Chronic Pain is Manageable with the Right Therapy

Chronic Pain is Manageable with the Right Therapy

I’ve been a family doctor for 30 years. Fifteen years ago, I started on a quest to understand how one of my fibromyalgia patients was getting better without pills.

Fibromyalgia is one of the most miserable pain problems in the world.

My patient was a stubborn lady who was frustrated with all the specialists and the side effects of pain medication. She planted the seed that began my quest to comb through all available data to explain why she was better. I wanted to use this miracle to help my other patients.

This journey lead me to realize I was given misinformation in the form of incomplete, biased, and outright false information about pain and what causes it. I need to let others recognize this misinformation so that the concept of pain becomes more logical.

Pain is not what I thought!

Pain is an awareness of something other than peace and quiet. It is a “dis-ease” within the body; a distress, a warning, a caution or even just a random signal. All pain may start out the same as an alert to “pay attention.” If the alert is innocent it usually goes away automatically or is resolved with some assistance; such as a scratch, rubbing, stretching, eating, running to the bathroom or resting.

Acupuncture1-1A pulled muscle, twisted ankle, cut, abrasion or laceration will all automatically heal. This healing cascade has been documented and is understood as a natural force not requiring any human intervention.

If the pain alarm is more dangerous, your logic will want confirmation. You will seek help from another. The source of this pain would come from more serious causes such as infections, cancer, tumors, broken bones, torn flesh, a hot stove or what we call space occupying lesions (aneurysms).

There is a third type of pain that is not understood and thus discounted because it does not fit into the innocent or dangerous category. This type actually begins in the innocent class. But if left untreated it will graduate to the dangerous level. Modern medicine calls it chronic pain.

Chronic pain is actually untreated, undertreated, misunderstood, discounted, medicated, pacified innocent pain that is blown up to be perceived as dangerous pain.

Read Janet G. Travell, MD, C. Chan Gunn, MD, Edward S. Rachlin, MD, Clair Davies, Amber Davies, David G. Simons and many others. These authors note that chronic pain emanates from stressed muscles and connective tissues called myofascial pain.

“All pain is myofascial until proven otherwise,” is how Travell puts it.

Myofascial pain is caused by wear and tear that causes a breakdown in muscle fibers. Normally the muscles repair themselves. But if the repair process gets overwhelmed, the healing process falters. An incomplete repair of a muscle fiber is called a “trigger point.” An accumulation of many trigger points within muscles will cause “dis-ease” and the faltering muscle will be sick.

Sick muscles will not function properly; restricting movement, causing a loss of flexibility, weakness, numbness, tingling, stinging, burning pain, and pinched nerves.

Achiness and stiffness will accelerate joint wear-and-tear, leading to bursitis and tendinitis. Tight muscles in the neck and scalp will lead to headaches and sinus issues. Tight muscles in the arm will lead to Carpal Tunnel Syndrome. In the buttock, tight muscles can cause sciatica. In the lower legs they will restrict or block arteries, causing numbness in the legs and feet.

Chronic pain can masquerade as many complex problems in medicine. Belittling this treatable pain will often lead to insomnia and anxiety. Some think that chronic pain, if left untreated, can lead to a form of Post-traumatic Stress Disorder.

Myofascial pain cannot be fixed by a surgeon’s hands as if it were a cancer or a tumor. It cannot be treated solely with pain pills.

Myofascial pain will corrupt the soul, so the soul has to be included in the therapy. The whole person has to be treated; mind, body and soul.

Myofascial pain will grow and spread to other parts of the body and burn deeply into the flesh.

Myofascial Release Therapy (MRT) comes in simple to complex forms. There are effective protocols to begin the healing process. ALL are safe, effective and straightforward. Yoga, acupuncture, stretching, and massage are all forms of MRT.

MRT must be done at the beginning of a chronic pain illness so that a fleeting ache, spasm, sting or shock will not evolve into a full blown entity.

MRT will reignite the healing cascade so the muscles and tissues will complete the healing cycle.

Then all the false signaling will go away, allowing better peace and harmony.

Stephen S. Rodrigues, MD

Stephen S. Rodrigues, MD

Stephen S. Rodrigues, MD, is a family practice physician in Dallas, Texas. He is a graduate of Howard University School of Medicine and interned at Howard University Hospital and D.C. General Hospital. He is certified by the American Board of Family Medicine and studied acupuncture at the Helms Institute of Acupuncture.

