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Date:         Mon, 11 Jan 1993 02:01:57 EST
Reply-To:     Bill McGarry <wtm@sheldev.shel.isc-br.com>
From:         Bill McGarry <wtm@sheldev.shel.isc-br.com>
Subject:      Handicap Digest # 3089

                             THE HANDICAP DIGEST

                                 Issue # 3089

                          Sunday, January 10, 1993

Today's Topics:


                                ******


                                Re: Adhesions
                           Topical Pain Medication
                               Bed and Pillow
                               Trigger Points
                               Trigger Points
                             Re: Water Exercises
                                  your pain
                             Shingles/Adhesions
                                  Adhesions
                         Stopping RSD by amputation


                                ******


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------



Subject: Re: Adhesions
From: Stefan.Welch@p0.f33.n125.z1.fidonet.org (Stefan Welch)
Organization: FidoNet node 1:125/33.0 - BODY DHARMA ONLINE, Oakland CA


[This is from the Chronic Pain Conference]

 -=> Quoting Steve Ambrosini to You <=-

 SA> One pain clinic described it as "nerve caught up in scar tissue". No
 SA> one had a solution.  A second pain clinic suggested it was adhesions.
 SA> Still no solitions.
 ...
 SA> If this proves to be adhesions, is there an operation to correct this?
 SA> Will it go away, or is this permanent?
 SA> Thoughts appreciated.

 Steve,

 Some thoughts: I'm no med specialist here, but have had some
 considerable experience with what seemed to be pain associated
 with surgical adhesions. Over the years (long duration) things
 have gotten better. Movement and stretching helped. I have been
 creative and experimental to try movements that would "reach"
 into the affected area. Has not gone away. However, as you well
 know, all situations are different.

 Best wishes  :-),

 Stefan

... Catch the Blue Wave!

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Subject: Topical Pain Medication
From: Bob.Paddock@f1000.n261.z1.fidonet.org (Bob Paddock)
Organization: FidoNet node 1:261/1000 - Nerve Center, Pikesville MD


[This is from the Chronic Pain Conference]

WB>     Many folks may know this already; but some may not. There is an
WB>over the counter pain medication made with extract from hot peppers. It
WB>is available in two strengths, 0.025% or 0.075%, Capsicum Oleoresin.

        There was a write up about it in "Discover" Magazine, August
1991 page 48-52 "Some Like It Hot; The substance that sets your mouth on
fire each time you bite into a chili pepper can also put out the flames
of pain.", by Richard McCourt.

        This hot pepper extract is also carried by, don't fall out of
your chair, Bicycle Shops!  It is sold under the brand name "HALT" you
spray it in dogs eyes when they start chasing you down the road.  It
cost about $4 for a 1.5 Oz can at a strength of 0.35%, what does it cost
you?  Mix it with cold cream and you end up with basically the same
stuff you get from the drug store.

                                !!!!
        DO NOT GET THIS STUFF IN YOUR EYES, IT WON'T HURT YOU, BUT YOU
WISH YOU WERE DEAD TILL YOU GET IT CRIED OUT!!!!
                                !!!!
___
 X SLMR 2.1a X

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Subject: Bed and Pillow
From: Bob.Paddock@f1000.n261.z1.fidonet.org (Bob Paddock)
Organization: FidoNet node 1:261/1000 - Nerve Center, Pikesville MD


[This is from the Chronic Pain Conference]

Bob, here:

DS> If you should happen to have any suggestions, please tell me.

DS> I gotta admit, my main problem is my very REAL fear of anyone in the
DS> medical field.  I have always had this fear...

        I feel that way about dentists.

DS> My neck stays tense constantly.  I am forever with a headache.

        Sounds just like Karen when I meet her.  Your message to Karen
reminded me of a couple of things that we have found that did relieve
some of Karen's pain, at least a little.

DS>     I have also started experiencing something happening with my
DS> spine.  It seems when I wake in the morning and after I get out of bed
DS> I can't seem to stand erect for quite a while because of the pain in
DS> my lower spine.

DS> I don't know if I mentioned to you about one morning waking up to my
DS> being stuck sideways in between my water bed mattress and the bed wood
DS> frame. I'm separated now, but at the time I do believe it was because
DS> being that my husband is a very big man and when he lays on the water bed
DS> my side goes up and I tend to roll.  This time I guess being asleep I
DS> rolled the other way and fell in between the mattress and the frame. Well,
DS> when I woke up I was in the position of like doing a side stroke of
DS> swimming with my arm straight up over my head and my neck totally stiff
DS> and terribly sore.  Well after that my neck has never been ok.  It got
DS> better at times but as soon as I do work like cut the lawn or trim a
DS> tree or anything a little strenuous, it starts all over again.

