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Pain Treatment Options

By Jeff Lutz, CMTPT September 17, 2014 No comments

There are, without a doubt, many ways to address any condition - treating pain is no different. There are conservative approaches along with invasive procedures.

When treating trigger points and Myofascial Pain it is generally in the best interest of the patient to exhaust the conservative treatments before beginning the invasive ones. Many times invasive procedures do not resolve the condition and sometimes make it more difficult to treat later.

Granted, this is why it is of utmost importance to educate yourself, as you are doing now, about your condition so you can make an informed decision. Whatever decision you make -- stick with it -- treatment, no matter what it is, does not work if you do not follow the direction of the practitioner.

Conservative Approaches

A conservative approach is any type of therapy that is not adding foreign materials to the body or invasively piercing the skin.


Myofascial Trigger Point Therapy

Myofascial Trigger Point Therapy was pioneered by Janet Travell, MD who was the White House Physician during Kennedy and Johnson's term in office. This therapy employs the use of manual therapy techniques to deactivate trigger points and restore normal range of motion. Once normal range of motion has been achieved a person may return to a pain free lifestyle. Modification of habit, which is generally simple and practical, is usually required to keep the pain from returning. Types of modalities a therapist may use, but not limited to:

Trigger Point Pressure Release - a therapist will locate and compress a trigger point until it refers its pain. The patient will let the therapist know when the pain begins to dissipate at which time the therapist will slightly increase pressure and repeat until the pain is no longer referred. The muscle is then stretched to its normal range.

Active Myofascial Release Techniques - this manual therapy technique is designed to break through adhesions which form in the fascia (connective tissue) of the body. This is usually performed on patients who have had their pain for long periods of time where this physical change has taken place.

Vapocoolant Spray and Stretch - spray and stretch is applied to encourage relaxation of a muscle by essentially distracting the central nervous system and allowing the targeted muscle to relax. A cold spray is applied over the area of the muscle and through its pain pattern while at the same time the practitioner is moving the muscle into a stretch.

Post Isometric Relaxation (PIR) - this manual therapy technique is used to facilitate more range of motion from a group of muscles. The patient will be placed into a position where they will be asked to exert low level force against the practitioner for about 5 seconds. The practitioner will then tell the patient to relax and will move the body part into the stretch position for the muscle group for which they are applying the PIR.

Heat - heat is applied to relax muscle and help with restoring range of motion.



Massage Therapy

Massage therapy is growing faster and faster all the time because many people are finding relief without having to use as much medication to control conditions such as pain and anxiety. The effect massage has on the body is stress reduction which in turn can translate into less pain in the body. Other physical benefits can be achieved depending on the type of technique utilized. In my opinion people do not look to massage for pain relief because of the mentality behind it. Massage is still looked upon as a 'pampering' or 'luxury' service. All I can say is that you do not know until you give it a try -- if you get the right therapist you may be very happy with the results.



Last, but certainly not least, is chiropractic care. From being in this field for 7 years, I have noticed a very important thing about chiropractors. They can do what I cannot. Chiropractic care is designed to manipulate joints, primarily in the spine, although some chiropractors will manipulate other joints as well. Chronic myofascial pain patients many times need manipulations after trigger point therapy to restore the motion of the joint itself. This sometimes must be done by what is called a HVLA adjustment, which stands for High Velocity Low Amplitude. The response I usually get from chiropractors is their patients adjust much easier after having muscle work performed.

Other devices are used in the chiropractic community such as activators and various electromechanical devices. Once again, it is important to find a chiropractor who fits your needs, and more importantly, keeps your best interests in mind. I like chiropractors who encourage their patients to keep themselves healthy so they do not need constant care and tend to refer to those types of chiropractors.


Moderately Invasive Techniques

Dry Needling and Trigger Point Injections (TPI's)

While these techniques are a part of trigger point therapy, they need to be separated because they may only be performed by properly trained and licensed health care practitioners. Types of practitioners who perform these techniques are MD's, DO's, PT's*, Nurses (RN's)*, and acupuncturists (AP). The practitioners with the * beside their credential are not licensed in all 50 states to perform this technique, but the others are.

Dry needling is performed by inserting a dry needle (a needle that will not be injecting any medication) into a trigger point. The practitioner is looking for a local twitch response (LTR), which is a clinical sign of a trigger point. The practitioner will then move the needle around while staying within the same injection site to penetrate and deactivated all trigger points in the area. A patient will then be stretched and given specific range of motion exercises to perform before returning for another round of therapy. Many times, because of this technique, a patient is sore from the needle being used to perform the technique. The pain does however go away and usually leaves the patient pain free.

Trigger Point Injections (TPI's) are essentially the same as dry needling except a medication or mix of medications are injected into the region of the trigger point. The injection will help with the post needling soreness along with making the actual therapy more tolerable to those with low thresholds for pain. Keep in mind, it is the needle that does the job, not the medication being injected.


Invasive Approaches

Invasive techniques are ones which pierce the body and remove tissue/bone and leave scars. Most surgeries are considered invasive procedures. Do not let surgeries scare you as they are sometimes necessary to alleviate pain, but many times can be avoided if a person pays careful attention to themselves and addresses conditions that come up in a prompt manner.

There are many different types of surgeries used for pain, so rather than talking about all of them, I will mention that it is far better to keep a certain mentality when considering surgery.

When considering surgery:

Try to make it a last resort. Most surgeons will agree with this statement and will order therapy for a specified time period before considering a procedure especially with 'borderline' patients.
Get a second opinion. You cannot undo a surgery so it is always good practice to have another specialist look at your case and give their opinion. The opinion may not have to do with getting surgery or not, but perhaps the approach or procedure itself could be different allowing a better chance for resolution and faster recovery time.

Stop Smoking.

If you smoke - stop. Most surgeons will not operate on a smoker especially if a bone fusion is being performed. The body will not fuse properly, and sometimes not at all, which is called a non-union.



Ask for referrals for a surgeon from a practitioner who works with cases like yours as they know who can provide the best resolution for you. The surgeons I recommend in this area I believe are top notch and always on the cutting edge of their field. Furthermore, they treat their patients with respect and allow a person to feel comfortable in making this important decision for themselves.


This article was written by Jeff Lutz, CMTPT of The Pain Treatment and Wellness Center, 245 Humphrey Rd., Suite 2, Greensburg, PA 15601, 724-853-2353,

NAMTPT 2011 Conference Fast Approaching

By Pressure Positive September 17, 2014 No comments
Join NAMTPT 2011 in Waltham, Massachusetts
Join NAMTPT 2011 in Waltham, Massachusetts

Pain management pioneer, David Simons, MD, once commented that Myofascial Trigger Points are unbelievably common yet commonly overlooked.

For more than 25 years the National Association of Myofascial Trigger Point Therapists (NAMTPT) has been the only organization dedicated to representing professionals whose primary training is focused on the identification and treatment of myofascial pain and dysfunction. But,  all pain practitioners, manual therapists included, can learn from the experts in the field at the annual NAMTPT conference this week in Boston.