Dr. Rodrigues’ website can be found here.

The information in this column is not intended to be considered as professional medical advice, diagnosis or treatment. Only your doctor can do that!  It is for informational purposes only and represents the author’s personal experiences and opinions alone. It does not inherently or expressly reflect the views, opinions and/or positions of National Pain Report or Microcast Media.

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@Siggy The treatment of spinal segment sensitization, as per Gunn and Rachlin, you have to unlock ALL tighten paravertebral and small rotators muscles. Plus seek and destroy all possible secondary or quiet points; Jaw, temporalis,traps, Pects, Rectus, adductors and calves.

Linda T

I have to admit reading all these comments rather gave me a headache. As a chronic pain patient from being injured on the job which was exacerbated by “two scientific failed back surgeries”, 3 years later but almost 20 yrs after the initial injuries, I’m worse off. Due to denial after denial by worker’s comp for treatment that was helping me; poor after care after surgery, it is the “scientific crap” that has kept me in bondage. It is the MFR Therapy, including: massage, chiro, exercise, water aroebics, acupuncture, trigger point injections that kept me off steroids and steriod-like meds.
Diagnosed with Fibro in 1997, secondary to my original injuries, with the MFR Therapy, working with a personal trainer, Pilates, swimming, I was able to work part-time, start my own business and go on with my life. When worker’s comp put their “scientific” crap into the formula and stopped these treatments, I eventually went into a major set back, deteriorating, ending up on major meds, including narcotics and steroids, gaining 35 pounds of which I had lost and Type II Diabetes. I have stepped out in faith the past 3 yrs., depsite what the scientific crap indicated, got off the drugs, lost 60 pounds, no meds for diabetes and using my own insurance, coming out of pocket when able, utilize MRT Therapy. In the midst I’ve had the scientific methods, i.e., Botox injections in the SI Joint and periformis, numerous nerve root blocks to the back and SI Joint which only last a short period of time, causing major flare ups of my blood sugar.
I have refused a 3rd back surgery with the 2nd leaving my left foot with neuropathic syndrome. Unless a miracle in surgery appears I will continue with the MFR Therapy Modalities, especially for the Fibro which I have also found Magnesium Malate to help instead of popping Lyrica everyday. Yes, I have to use it sometimes but more for the neuropathic pain.
One thing we must realize; we can’t place people in a box. We all have different symptomatology for different reasons. Mine started with an on the job injury and later and auto accident which was still apart of the job; the 2nd aggravating the 1st and causing the back surgeries. Each chronic pain patient must be treated individually, one big thing the worker’s comp system has NOT done and it sounds like some of the input in this dialouge. I refuse to be labled handicapped, altough my doctors are telling me right now I’m disabled. I know this is a process as I remove myself from under the treatment of the worker’s comp “scientific crap” and allow my body to tell me what it needs and wants to survive and LIVE.

How about a central pain syndrome/centrally mediated pain that doesn’t respond to Trigger Point injections or opiates , or a spinal chord stimulator etc. Where do I go from here? In Chronic pain for 38 years but now 14/7/ Help!

That should have been “looked” at the research. Oh, that’s right, I have trigger points in my fingers and arms. And fibromyalgia. I remember the day when Roland Staud took my hands in his and he told me his research was indicating that the central sensitization of FM was due to peripheral nociception. He’s proven it. Others have as well. Yes, this is dangerous. To the debunkers. So lets all be dangerous to them, because they are so dangerous to the patients. Imagine living to deny others benefits. So sad. Devin

Stephen, I have loved at the “research” done by this one, and it seems he is a professional debunker. There are naysaying pitbulls out there who won’t believe any research that shows either trigger points or fibromyalgia are real. They want to put them under “functional” or somatoform labels. Most of their articles I don’t not consider worthy of review, as their conclusions are skewed so far one must read them sideways, but I did annotate one, briefly, on my references for research section of my website: “Quintner J, Buchanan D, Cohen M et al. 2003. Signification and pain: a semiotic reading of fibromyalgia. Theor Med Bioeth 24(4):345-354. These authors contend fibromyalgia does not exist. I wonder if they have read any of the articles in this reference section. While some researchers are zeroing in on causes and treatments options for patients with fibromyalgia, there are still a few who spend their time creating fodder for lawyers bent on denying benefits and care to patients with this condition. They are part of the problem instead of part of the solution and seem determined to ignore the ever-mounting evidence that fibromyalgia is real and very treatable, and thus deny early interventions that may in many cases help prevent full-blown fibromyalgia from developing.” Some people will never learn anything because they already know everything there is (that their brains can hold, anyway.) Please don’t waste your time. One can’t argue with the unreasonable. They seem to have forgotton the oath they once took. If we are to be painted by them with the same brush as Travell and SImons, Bob Gerwin, HY Gee, CZ Hong and all the thousands of great researchers who are actually working on the problem instead of becoming part of it, let us rejoice. We are in great company. Let’s get back to the work we have been called to do, and heal people. And hope that the others don’t do too much harm. Devin