        Most all of the Doctors that we have talked to have said to NOT
use a water bed.  Are you still using yours?  They do not give your back
and neck the support that it needs for proper rest.  You don't want to
lay on a board either, just some thing that is firm.

        Also use a cervical neck pillow, to properly support the curve
in your neck.  You have to get one that feels good to you, the wrong one
will make you feel worse.  You can get them from most medical supply
places, or a lot of chiropractor offices.  No, you don't usually have to
actually see the doctor to get a pillow.

        I use one that no longer worked for Karen, as it got to soft to
support her neck.  I find that I sleep a lot better with it myself.

        To improvise one to see if it will help you out before
investing any money in one, roll up a bath towel till it fells like it
is the correct thickness to keep the curve of your neck supported.  If
you sleep on your side you need to make it a different thickness.  Don't
sleep on your face.  You don't want to sleep with your neck in any funny
angles like a normal pillow might cause.
___
 X SLMR 2.1a X

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Subject: Trigger Points
From: Bob.Paddock@f1000.n261.z1.fidonet.org (Bob Paddock)
Organization: FidoNet node 1:261/1000 - Nerve Center, Pikesville MD


[This is from the Chronic Pain Conference]

Bob, here:

DS> If you should happen to have any suggestions, please tell me.

DS> My neck stays tense constantly.  I am forever with a headache.

DS>     It got better at times but as soon as I do work like cut the
DS> lawn or trim a tree or anything a little strenuous, it starts all
DS> over again.

        When I meet Karen she walked around like she had a board strapped
to her back and she would never turn her head, she turned her whole
body.

        This is one of the other things that we have found that did
relieve some of Karen's pain, at least a little.

        Some thing called Myotherapy or the treatment of "Trigger
Points":

        Here is a quick introduction from The Trigger Point Manual, this
is !!THE BOOK!! that Myotherapy is based on:

                Myofascial Pain and Dysfunction: The Trigger Point
Manual by Janet G. Travell, M.D. and David G. Simons, M.D.,
Illustrations by Barbara D. Cummings.  Published by Williams & Wilkins
428 E. Perston Street, Baltimore, MD 21202, U.S.A.  ISBN 0-683-083366-X.

        Volume One covers The Upper Extremities (Waist and above), Volume
Two covers The Lower Extremities (Waist and below).  You must have the
introductory information from Volume One to use Volume Two.

        From the Foreword:  "At last a text is presented about the pain
and dysfunction of myofascial tissues (Mucles), a condition that
confronts the medical practitioner daily, but remains poorly understood
and frequently overlooked by the medical profession.  Yet, patients
continue to present themselves with symptoms that are attributable to
myofascial trigger-point pathophsiology.  These patients often fail to
receive proper evaluation and, therefore, appropriate treatment.

        "'Trigger points' have been inadvertently discovered by
patients, their spouses, therapists, non-medical practitioners; yet,
many of their physicians who have examined them, have attributed their
condition to various etiologies, and treated them with ineffectual
methods.  Failure to achieve success has resulted in the assumption [By
the Doctors] that patients in their noncompliance are the cause of
failure, rather than therapeutic misguidance [Doctor being wrong
{Doctors are never, ever wrong, even if they are}].

        "For decades, Janet Travell has labored to document the
scientific basis of myofascial pain and dysfunction.  Her clinical
reports have been ridiculed and ignored by some, but believed and
confirmed by many."

        The Myotherapits that we have meet have made believers out of
us.  Remember I said Karen would not turn her head because of her tight
muscles?  Karen was setting on the therapy table with the therapies
behind her.  After the theraipits treated her the first time, for about a
hour, the theraipits asked her a question.  She turned her head to look
behind her to answer him.  She didn't even realize that she did it.  I
almost cried.  After the first treatment she said she had noticeably less
pain.  Gone by no means, but that was the first thing that even made a
dent in her neck tenseness.

