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Is there a place for "trigger points" in the explanation of pain?

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  • ??? Is there a place for "trigger points" in the explanation of pain?

    http://www.rmtedu.com/blog/those-sor...n-your-muscles


    I saw this today on Facebook, and I question the author's statement regarding treatment and trigger points:

    Even though the etiology of these enigmatic sore spots is still not completely understood, people seem to benefit from treatments aimed at localized sore spots. Often what therapists are assessing and treating is described as a local induration of soft tissue with a replicable pain pattern which may or may not be associated with a local twitch response.

    The explanations used in the past of this observable phenomenon seem to be flawed in reasoning, but I do not think there is a need to abandon treatment approaches that provide patients with pain relief. What is needed is an updated model of what causes these sore spots to develop and what is the most effective way of delivering a treatment that will help people in pain.

  • #2
    Yes...

    A normal, non-threatening sensitive area you keep perseverating on. In doing so, you continue to visit countless individuals and spend overwhelming amounts of money for attention and time to express your frustrations with more important and threatening life situations while padding the wallets of those providing you with non-sense treatments.

    I think that covers it...
    "The views expressed here are my own and do not reflect the views of my employer."

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    • #3
      I just posted this at our training site. It's a quote from Elizabeth Gilbert's The Signature of All Things.

      "Argument is our most steadfast pathway toward truth, for it is the only proven arbalest [crossbow] against superstitious thinking, or lackadaisical axioms."

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      • #4
        Understanding requires thoughtfulness and curiosity. All are in short supply.

        There's that Puritan Ethic thing too, which is a product of, well, you know.
        Barrett L. Dorko

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        • #5
          Originally posted by NickNg View Post
          ....what is the most effective way of delivering a treatment that will help people in pain.

          How about a treatment that works, and that keeps working no matter what research you can come up with to disprove it.
          Marcel

          "Evolution is a tinkerer not an engineer" F.Jacob
          "Without imperfection neither you nor I would exist" Stephen Hawking

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          • #6
            Trigger point - an eliptical nodule with increased stiffness and reduced blood flow. Maybe this has been posted already. 2009 paper.

            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2774893/

            So, Nick, the updated model you were after might go something like this:

            Negative emotion --> ego defense (repression, suppression, denial etc) --> "stress" (disruption of HPA axis) --> sympathetic stimulation and increased NA/NE release --> vasoconstriction --> increased vascular bed resistance (as seen in the study above) --> muscle hypoxia and tensioning --> pain.

            Everyone knows that poking trigger points relieves pain, but that relief will only last a very short time if the stuck emotions are not released.
            Last edited by EG-Physio; 22-06-2017, 03:20 PM.

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            • #7
              Negative emotion --> ego defense (repression, suppression, denial etc) no evidence for this - no test--> "stress" (disruption of HPA axis) --> sympathetic stimulation and increased NA/NE release --> vasoconstriction --> increased vascular bed resistance (as seen in the study above) --> muscle hypoxia and tensioning --> pain.

              So, if we critically examine the first step in this long list of assumptions of a linear nature (not consistent with what we know about pain: a non-linear experience), and come to the conclusion that it A) can never be reliably tested, B) there is no epidemiological data or other evidence for it, and C) there is noo discrete thing such as a "negative emotion" - the long list after that becomes moot.

              EG, having a theory is fine, but YOU have to then start finding supportive evidence for EVERY single step in the proposed model/mechanism.
              As you can see, the first step alone is missing any evidence.
              We don't see things as they are, we see things as WE are - Anais Nin

              I suppose it's easier to believe something than it is to understand it.
              Cmdr. Chris Hadfield on rise of poor / pseudo science

              Pain is a conscious correlate of the implicit perception of threat to body tissue - Lorimer Moseley

              We don't need a body to feel a body. Ronald Melzack

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              • #8
                There is evidence for each step. Do I have to dig it all up?

                Ego defenses typically reduce stress in the short term by pushing the unwanted emotion undergound. So they can be adaptive in some situations, but if the emotion is strong, they fail to cope and the body-mind becomes stressed.

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                • #9
                  Yes, you have to provide evidence - especially for the first step.
                  "Pushing unwanted emotion underground" is another concept that has no value. What "pushes"? And where is "underground"? And which emotion is "unwanted"? (Anger, sadness, fear? And does it matter?

                  For a "model" to scientific validity, you must indeed reference each step with solid research or other plausible evidence (consistent with existing laws of nature).
                  We don't see things as they are, we see things as WE are - Anais Nin

                  I suppose it's easier to believe something than it is to understand it.
                  Cmdr. Chris Hadfield on rise of poor / pseudo science

                  Pain is a conscious correlate of the implicit perception of threat to body tissue - Lorimer Moseley

                  We don't need a body to feel a body. Ronald Melzack

                  Comment


                  • #10
                    There is evidence for each step. Do I have to dig it all up?
                    Please.

                    Then, for fun,list your timeline of proposed events....but this time start with pain and go backwards.