Good heavens! Trigger points have been imaged at NIH and the Mayo Clinic. The over 30 noxious substances released during a trigger point twitch have been identified (Jay P. Shah–multiple peer-reviewed papers). There is so much evidence on trigger points it boggles the mind that anyone would think of it as a “belief system” rather than based on scientific evidence, unless those people can’t palpate and can’t read. It is sad that those who claim to “debunk” Travell and Simon refuse to look at any research that doesn’t agree with their very narrow point of view. Their political one-upsmanship and “gotcha” mentality should have no place in true medical science. Fibromyalgia can’t cause numbness and tingling, etc., but myofascial trigger points can. So many of the symptoms that are generally believed by many to be part of fibromyalgia are actually due to TrPs, and if you treat the TrPs and control the perpetuating factors, they get better. The central sensitization of FM can’t cause localized symptoms. If you look at the research by Ragi Doggweiler MD, chronic pelvic pain can be caused by TrPs alone. I could quote research all day. It would not help those who are invested in not reading it. Patients are being helped, and will eventually vote with their feet when they have the option of going to care providers who know TrPs and can help, and those who don’t and can’t. The research is there. You can lead a horse to water and you can’t make him drink. You can lead a doc to research but you can’t make him think. All of the work in my books and on my website are medical journal referenced. So are the Trigger Point Manuals. Devin

Dennis Kinch

I am a chronic pain sufferer of over 20 years. After losing my job, losing my kids, and ending up homeless becuase of my disorder, I decided that it was time to do something about how pain patients get treated in the U.S.

I was taking physical therapy at the time, and through this, learned that walking was good for me and my condition. After going on long walks every day, I decided that I was going to go on a really long walk from Boston to Washington D.C. to raise awareness about chronic pain. This lead to my partnership with a pain foundation that sponsored my walked across the U.S., from Chicago to Los Angeles along the famous Route 66.

Along this path, I discovered and walked through what I call the Pain Cycle, learning how to live with my condition in a positive way. Since then, I have started PEAR, with several dedicated volunteers and supporters, as a way to get this new found insight to the community, through a written book, a documentary, and a series of videos that help patients answer their questions they have about pain. Starting this process has been slow because I am disabled and have no source of funding. So I am turning to you.

With this campaign, we want to raise the funds to create a Q/A video about commonly asked questions about pain. We have doctors across America wanting to have this product in their waiting rooms. We have a professional videographer ready with reels upon reels of footage from the Walk to help us make this happen. Now all we need is your contributions so we can get the word out to millions of pain sufferers that there is a better way to live.

Your generous donation would help millions of people and help create a community of people helping those in pain.

My daughter did an amateur school project where she made an example of what kinds of questions these videos would answer. It can be seen here.

That’s what makes mrf so powerful, it is a function of nature which is an awesome force from the universe or heaven or God. I don’t have to prove anything!! How do you prove healing?? By asking the patient how they feel after therapy. You apply basic principles of natural healing and the body does all the work. God or Nature is the healing force we are just the assistants.

“Put that is your pipe and smoke it”

The moderator is going to bed!

While an interesting and mostly civil debate, I suggest we call a halt to it.

@John, if you are interested in posting a column of your own on this subject, I suggest you contact us.


John Quintner

@ Stephen. The onus of scientific proof rests squarely upon the person making the extraordinary claim(s) (i.e. upon YOU). I was taught this fundamental principle in medical school. However, it appears to me that you are really espousing the central tenet of homeopathy – “like cures like”. In this case you believe that there is some form of muscle damage causing localized deep pain. You then insert a steel needle into the suspect muscle, thus causing more damage in an attempt to heal the original damage (as yet unproven). How weird is that?

Ghee the moderator is a little slow.