        From the Glossary:  "Active Myofascial Trigger Point:  A focus
of hyperirritability in a muscle or its fascia [the bag like stuff that
covers muscles] that is symptomatic with respect to pain; it refers a
pattern of pain at rest and/or on motion that is specific for the
muscle.  An active trigger point is always tender, prevents full
lengthening of the muscle, weakens the muscle, usually refers pain on
direct compression, dediates a local twitch response of muscle fibers
when adequately stimulated, and often produces specific referred
autonomic phenomena, generally in its pain reference zone.  [For example
a trigger point below your ear will give you a headache behind your
eyes.]  TO BE DISTINGUISHED FROM A LATENT MYOFASCIAL TRIGGER POINT.

        "Latent Myofascial Trigger Point:  A focus of hyperirritability
in muscle or its fascia that is clinically quiescent with respect to
spontaneous point; it is painful only when palpated.  A LATENT TRIGGER
POINT MAY HAVE ALL THE OTHER CLINICAL CHARACTERISTICS OF AN ACTIVE
TRIGGER POINT, FROM WHICH IT IS TO BE DISTINGUISHED.

        "Referred (Trigger-Point) Pain:  Pain that arises in a trigger
point, but is felt at a distance, often entirely remote from its source.
The pattern of referred pain is reproducibly related to its site of
origin [You press on the Trigger-Point and it makes your pain feel
worse, usually some placed remove from where you are pressing].   THE
DISTRIBUTION OF REFERRED TRIGGER-POINT PAIN RARELY COINCIDES WITH THE
ENTIRE DISTRIBUTION OF A PERIPHERAL NERVE OR DERMATOMAL SEGMENT.

        "Referred (Trigger-Point) Phenomena:  Sensory and motor
phenomena, such as, pain, tenderness, increased motor until activity
(spasm), vasoconstriction [Preventing proper blood flow; for example a
trigger-point on the back of the neck can cut down blood flow to the
eyes], vasodilation [To much blood flow], and hypersercretion caused by
a trigger point, which usually occur at a distance from the trigger
point."

        We got our copy of this book from B.Daltons Book store, each
volume cost about $80.  [I hope you didn't fall over, please stick with
me for a bit.]  Check your area libraries.

        Ok so much for a basic introduction why are we telling you this?

        [This messages is getting a bit long, so please see the next
one.]
___
 X SLMR 2.1a X

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Subject: Trigger Points
From: Bob.Paddock@f1000.n261.z1.fidonet.org (Bob Paddock)
Organization: FidoNet node 1:261/1000 - Nerve Center, Pikesville MD


[This is from the Chronic Pain Conference]

[This is continued from the last message:]

DS> No pain at the time. Really, I can say I didn't feel any pain at all.  I
DS> don't know if I mentioned to you about one morning waking up to my being
DS> stuck sideways in between my water bed mattress and the bed wood frame.
DS> I'm separated now, but at the time I do believe it was because being
DS> that my husband is a very big man and when he lays on the water bed my
DS> side goes up and I tend to roll.  This time I guess being asleep I
DS> rolled the other way and fell in between the mattress and the frame. Well,
DS> when I woke up I was in the position of like doing a side stroke of
DS> swimming with my arm straight up over my head and my neck totally stiff
DS> and terribly sore.  Well after that my neck has never been ok.  It got
DS> better at times but as soon as I do work like cut the lawn or trim a
DS> tree or anything a little strenuous, it starts all over again.

        Keep in mind I'm not a doctor and I can only speculate what has
helped Karen might help you.  This is my speculation:

        Your accident gave you a Latent Trigger Point [every one as a at
least a few, but the may never become active, where they cause pain].
Then your sleeping wrong gave you a Active Trigger Point.  When you get
a bit better at time you end up doing some thing that irritates your
Trigger Points again so you have a relapse.

        What the book teaches is three techniques to get rid of trigger
points, it also covers a exercise for each muscle to get each muscle in
the body stretched out to its maximum length, with out over extending it.
You do these exercises very slowly and gently.  Over doing, by
stretching to far, could damage your ligaments.  You need to do them
often and the should never make you feel any worse than when you
started.  They should make you feel just a bit better, maybe not much
when looked at on a day by day basis, but looked at over a longer period
of time they do help.

        When the muscles are relaxed at their optimal length they tend
to not to go into the very painful spasm. ie. Your tight neck muscles.
You need to keep doing the exercises to keep the muscle lengthened out,
to keep the spasms from coming back.

        I wish I could figure out how to describe these exercises, as
they are mostly pictures in the book.

        The three techniques are:

1) Injection of a anaesthetic by a doctor into the Trigger Point site,
doing it wrong will just give you more Trigger Points.  We can forget
about this one in this context.

