During the course of the 2011 Myopain Seminars teaching year, great emphasis was paid to the subject of pain science. I wish I could quote you the name of a single text that can be used as a reference. I can’t. I sampled far and wide and still do.

Readers of a previous blog will understand my frustration at western medicine’s blinkered approach to pain. I’ve been pretty much silent since that blog. (Even my favourite series of Fascia Research Congresses under-emphasize the role of pain and fascia.) Despite this, all the students of Manual Trigger Point Therapy have been introduced to a broad and comprehensive understanding of pain’s complexities. Prolonged pain is what has kept 360 NMT solvent throughout the economic downturn.

Let’s investigate pain, then give you some examples of therapeutic intervention. Trauma releases substance P (P for pain) in the tissue and signals are sent to the brain. The brain processes this unpleasant sensory information, determines the damage and danger, and usually produces an appropriate amount of pain then sends it to the appropriate location. I say usually, but the brain can get this very wrong. (More on this in a later blog.)

In response to pain, the body can produce hormones called endorphins in the periphery and neuropeptides called enkephalins in the brain, both of which inhibit substance P (P for pain). There are many ways to stimulate these analgesic biochemicals. Three of them are: one is to cause pain itself, two is by physical effort, and a third is by listening to thrilling music. What?

Thrilling music is defined by music that sends tingles up (or down) your spine. A research study was published whereby a surgical outpatient department in New Haven, CT gave each of three groups of people the ability to control their post-op pain meds as delivered by drip. One group listened to thrilling music, one to white noise and the third to general OR sounds. Seventy percent of the first group needed no analgesia. Of the other thirty percent of this same group, they used half that of the other two groups.

This revelation created great interest amongst 360 NMT staff.  As I write I’m listening to a 2 disc set of tunes compiled by our own Jennifer Parmenter from submissions of music from the 360 NMT staff that were considered thrilling (and with that the possibility of analgesia). We were asked to pick just three, a pretty much impossible task! As I listen to the discs I can’t help wonder at the variety; from pop to classic, from hard rock to jazz, from Icelandic to African. All considered thrilling.

Can we use this therapeutically? The traditional world-view of massage music is ambient music; full of waterfalls, native pipes and distant drums washing over you. Not so thrilling. But with Neuromuscular Therapy our clients don’t come to luxuriate. They come for pain relief. Should we bombard them with Radiohead, Rachmaninov, Sigur Rós or Edith Piaf? Not so great for our renowned active client/therapist communication process. More reasonably, should we ask each person to choose their own thrilling music and bang the headphones on in the comfort of their own living room? Musical homework? Sounds good.

I recently attended the Institute of Natural Resources (INR) seminar called ‘Conquering Pain’ in Providence RI. I was attending to see whether current western concepts could enhance my manual therapy outcomes. The presenter was Mary O’Brien, M.D. who came well credentialed with 30 years experience and who now practices in gerontology. To say that I was disappointed was an understatement.  Let me explain.

My first inkling of a bad day was at introduction time. Nearing the end of the schoolyard pick of medical modalities we massage therapists were pointed out as the people to go to at lunchtime for a nice relax. Anyone familiar with our neuromuscular therapy field knows that this form of manual therapy is for the sole purpose of reducing pain and improving function. Nothing relaxing about what we do.

After seventy five minutes of the presenter’s delivery the opinionated Doc O’Brien had barely covered one page of the 24 page course handout. I was a bit worried. I took a break during a tirade on a subject, her opinion of which, I had no interest. (Throughout the day the doc fulminated on chicken pox, war, drugs, medicare, diet, exercise, vaccinations, aging, patriotism etc.)

Well, I decided to persevere, believing that there must be something to make my long journey worthwhile. Alas, it seems to her that the only way to treat (conquer) pain is to invest in western medicine’s pharmaceutical approach. If this approach was true then Americans wouldn’t be suffering more pain right now than they ever have. I remember reading the prophetic epitaph of 150 years ago whereby the statement “the end of pain’ followed the discovery and use of ether at Massachusetts General Hospital.

Throughout the presentation there were many examples of falsehoods spoken as truth. O’Brien described the difference between a tender point (as found in Fibromyalgia) and a trigger point (as found in Myofascial Pain Syndrome) as a ‘nuance’. What a crock. The active trigger point has been sampled in-vivo for its biochemical constituents and is clearly different from a latent point and normal muscle tissue. The trigger point has also been visualized in-vivo using Vibration Sonoelastography (VSE). Both pieces of research come from the NIH in Bethesda. There is no nuance – trigger points and tender points are entirely different entities.

Now I’m going to get into deep water. I humbly offer at an alternative line of study; exploring the individual, subjective, unpleasant, emotional perception of pain, much of it derived from myofascial roots.

I invite everybody to, at some time, read the 20 year old classic ‘The Culture of Pain’ by David Morris. The key word that occurs throughout this book is ‘perception’. To alter pain we healthcare professionals need to alter people’s perception of it. We manual therapists are well acquainted with the wonderful information found within the two volume set ‘Myofascial Pain and Dysfunction’ by Drs Travell and Simons. These can be accompanied by the newer two volume set called ‘Muscle Pain’ by Drs Mense and Gerwin (my own teacher). There is also ‘Fibromyalgia and Chronic Myofascial Pain’ by Devin Starlanyl and any number of prolific research publications of Jay Shah, Siddharta Sikdar, Hong-Yu Ge or Cesar Fernandez de-las-Penas. These authors are regular contributers to the Journal of Musculoskeletal Pain, the Journal of Bodywork and Movement Therapies and other peer-reviewed journals.

Specifically, on the subject of migraine and headache we should consult the text ‘Tension-Type and Cervicogenic Headache’ by Cesar Fernandez de-las-Penas from Spain: on the subject of shoulder pain we should read anything by Carel Bron from the Netherlands; on the subject of back pain we should acknowledge that many studies have been published visualizing MRIs with bulging discs in asymptomatic, normal, healthy people starting with Branowadski & Jenson in the New England Journal of Medicine way back in July 1994. As for the subject of feet, I was stunned at the daily drug-taking revelations concerning the presenter’s own foot pain.

Sure there are valid pharmaceutical approaches to pain (I’ll take a pill for a headache). But, to not acknowledge the contribution of trigger points to almost every pain condition listed in the INR handout is so last-century. Strangely, not even one of western medicine’s favourites, ‘Bonica’s Management of Pain’, was quoted in the INR reference section.

The most depressing part of this presentation was that the enraptured audience all seemed to believe. I’ll stick with a more comprehensive, evidence-informed education, along with a rounded ability to reason and strategize, plenty of empathy, and a diverse portfolio of treatment methods when it comes to managing pain of soft tissue origin.

Julius Ceasar made famous the phrase ‘veni, vidi, vici’ to describe a military accomplishment. Legions of medics can come and see pain, but I don’t believe that pharmaceuticals will ‘conquer’ it. I have written to the INR and suggested that they more appropriately rename the seminar ‘Medicating Pain’.

Stew