Myofascial Release Therapy (MRT) comes in simple (Hands-on) to complex (invasive with the use of needles). ALL are safe, effective, non-toxic, available, no real contraindications.

Hands-on therapy; Yoga, stretching, massage, foam roller, massage, using a Thera-cane or balls, “Spray and Stretch,”Chiro adjustments are all forms of MRT. Find a John F. Barnes therapist.

Complex with needles; Acupuncture is part of the invasive needle therapy, dry needling to Travell’s trigger point injections. Even injection therapy with various substances; Prolotherapy, Steroid Injections and Botox Injections. These, in my opinion are off the table of choices because the others are the treatment of choice.

Important: All Acupuncture, TPs, Massage, etc are not created equal. After a session you should feel at least 5-10% better. I force it to 20-25% improvement to make sure I’m not wasting the patients time. There are ?? many types of Acupuncture, I learned French Energetics and some Traditional Chinese. I have not used botox or prolo in half decade!

@John, how would one go about proving a truth?
Is it really possible to prove something that you wish NOT to see?

This is what I tell most folks who wish to know why this therapy works. Excuse my simple minded description, it is very difficult trying to describe such a God given natural process. This is also for the benefit of patients who wish to understand why they are in pain and no professional can find anything on scan or in the blood testing.

Myofascial Release with a needles is only a 2 step process as per Gunn;
1. Gunn noted that the inserting a thin flexible solid stainless steel needle into the skin and muscle causes microscopic tissue injury. The cell injury and bleeding triggers the healing cascade of repair. A repair cycle begins which will start primary healing and secondary healing stressed muscle fibers. Muscle stem cells proliferate to restore muscle health and power.

2. Gunn also noted that he stainless steel needle, once it enters the muscle, triggers a muscular re-polarization creating a muscle twitch response. After the twitch, the muscle would relax. The relaxed muscle would be a little longer, less tense and tight. Better able to fit and correctly realign the flesh and a joint.

@Devin, FM can evolve into a more sinister evil brother called Spinal Segment Sensitization syndrome. Gunn and Rachlin describes a way to release the spine and begin the healing by using the TCM Hua Tuo Jia Ji points. You have access the small rotators muscles of the spine bilaterally with needles. This can be uncomfortable but if done slowly can be accomplished with good results.


@Dr. Rodrigues: I am not a patient at a pain management clinic. I do not have access to “myofasial release therapy.” I am not understanding how it would “heal” my pain. You sort of freaked me out with your comment: “Pain medications allow slick flesh to seed & grow.” How does that apply to nerve pain? I am “trapped??”

I would love to be able to taper off pain meds But the reality is I suffer from chronic pain that is under-treated.

The suicide rate is high among chronic pain sufferers. If the DEA continues to target pain patients in their “war on drugs,” we are doomed.

John Quintner

@ Dr Starlanyl. On a much lighter note, I wondered whether Myopain 2013 will be opened by Engelbert Humperdinck singing “Please release me …” Now that I would like to see!

John Quintner

@ Dr Starlanyl. I am quite familiar with the papers from which you quote. The metaphysical nature of “trigger points” is quite evident in their various writings. In response, please see the final paragraph in my initial post of May 12. The house of cards built upon the ubiquitous myofascial “trigger point” has long since collapsed. Nevertheless, Myopain 2013 will no doubt provide another uplifting religious experience for those who choose to worship at the Temple of the Holy Trigger Point. More to the point, will you be discussing the fundamental epistemological errors committed by the late Drs Travell and Simons? I will not be holding my breath for an answer.

