roots known as spondylotic radiculopathy (aging of the nerve roots).   These individuals are candidates for progressing into chronic pain when an injury occurs.  This injury may be sudden as that resulting from an auto accident, a fall or a lifting injury or more insidious as from activities of daily living, repetitive motion activities or overuse injuries. Whenever pain occurs from further trauma to the nerve roots, there is more signaling from the nerve roots to cause further shortening of muscle fibers at the trigger points.  Formation of many more new and active trigger points with active muscle spasms compound the original tightness related long-standing trigger points.
 
So what is the mediate source of pain and/or discomfort in the majority of individuals?  Consider ischemia (deficient blood supply) at trigger points from the vice-like clamping effect that muscle spasms have on the intramuscular blood vessels and nerves.   Also, the tugging effect of these muscles in spasm on the pain sensitive bone and joints constitute to magnify the pain.
 
If pain is so deep and present in so many trigger points of many muscles, how best to approach them?  Clearly, the usual armamentarium for treating pain will not be sufficient to address this problem of neuromuscular pain and/or discomfort.  Pain related to  neuromuscular problems is difficult enough to address when it is focal involving only a joint or one limb segment as in myofascial pain but truly very difficult when the problem is diffuse as in fibromyalgia. 
 
Physicians always advise patients to exercise.  But the hallmark in neuromuscular pain due to ischemia as in myofascial pain or fibromyalgia is pain on movements with or without resistance. These patients cannot exercise since too many muscles and too many joints are moved simultaneously.   However, active exercise can still be performed by stimulating the trigger points in individual muscles.  This stimulation induced active exercise can produce an internal stretch where muscle spasm is concentrated, namely the trigger point.  This way, many shortened and tight muscles can be exercised one at a time painlessly, often accompanied by pleasant and pleasing sensations that lead to pain relief.
 
It thus behooves those in the technology sector to find ways that can address pain at the deep trigger points.  This type of technology should be able to manage pain and/or discomfort non-invasively, and should be able to be used long-term regularly and consistently even on a daily basis with few contraindications and rare side effects.   Finding this technology is akin to finding the holy grail for managing the ubiquitous disease known as neuromuscular aging.  And this technology exists now.
 

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