2) Number two is known as Stretch And Spray.  As a Theripits stretches
your muscles as they spray them with a very fast evaporating cooling agent
[Florla Methane I think but I'm not sure.] that causes the muscle to
lengthen.

3) Direct Trigger Point pressure.  This is some thing you can learn to
do your self with a bit of practice.  Altho for some Trigger Points
that are on your back it is easier to have help from some one else to
press on them.  When you, or some one finds a Trigger Point, you'll know
it.  It will make your pain much worse, and muscles tighter, and keep in
mind that the Trigger Point may be far removed from where your pain is,
tho it will always be within the same muscle as the pain.  However you
can get a overlapping effect because many muscles do overlap [A Trigger
point might be on the muscle under the one that you are actually
pressing on.  A trained theripits knows how to deal with this, the book
is a bit hard for me to follow in this area].

        If you had the book you can look at the pictures and charts that
say if it hurts here, press there.  Don't start by pressing where it
hurts, that is almost never the Trigger Point, tho there are exceptions.
Without the book you just have to explore.  The pressure that you apply
should be a firm continuous pressure, no poking, no jabbing, no rubbing
in circles, and never press so hard that it causes bruising.  Since it
makes the pain worse you have a tendency to try to wiggle away from the
pressure, because of this it is more effect to have some one else press
them; how ever you can learn to do it yourself.

        Ok, now why would you want to press on a Trigger Point if it is
going to make the pain worse?

        With brief pressure the pain gets worse, but with sustained
[Seconds to minuts, it just depends] pressure the muscle will relax.
One of the theories (there are several) of what happens here is that the
pressure on the Trigger Point causes some thing call 'no-knox-ia' (Not
sure of the spelling that is how the word sounds to me), ie.  The amount
of oxygen going to the muscle is cut down, the muscle can't work with
out oxygen so it relaxes.  Some times they stay relaxed, some times they
don't, it depends on what caused the Trigger Point in the first place,
and what might keep them irritated.  If you can keep the muscle relaxed,
and the Trigger Point unirritated, the trigger point goes away after
awhile, or at least not cause pain any more.

        Thats the best that I can do for a introduction to Trigger
Points, I have not done the subject justice, but I hope that it at least
points the way...

DS> I don't have any friends and it has helped being able to say a
DS> little to someone. Thank You.

You have us and your children.  Don't just wish for Miracles, rely upon
them!
___
 X SLMR 2.1a X

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Subject: Re: Water Exercises
From: Kathleen.Mcintosh@f181.n264.z1.fidonet.org (Kathleen Mcintosh)
Organization: FidoNet node 1:264/181 - Les's Corner BBS, Richmond VA


[This is from the Chronic Pain Conference]

 [KJ] > It has not been bad since I started swimming everyday and
 [KJ] > manually moving my legs in a bicycle motion while underwater.

When I do pool therepy, I wear a special flotation vest that keeps
me upright while I "walk" in the water.  It's really great for
conditioning.  It's the only time I feel no pain.  I know you can
buy these vests, but they're not cheap ($100.)  Maybe you should
look into one.

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Subject: your pain
From: Kathleen.Mcintosh@f181.n264.z1.fidonet.org (Kathleen Mcintosh)
Organization: FidoNet node 1:264/181 - Les's Corner BBS, Richmond VA


[This is from the Chronic Pain Conference]

* In a message originally to Stefan Welch, Linda Cummings said:
 [LC] In a message to Nancy Kowall:

 [LC] >  best courage--someone will invariably say, "Well, you look
 [LC] >  really good, what's the matter with you? You must not have much
 [LC] >  of a pain problem." AAARRRGGGHHH!!!

When I was very sick with cancer, people would always tell me that I
couldn't be sick because I looked so good.  I'd just say, "well,
this is what a person with cancer looks like."  I also liked the
people who would tell that I was much too young to be so sick.  Gee,
I wish I could have waited, but life decided otherwise!  I feel
sorry for people who are always so healthy, they have no concept of
what it's like and can not be sympathetic.  I see all the
compassionate people on this echo and know that we have all gained
something.
Hugs,
Kathleen

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Subject: Shingles/Adhesions
From: Arthur.Saus@p160.f72.n376.z1.fidonet.org (Arthur Saus)
Organization: FidoNet node 1:376/72.160 - Mail Room, Columbia SC


[This is from the Chronic Pain Conference]

Hello Steve!