The documentation for the TrP/OA connection will be found in “Healing Through Trigger Point Therapy: A Guide to Fibromyalgia, Myofascial Pain and Dysfunction”, coming August 6th. Some of it is in the Chronic Myofascial Pain chapter that I wrote for the next Travell and Simons text, which was released to me upon David Simon’s death. It is on the doctor’s side of my website, complete with medical journal references. Some of the work indicating that peripheral trigger points are responsible for central sensitization of FM is as follows: Ge HY. 2010. Prevalence of myofascial trigger points in fibromyalgia: the overlap of two common problems. Curr Pain Headache Rep. 14(5):339-345. Now that we have objective evidence of the reality of myofascial trigger points, it is becoming more apparent that they contribute to many chronic regional and widespread pain conditions. “Active MTrPs as tonic peripheral nociceptive input contribute tremendously to the initiation and maintenance of central sensitization, to the impairment of descending inhibition, to the increased excitability of motor units, and to the induction of sympathetic hyperactivity observed in FM. The considerable overlap of MTrPs and FM in pain characteristics and pathophysiology suggests that FM pain is largely due to MTrPs.” Gerwin R. 2010. Myofascial pain syndrome: here we are; where must we go? J Musculoskel Pain. 18(4):329-347. “Miniature endplate potentials are thought to be the result of spontaneous release of acetylcholine from motor nerve potentials….It is now clear that motor endplates are more widely distributed throughout the muscle than just the endplate zone….A greater endplate activity and consequently greater focal muscle sarcomere compression can be thought of as being associated with greater local muscle injury and local release of nociceptive substances.” “It is likely that TrPs are first formed as latent TrPs and then become tender as muscle is activated. Latent TrPs exist without spontaneous pain. Furthermore, TrP tenderness does not occur except in regions of muscle hardness, but regions of muscle hardness occur without local or referred pain. Hence, muscle hardness or the taut band that occurs in the absence of pain may be the first abnormality, and the active TrP is a more activated TrP.” Giamberardino MA, Affaitati G, Fabrizio A et al. 2011. Myofascial pain syndromes and their evaluation. Best Pract Res Clin Rheumatol. 25(2):185-198. “This article reviews the available published knowledge about the diagnosis, pathophysiology and treatment of myofascial pain syndromes from trigger points. Furthermore, epidemiologic data and clinical characteristics of these syndromes are described, including a detailed account of sensory changes that occur at both painful and nonpainful sites and their utility for diagnosis and differential diagnosis; the identification/diagnostic criteria available so far are critically reviewed. The key role played by myofascial trigger points as activating factors of pain symptoms in other algogenic conditions – headache, fibromyalgia and visceral disease – is also addressed. Current hypotheses on the pathophysiology of myofascial pain syndromes are presented, including mechanisms of formation and persistence of primary and secondary trigger points as well as mechanisms beyond referred pain and hyperalgesia… Read more »

John Quintner

@ Drs Rodrigues and Starlanyl. Thank you for your responses which, in my opinion, are characterized by similar pseudo-scientific theory. I am really appalled that this speculative nonsense is being promulgated by licensed medical practitioners. My main concern is that innocent muscles are being subjected to an endless barrage of steel needles under the guise of legitimate medical treatment. If by some accident of fate such treatment that you administer happens to be effective, then you are both obliged to publish your results for critical analysis. I don’t mind in the least if you engage in such tactics as “argument ad hominem” or “shoot the messenger” but as Carl Sagan observed, extraordinary claims require extraordinary evidence. So far, all you have produced is “noise” and it is extremely painful noise at that!

Ghee, I had no idea I would be rescued by the renowned Devin J. Starlanyl, M.D.
We have to talk, there is a few clues to linking Travell, Simons, Gunn, Rachlin, Hackett and Acupuncture. If you add or overlay all the protocols together you can began the therapy to reverse the damage from any complex chronic pain syndrome.

There a many naysayers in the way of effect pain relief therapy. They want to find a magic pill solution. They don’t want to see that there are real solutions to complex pain issues. and I wonder if it’s because of ignorance, malfeasance or just plain evil. One in particular associated with Face pain Network who discounts MFR therapy which I thinks is a travesty. Allowing face pain patients to suffer in misery is a sin.

@John, I know hardcore scientist discount word of mouth testimony, but if you like I can collect a few videos of some cases for you to see. But you will have to take off your double-blind blindfold to SEE them. I can email you the links.

John Quintner

Devin, sadly your missionary zeal is no substitute for good science. Where is your evidence to support the nonsensical claim that ‘trigger points are the driving force behind osteoarthritis and fibromyalgia and the CAUSE of so many of the symptoms that are often attributed to fibromyalgia or called “somatoform” or “functional”?

Stephen, I have concluded that yours is entirely a lost cause.

