I have adapted many of the current treatments for chronic muscle pain based on my understanding of muscle physiology and the likely points of failure in the system. I do not rely on the drugs developed and tested in the treatment of neuropathic pain, unless they are particularly warranted and prove to be effective when tried.
Treating Chronic Pain.
My treatment approach takes the view that chronic pain has a muscle component to it until proved otherwise. Because muscle pain is easily diagnosed, is readily treatable and curable, it is abhorrent to me that patients are made to learn to cope with this pain rather than helped to cure it. I try to remove all of the factors that are adversely affecting muscle function. I prescribe supplements and drugs that help to restore balance and intervene with injections to rescue the muscles that are latched, without blood flow and in pain.
I seldom prescribe the drugs that are currently used to manage chronic pain. The four main classes of drugs are non-steroidal anti-inflammatories (NSAIDs such as Celebrex, ibuprofen etc), opioids (morphine, hydromorphone, oxycodone, fentanyl, methadone, codeine), anti-epileptics (gabapentin, pregabalin and tegretol) and anti-depressants (amitriptyline and Cymbalta most common).
In fact, I usually only consider my work done when my patient is successfully weaned off all pain medications and living normally without pain.
It is important to understand that none of these 4 classes of drugs have been approved or have ever been tested successfully in the treatment of myofascial pain. Therefore, the diagnosis of myofascial pain actually precludes the use of these drugs rather than requiring the treating physician to prescribe them.
This is the big disconnect in chronic pain today. A diagnosis is usually made of the disease that mimics the pain caused by a particular grouping of muscle pain. Treatment for an incorrectly diagnosed “mimic disease” is then used. When research is done to prove the benefits of treatment for the “mimic disease”, subjects are carefully selected to exclude those who do have myofascial pain. Subsequently, the vast majority of sales of these approved drugs are made to patients who do have myofascial pain.
Myofascial pain is a ready supply of pharmaceutical consumers and a convenient disease to ignore! As long as myofascial pain is ignored or discredited, there are no annoying ethical dilemmas in prescribing these treatments inappropriately.
The greater insult to chronic pain patients after the wrong diagnosis is made, is the high cost of the drugs, both financial and in side-effects.