13 Dec 92, Steve Ambrosini writes to You:

 SA> My father recently has been diagnosed with Shingles.
 SA> I had been diagnosed about 2 years ago.
 SA> I apparantly caught mine early enough (in a preliminary rash
 SA> stage) and medication minimized my pains and now have no signs of it.
 SA> His was a full blown rash with erupting blisters either naturally or by
 SA> his itching, before he sought medical attention.

 SA> After two weeks on the medication (zovirax 800mg), he still has blisters
 SA> (that seem to be easing) and intense pain sessions.
 SA> Might this be a premanent condition?

The blisters should go away, but many patients are left with a
permanent discoloration of the skin where the blisters were.  Some
patients do recover without any residual effects, but others are
left with a chronic pain problem that can be very severe.  That
pain is in the same area where the blisters were, and is a very
strange type of pain.  Careful testing will reveal that this area
is actually numb, but the patient experiences pain in this "numb"
area, thus the name for this condition: Anesthesia Dolorosa.

 SA> Is there any other medication that might help?

Since "Shingles" is caused by a virus, an antiviral medication such
as Zovirax is probably the best approach.  Various other techniques
and medications (such as salves, icepacks, etc.) may provide some
relief of symptoms, but only an antiviral medication will go after
the source of the problem.

Arthur

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Subject: Adhesions
From: Arthur.Saus@p160.f72.n376.z1.fidonet.org (Arthur Saus)
Organization: FidoNet node 1:376/72.160 - Mail Room, Columbia SC


Hello Steve!

13 Dec 92, Steve Ambrosini writes to You:

 SA> If this proves to be adhesions, is there an operation to correct this?
 SA> Will it go away, or is this permanent?

If adhesions are present, they can be surgically lysed.
Unfortunately even if they are lysed, some people just have a
tendancy to again form the adhesions. There is no way currently
known to prevent or control this phenomenon. Adhesion lysis is
usually done when the adhesions interfere with the function of an
organ; it is not usually done for management of pain or
discomfort.  To prove that adhesions were present, a major surgical
procedure such as laparoscopy (at least), would have to be done.

Arthur

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Subject: Stopping RSD by amputation
From: Arthur.Saus@p160.f72.n376.z1.fidonet.org (Arthur Saus)
Organization: FidoNet node 1:376/72.160 - Mail Room, Columbia SC


[This is from the Chronic Pain Conference]

Hello Jim!

15 Dec 92, Jim Graham writes to All:

 JG> I wonder if it is possible to stop the SPREAD of RSD by amputating
 JG> the affected limb?

Probably not, although to my knowledge this has not been rigorously
tested scientifically.  Based on the most likely theories of the
disease however, I do not believe this would have much probability
of success.

As you know, RSD starts with a known injury (at least in most
cases, although I do know of RARE exceptions).  The Sympathetic
Nervous System gets involved in this process to exacerbate and
continue the problems, but this PROBABLY happens at the level of
the Spinal Cord, not in the affected extremity itself.  It
certainly appears that there are effects of Sympathetic Nervous
System involvement in the extremity also, but I believe this
maintains the process rather than initiating it.

Following this reasoning, amputation of the extremity MAY further
exacerbate the problem, rather than cure it, since that amputation
would be a further injury to the nervous system in that extremity.

 JG> Its presently about 6 inches below knee, in terms of pain and tissue
 JG> variations, but has been and continues to slowly "creep" upward.

This is consistant with the "natural history" of this disease
process.  This is exactly how it behaves if it is not treated.  My
best recomendation is for you to see a physician who can confirm
the diagnosis of RSD for you and begin therapy as soon as
possible.  There is more than one way to treat RSD, and if you have
tried one approach that didn't work, that just means it is time to
try another (if indeed the problem is truly RSD and not something
else).

 JG> I am aware of several cases where it begins in the foot, and ends up
 JG> spreading to the entire body.

I disagree with this unless you are intentionally exaggerating.  I
agree that it may spread to involve the entire limb, but I have
never seen good medical literature describe the spread of RSD to
involve the whole body.  Can you quote your source of this "fact"?

 JG> Simply put...

 JG> Do I have a good chance of getting rid of the RSD if I have my leg
 JG> amputated ABOVE the area of pain and tissue damage?

Simply put... I don't think so!

Arthur

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                                ******

                  End of Issue # 3089 of the Handicap Digest

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