Good for you, Stephen. The reality is that trigger points are the driving force behind osteoarthritis and fibromyalgia and the CAUSE of so many of the symptoms that are often attributed to fibromyalgia or called “somatoform” or “functional.” They are very real and have been imaged by the National Institutes of Health and the Mayo Clinic. Doubters and skeptics can look on my website http://www.sovernet/~devstar on the care providers” side, “References for Research” section, for annotated research, for tons of documentation. But they’d rather scoff, because they are financially and academically invested in denying TrPs because they have no idea how to deal with them. Their patients suffer the consequences. I congratulate you for your wisdom, and your patients for choosing you as a doctor. Patients will eventually be able to vote with their feet, as they flock to those who can diagnose and treat myofascial trigger points. It is sad that right now they spend so much money paying physicians who can do neither and yet still take money to treat pain and other symptoms that could otherwise be managed.

Let me clarify …
Myofascial tissue release therapy is an ongoing “Therapy” (weeks, months or years) until healing is completed.

MFR therapy is water, so water can put the fire out! That is a good analogy, because if you put a little water on a fire it will cause a lot of steam and more heat … ouch. MFR therapy is not harmful but will add stress to the flesh and may aggravate the pain. This is a necessary evil. In the beginning of a complex case, I will flood the flames with lots of water (needles and TPIs) to smother the fire then you will be able to see where the hottest parts are located. Then you flood these coals and can find any embers that may be lingering in other parts of the body.

MFR Therapy come in two categories.
1. Using leverage and Hands-on therapy; from stretching, foam rolling, Swimming, Aqua-Therapy and Hot-tub Spa, yoga, Pilates, hands-on manipulations, to Chiropractic adjustments. Get help from a professional massage and/or find a John F. Barnes therapist.
2. Invasive with needles; from traditional Chinese Acupuncture, dry needling which can be also called IntraMuscular Stimulation (C. Chan Gunn), then on to Travell trigger point injections.

All wellness programs require sleep and prepping from magnesium. I suggest Epsoms salts soaking. Oral magnesium (I like Glycinated forms)

Who pays for these services? My answer, the insurance company is suppose to pay. The insurance industry figured out how to tweak the wording of the contracts so they benefit and can deny. Most times there is a way around the blocked coverage. Ask your employer, WC adjusters or your Primary Care doctor apply for approvals.

From 97-2004, I was on a mission to twist the arms of the insurance industry to cover Acupuncture. They won, these days employers with the suggestion form employees are adding the benefit into contracts. (Billing and prior authorizations can be an additional topic).

John Quintner

Dr Rodrigues, may I remind you that you are the one who is making these extraordinary claims for a therapy that lacks both a scientific rationale and an established evidence base.

As Mark Twain observed: It is easier to fool people than to convince them that they have been fooled. It appears to me that you might have fooled yourself.

Dennis Kinch

It seems a lot of healing techniques and medicines can be easily touted as “the best thing to come along to heal pain since novocaine”, and just as easily debunked as pure faith and placebo and everything in between. What everyone seems to always miss is the patient and their unique personal chemistry and external factors affecting everything they do to get some relief from pain. I know for a fact that breakthru pain for me is like being on fire and I am only looking for water. What we have here with MRT therapy, is more water. It may have the effect of lessening the flames at the onset of chronic pain and would at least be a cool spray on the burning effect of pain. The question is, “Does it do any harm?” There are other questions after this, such as; “Is it affordable? or How effective will it be for this patient?” All I can think when I read these treatises is “Will it harm me?, and, Where can I get it done affordably?” So please come off your pedestal, and please don’t de-bunk this if it’s actually helping chronic pain. Let’s just add it to another “Weapon of Healing” that will help some people and leave it at that. If it does no harm, shouldn’t all doctors present it as a possibility for relief? Is it covered by insurance? It just goes to show at any rate that the Pain Cycle is a complex animal and our job as healer is to tame the monster, any way we can, as soon as possible, at least for the 20 million standing at the beginning of this wretched Cycle.

@notsonutso, your case is an example of the confusion and narrow views in medicine. You have a treatable complex pain syndrome that has been compounded with narcotic pain meds. The pain meds allow the sick flesh to seed and grow, plus the withdrawal if you miss a pill. You are trapped without myofasical release therapy. It is the only way to began the healing and improve your quality of life. If the moderator will allow, I will put some links to pages so you can read, educate yourself and begin today clawing yourself out of the hole. It is possible … don’t give up hope!

Researchers want to study an idea or thought in an attempt to find what is really true/truth. This is more of a philosophical observation, but what is true may not be the truth. And we could spend the rest of our lives debating what is true/truth.

I have read hundreds, if not thousands of research, trials, studies etc. What these studies want to accomplish is to find the truth. What I look for is rock solid data and the only way for me to find it in clinical practice is to ask the patient.

