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Soma & Trigger Points June 21,
2000 Dr. Lowe: The best I can do is make an educated guess. In 1995, Tavares and Branco[1] reported a finding that may explain the difference between your and your sister’s reaction to Soma. These researchers found a positive correlation between the number of tender points female patients had (by the ACR method) and the feeling of muscle tension when they were going to sleep. That is, the more tender points a patient had, the more tension she felt when going to sleep. When your muscles are tense, they send excess impulses through nerves into your spinal cord and brain. Also, your tense muscles may compress some tender points. They may also stretch the tissues that house other tender points. In either case, your muscle tension may irritate your tender points. If so, your irritated tender points send excess nerve impulses into your spinal cord and brain. After the excess nerve impulses from irritated tender points enter your spinal cord, they travel through nerve pathways up to your brain stem (at the base of your brain). Excess nerve impulses reaching your brain stem can disturb your sleep. The impulses disturb your sleep because they overstimulate a nerve network called the "reticular activating system." Overstimulating this network activates your entire brain. The brain activation makes you too alert to sleep. In view of this possible connection between tense muscles, tender points, and the brain stem, it’s possible that Soma has several beneficial effects for you. The medication may (1) relax your muscles, (2) reduce the nerve impulses reaching your spinal cord and brain, (3) relieve overstimulation of your reticular activating (alertness) system, (4) and slow your brain activity enough for you to sleep. In quite another way, Soma may have increased your sister’s pain and disturbed her sleep. You wrote that when she took Soma, she had pain on the right side of her neck during the night. We consider pain on only one side of the neck "regional"—that is, the pain is limited to a particular region of the body. Regional pain is different from fibromyalgic pain, which is widespread. Many fibromyalgia patients have both regional and widespread pain, but the two types of pain may have different causes. Trigger points (highly irritable spots) in muscles are the most common cause of regional pain. It’s possible that your sister has one or more trigger points in a muscle, and that the points are usually "latent" (don’t refer pain). But when the trigger point is irritated, it may refer pain to the right side of her neck. Odd as it may sound, her use of Soma (a muscle relaxing drug) may have led to irritation of her trigger point. Travell and Simons (authors of the famous Trigger Point Manual) explain how this may happen.[2] They wrote that muscle relaxing drugs may contribute to referred pain from trigger points. The drugs may contribute by relaxing muscles that have been "protectively" contracted. The protective contractions may essentially "wall off" the part of a muscle that contains a trigger point. The walled-off part of the muscle keeps the trigger point from being irritated by muscle contractions, stretching of the muscle, or pressure into it. When a patient takes a muscle relaxing drug, such as Soma, the drug may reduce or stop the protective muscle contractions. The previously "walled-off" trigger point then becomes exposed. When exposed, the trigger point may become irritated. For example, a particular sleeping position may cause pressure on the trigger point. The pressure may irritate the point and cause it to refer pain. Also, occasional muscle contractions during the night may squeeze the exposed trigger point and cause it to refer pain. Hence, it’s possible that your sister stopped protective contractions by using Soma. Then, the exposed trigger points became irritated and referred pain to her neck. Once a trigger point is irritated during the night, it may continue referring pain until the person wakes up and does something to stop the pain. For example, the person may wake up and rub and stretch the muscle that contains the trigger point. Or she may take pain medication and drink coffee, which may take the edge off the pain. Regardless, she’s now awake! As I said, this explanation is only an educated guise. In case I’m right, however, I suggest that your sister consult a practitioner skilled at trigger point therapy. Some medical, chiropractic, and osteopathic physicians are skilled at this therapy, as are many massage therapists and physical therapists. However, if a trigger point myotherapist is available where your sister lives, she can be confident that she’ll get the best care available by consulting him or her. She should try to find a trigger point myotherapist with MTPT behind his or her name. These letters stand for "Myofascial Trigger Point Therapist." If she can’t find one in her area, I suggest that she ask for a referral from Richard Finn, MTPM. She can contact him through the Academy for Myofascial Trigger Point Therapy. When a practitioner properly treats trigger points, they quickly cease to be a problem. Trigger points in fibromyalgia patients may be tougher to get under control. But a practitioner who is expert at trigger point therapy may give even fibromyalgia patients dramatic relief from regional pain. References |
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