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Myofascial Syndrome

Reducing Pain and Associated Depression

The supplement S-adenosylmethionine (SAMe) has been shown to be specifically effective as a therapy to reduce chronic pain and depression associated with fibromyalgia (Jacobsen 1991). SAMe is synthesized in the body from the amino acid methionine. The enzyme methionine S-adeno-syltransferase (MAT) catalyzes a reaction between methionine and adenosine triphosphate (ATP) to form SAMe. SAMe has been tested for depression caused by a variety of diseases, including Parkinson's disease, fibromyalgia, cancer, cardiovascular disease, and rheumatoid arthritis. Researchers have used SAMe successfully in conjunction with drug and alcohol withdrawal.

In a study, 44 fibromyalgia patients took 800 mg of SAMe for 6 weeks. Results showed that SAMe reduced pain at the tender points, as well as fatigue, morning stiffness, and resting pain (Jacobsen 1991).

Dietary Changes to Improve Symptoms

Patients with MFS are encouraged to employ proper basic nutrition and supplementation. Women with MFS have been found to have higher cholesterol levels than women without MFS, but no conclusive link has been made between blood lipid levels and MFS (Ozgocmen 2000). The following dietary recommendations will improve overall health:

  • Limit intake of stimulants (caffeine) and depressants (alcohol) due to their potential to disrupt neurological and metabolic function.
  • Limit intake of refined sugars to avoid fluctuation of blood sugar levels, mood swings, lowered energy, and lowered immunity.
  • Consume whole foods such as fruits and vegetables that contain phytochemicals and fiber. Fiber is helpful for maintaining digestive regularity. Eat slowly, chewing food well.
  • Increase intake of cold water fish that supply essential fatty acid building blocks (gamma linolenic acid, GLA; eicosapentaenoic acid, EPA) needed for cell membrane maintenance and function.
  • Increase intake of probiotic cultures from food or supplements. Probiotics are "healthy" bacteria that normally reside in the gastrointestinal tract. "Healthy" bacteria aid proper digestion of food and prevent absorption of ingested toxins.
  • Drink plenty of water (preferably purified) to ensure adequate fluid levels (Findley 2009).

Amino Acid Supplementation

Phenylalanine is one of the 20 essential amino acids that must be obtained from the diet. It is a necessary precursor for neurotransmitter biosynthesis and may be helpful in relieving chronic pain. The amino acid tyrosine is synthesized in the body from phenylalanine. It is a precursor to the biosynthesis of the neurotransmitters epinephrine, norepinephrine, and dopamine. Tyrosine has been used as an antidepressant because it positively affects the neurotransmitters required to prevent depression. Supplementing with these two amino acids may be beneficial to people with MFS. Vitamins B6 and C are cofactors in the bioconversion of these amino acids to their neurotransmitter receptors.

Exercise

With the help of a physical therapist or other health care professional, exercises can be designed that will avoid causing undue stress and pain to sensitive trigger points while improving physical fitness. In addition to promoting overall fitness, physical activity assists in maintaining flexibility, building muscle strength, and helping protect joints. Walking, bicycling, swimming, and some types of weight-bearing exercises are good examples of physical activity that may be appropriate. It is important to note that lack of exercise can lead to brittle bones as well as causing muscles to become smaller and weaker. In particular, people with MFS should avoid repetitive weight-bearing exercises involving affected area. Gentle stretching of muscle groups should be done daily to their full range of motion within the limits of pain.

Summary of Treatment Modalities

  • Trigger point therapy: myofascial release therapy, myotherapy, massotherapy spray, and stretch technique (stretching of the muscles with a vapocoolant spray, where a coolant is sprayed on the trigger point to lessen the pain, then the muscle is stretched). This is often done by a physical therapist.
  • Trigger point injections: local anesthetics (eg, lidocaine) are injected directly into trigger points. Trigger point injection has been shown to be one of the most effective treatment modalities to inactivate trigger points and provide prompt relief of symptoms (Alvarez 2002).
  • Dry needling: the use of a needle without injecting anything. TrP injections and dry needling mechanically disrupt the trigger point. The use of lidocaine is no more effective, but reduces soreness after injection.
  • For MFS, there is no role for injected steroids.
  • Acupuncture is recommended as a treatment option for patients with associated musculoskeletal conditions (Kam 2002).
  • The application of ice packs will numb the affected area, providing temporary relief.
  • Chiropractic or osteopathic manipulation treatment.
  • Physical therapy (hands-on).
  • Elimination of stress; biofeedback; counseling for depression that may result from chronic pain.
  • Follow good basic nutrition.
  • Buprenorphine is a mild narcotic that can safely relieve multiple symptoms of MFS. Contact a compounding pharmacy to make a sublingual preparation. Buprenorphine must be prescribed by a physician.
  • Consider regular exercise under the guidance of a healthcare professional to maintain cardiovascular and musculoskeletal fitness.