                    This pattern plays out consistently:
                    x causes pain--I can't test if x even exists--but trust me,
                    I will teach you how to feel it
                    Treat x with y--y and the effects can't be tested--but look the patient feels better now
                    So x is real and causes pain
                    And y's effects are real and take pain away for everyone

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                    • #11
                      If "ego defense" is based on Freud's work, for instance, it is not based on evidence, but only on unproven and disputed assumptions.
                      We don't see things as they are, we see things as WE are - Anais Nin

                      I suppose it's easier to believe something than it is to understand it.
                      Cmdr. Chris Hadfield on rise of poor / pseudo science

                      Pain is a conscious correlate of the implicit perception of threat to body tissue - Lorimer Moseley

                      We don't need a body to feel a body. Ronald Melzack

                      Comment


                      • #12
                        Stress and cortisol are linked, yes? And cortisol is the major stress hormone in the HPA axis, yes?

                        Regarding ego defense...

                        -- https://www.ncbi.nlm.nih.gov/pubmed/3042992

                        "In 6 of 7 samples studied to date, a significant ED-cortisol correlation was obtained".

                        -- https://www.ncbi.nlm.nih.gov/pubmed/432362

                        "The results indicated no relationship between defense effectiveness and cortisol production rates in the out-patient department [easier environment to cope] and an inverse relationship between cortisol production and defense effectiveness under the stress of hospitalization [harder environment to cope]". Square brackets are mine.

                        -- http://psycnet.apa.org/psycinfo/1996-01717-013

                        "These findings suggest that both heightened distress and the inhibition of distress may be independently linked to relative elevations in cortisol".

                        When stress is mild/moderate, we can either:

                        1. Fully allow the emotion so that it passes, or...
                        2. Employ ego defense mechanisms.

                        Both are ok but the former is preferable.

                        When stress is severe, the body will be affected no matter what. Defense is useful in the short term, in order to avoid the body being damaged by the intense chemical cascade. Eventually, if the emotion can be accessed and released safely, that's obviously going to have health benefits because ego defense uses up an enormous amount of energy.

                        'Safely' is the key word. The mind judges negative emotions to be 'bad', because the mind's job is to obsess about survival and reproduction. When the mind is quiet, negative emotions just *are*. That's the only way to access and release intense negative emotions. Hence the great need for practitioners to learn how to quiet the mind and enter altered states. All the world's top healers do this.
                        Last edited by EG-Physio; 23-06-2017, 01:50 AM.

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                        • #13
                          Saw this quote by Quintner on pudendalnerve.com.au. I don't know if he still visits here.

                          Do you believe pain will be explained one day?

                          "The short answer is NO. Attempting to explain the experience of pain is inextricably linked to our inability to explain consciousness. You could ask if we will ever explain LOVE and I would give you the same answer".


                          I agree with this, in part. It was that last sentence which really grabbed my attention. Is pain the end result of a lack of love, or disconnection from love? Maybe the difficulty in pinning down pain is due to the fact that we are trying to define 'lack'. How do you define lack of anything, other than by referencing the thing that's absent? And if we cannot define love, then it's always going to be difficult. Make sense?

                          Philosophy and religion have offered some interesting perspectives to complement what we know from scientific investigation. eg. Love is that which is prior to consciousness.

                          How to access it for therapy? Master healers enter altered states of consciousness on demand - this implies that meditation is probably going to be the most useful skill.

                          Comment


                          • #14
                            EG,

                            There's nothing wrong with mediation, wholeness or many of the other things you have brought to our attention. "Community" is another thing you've brought to our attention.

                            Your definition of "healing" and "authentic" probably clashes with what science "knows."

                            Do you suppose therapists know nothing of this?
                            Barrett L. Dorko

                            Comment


                            • #15
                              Originally posted by Barrett Dorko View Post
                              EG,

                              There's nothing wrong with mediation, wholeness or many of the other things you have brought to our attention. "Community" is another thing you've brought to our attention.

                              Your definition of "healing" and "authentic" probably clashes with what science "knows."

                              Do you suppose therapists know nothing of this?
                              Not sure what science thinks about the word 'healing'. 'Authenticity' (congruence) was comprehensively studied by Carl Rogers, and as far as I'm concerned he's the #1 expert on that topic.

                              Most therapists seem to practice some form of FTSSASI (find the sore spot and stimulate it). I'm ok with that. Really all that matters is that patients get what they want without risk and without excessive time or cost.

                              But, FTSSASI won't work if the room is devoid of that crucial ingredient. Another way to look at it is this: if the crucial ingredient is present at a high level, you don't need to do much else.

                              One of the most successful therapists I've met used to routinely spend 5-10 minutes with patients. On most days, he had 'it' operating at some level. Actually I worked for this guy and the place would be buzzing (not due to my efforts, unfortunately). I'll never forget the time his wife went on a holiday with a relative, leaving him on his own for a few weeks. The easy flow evaporated and patients would look at him as if to say "who is this guy??". Temporarily, numbers dropped right off. I learnt a lot from that.

                              So this guy... I'd always try to pick his brain but he wasn't really into talking about it. Very conservative, old fashioned guy. Then one day he said "I work at my best when I'm in a sort of a trance".
                              Last edited by EG-Physio; 03-07-2017, 02:46 AM.

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