This is an example of true/truth:
A patient has had 5 back surgeries in 5 years and is still in pain @ 5-7 levels and is miserable. His medical bills run into the hundreds of thousands!! (He has never had Travell’s MF protocols, dry needling or acupuncture.)

I treat him in the office as per Travells, Gunn and Rachlin protocols, approx 45 min visit, he gets off the exam table and notices his pain level is down to 3-4, with better range of motion. His statement is “Wow that feels better, I can touch my knees, I can walk standing up straight” and
“Why none of my other doctors suggested this therapy? This is the best I have felt in years”

That is an example of Truth! Over the past 15yrs, these cases has convinced me that MFR is the best tool in medicine. Placebo? Doubtful. Not unless you believe the patient is lying.

Myofascial Release Therapy is not what I thought!


I have terrible pain from abdominal neuralgia. I also have upper & lower back pain & pain from very large (fleshy) lipomas on both outer thights. Last but not least I suffer severe leg pain. If I did not have my pain meds (150 percocet 10/650 & fentanyl 25 mcg) I would be dead. I’m serious. Even now, I am in pain much of the time. I live in fear of my doctor retiring & being without pain relief. I am a Medicaid patient & cannot afford the “fancy” alternative treatments like yoga & acapuncture. I’ve been “awarded” the diagnosis of FM. I was in denial for years, surely it was something more than that. I almost wish I had a life-threatening condition like cancer. Then at least there would be an end in sight-recovery or death.

John Quintner

Dear Dr Rodrigues, I look forward to reading your publication, preferably in one of the peer-reviewed medical journals. But you do need to bear in mind that Drs Travell & Simons made some fundamental errors of epistemology and logical reasoning in their influential book – The Trigger Point Manual. These are clearly delineated in our 1994 paper.

Does any of this matter? Well it does to those who are being asked to pay for treatment (Myofascial TrP/release) that has been shown not to work!

The placebo effect, natural history of the condition, regression to the mean, expectation bias, and confirmation bias, are some of the confounders that need to be factored into this equation.

Travell Debunked?? In my opinion, Travell’s protocols are the most powerful in medicine. She gives explicit descriptions in every aspect of care. I was actually obliged by many patient to go into more detailed examination and therapy because they felt better immediately. Finding the key TPs can be a challenge but once “deactivated” the patient knows and feels relief. I have to admit without the fine filament stainless steel acupuncture needle, Myofascial/TP therapy would be a little more hairy.

Double blinded studies, pages of data, gigabytes of microscopic images are moot to me when you see the face and happy tears of a patients who has less pain and hope for a more normal life.

The didactic and research are important but patients are miserable and need help now! If you like I can try to piece together all the ideas as per the authors below.

Here are my authors:
IMS as per C. Chan Gunn, MD.
Trigger Point Injections using the techniques of Janet G, Travell, MD, David Simmons, MD and Edward Rachlin, MD.
Ligament and tendon relaxation techniques of George Stuart Hackett, MD.
CraigPENS as per the world renowned William F Craig, M.D.
Myofascial Release by Gokavi, Cynthia N. Gokavi, MBBS.
Advanced Soft Tissue Techniques as per Leon Chaitow, ND, DO
Medical Acupuncture as per French Energetic protocols of Joseph Helms, MD.

John Quintner

Dear Dr Rodrigues. I beg to disagree with you. The scientific evidence to support your claim that “myofascial trigger points” are zones of primary hyperalgesia (i.e. “breakdown in muscle fibers”) is unconvincing, to say the least.

Furthermore, systematic reviews of “trigger point” therapy (i.e. acupuncture, dry needling and massage) do NOT support the efficacy claimed for these treatment modalities. This is not surprising, given that “myofascial release therapy” is based upon the application of flawed logic to a clinical problem.

In fact, the construct that was promulgated by the late Drs Travell and Simons in mid-20th century has been effectively debunked. [see: Quintner JL, Cohen ML. Referred pain of peripheral neural origin: an alternative to the “Myofascial Pain” construct. Clin J Pain 1994; 10: 243-251.]

Particularly dangerous, to my way of thinking, is the speculative theory that nociceptive input from “myofascial trigger points” is responsible for the widespread pain characteristic of Fibromyalgia Syndrome. This idea, for which there is no evidence, may spawn yet more ineffective treatment for patients who have been awarded the FM label.