Copyright 2002, E. Franklin Livingstone, M.D.

Chronic muscular pain is a complicated disease, which represents the cumulative effects of healing and deteriorative processes at the muscular level. This muscular disease process is the most common cause of chronic back and neck pain and may result from muscular injury, muscular overuse, and other determinants. Once started, this process is cyclical and tends to be perpetuated easily. To understand and treat chronic muscular pain, a comprehensive approach is necessary. As you will see, there are many forces which may promote muscular deterioration. If any of these detrimental factor's persist, it will tend to advance the disease process. The purpose of this article is to develop the idea of cyclical muscular deterioration as a primary component of the fibromyalgia and myofascial pain syndromes.

This cycle of deteriorative forces is almost self-perpetuating except that healing processes are occurring also. Healing is relentlessly slow, however, when compared to the potential speed and diversity of deteriorative processes. With this in mind, the treatment approach becomes obvious; increase the healing forces while decreasing the deteriorative forces.
There are many factors which contribute to deterioration of muscle. The effect of any of these deteriorative factors may be inconsequential except for its' addition to the effects of all other deteriorative processes. These factors include: direct muscular injury, damage caused by the inflammatory process, effects of muscular tension and spasm, and the effects of decreased blood flow. There are other deteriorative factors not well defined yet, including he multiple detrimental effects of sleep deprivation, and psychological or emotional stress and tension processes. These various deteriorative processes are not only additive, but feed back upon one another causing further disease progression and restraint of healing.

Muscular damage by injury or reinjury, or by overuse injury causes significant deterioration of the muscle and remains one of the most important perpetuating factors in muscular pain. Muscle that undergoes deterioration is unhealthy and is easily damaged further. This is the main reason for low tolerance to activity or exercise.

Inflammation, while a major aspect of the healing process, is a two-edged sword, causing its' own deteriorative effects as it tries to cause repair and healing. It is because inflammation is not totally specific, and does cause tissue damage, that it is part of the cycle of muscular deterioration.

One very important result of chronic inflammation is fibrosis, or scarring in the affected muscles. This microscopic scarring is not well tolerated in muscle tissue. Besides scarring there may be accumulation of other substances that act like "glue" to affect muscular function. These changes result in reduced efficiency of the muscle, and contribute to the weakness, poor endurance, and easy fatigability that are present.

Muscular spasm and muscular tension have similarities in their deteriorative effects on involved muscle. When muscle tissue is damaged or deteriorated, it has a difficult time getting enough oxygen and nutrients from the blood that is circulating through it. Increased muscle activity due to spasm or muscular tension causes a proportionately increased demand for oxygen and nutrients and also for the removal of waste products of metabolism. This increased metabolic demand only aggravates the balance further and causes additional deteriorative effects on the muscle.

Many deteriorative processes relate in one way or another to blood flow. Blood is the only source of oxygen and nutrients for muscle cells. Blood provides the vehicle for removal of accumulated metabolic end-products and waste materials. With optimal blood flow, there is adequate oxygen and nutrient delivery while washout of waste is rapid and accumulation does not occur. There may be multiple aspects of blood flow control that play a part in deterioration of muscle tissue.

Anything that causes significant changes in blood flow causes proportional changes in metabolic efficiency. This can have significant effect on the extent and success of healing, which is dependent upon and proportional to the amount of blood flow.
In developing a rational approach to the treatment of chronic muscular pain, the relationship of blood flow to healing is an important consideration. We must do whatever we can to optimize blood flow and to eliminate those factors which tend to reduce it. Many of these factors will cause deterioration in part by reduction of blood flow and its' healing effects.

Understanding the cyclical nature of the chronic muscular pain syndromes, and identification of deteriorative factors is vital to the development of control and then resolution of this complicated disease process. If you suffer from this problem, and you want to gain control, you will have to study this information until it "lives in your mind." There is no replacement for proper depth and scope of knowledge and understanding. Your success will reflect proportionately, your determined efforts at understanding every detail of your chronic muscular pain, its' effects on you and your effects on it.


I. EDUCATION: You must learn as much as you can about all the many aspects of your problems. This information is an good starting point, but don't feel confined, explore, use your libraries and bookstores. The investment of time and effort that you make in your education will pay dividends. Without adequate knowledge, your likelihood of success is not high.

II. PREVENT THE CYCLE OF DETERIORATION: Your muscles will not heal completely unless you do this. You must learn what it is about you, your behavior, your activities, and your emotional and psychological status that gives you the tendency for this problem. Your muscles would have healed themselves long ago if it were not for these "cyclogens." If you make a mistake and aggravate yourself, treat the aggravation and learn from the mistake so that you never make it again. Mind yourself in all activities, put your brain in gear, before putting your body in motion. Identify and eliminate all "cyclogens." Become more aware of tension in your muscles and of factors or situations that tend to cause tension. If inner psychological or emotional difficulties are feeding into our problem, deal with them. Do some soul searching and introspection to get a handle on these issues, and seek professional help if necessary, knowing that nobody but you can really change your attitudes and beliefs. You cannot ignore any "cyclogens" and expect to resolve muscular problems as they will prevent complete healing.

III: FACILITATE HEALING: There are four aspects to pursue and all of these cause decreased muscle tension and increased blood flow.

A. COLD THERAPY: Use your cold packs frequently and on a time schedule. Use your cold packs when needed for exacerbations, such as with overdoing it. Use your cold packs for no less than 25 to 30 minutes when you do use them.

B. STRETCHING PROGRAM: Develop a regular stretching program and perform it frequently, but for short duration. Do stretching before and after exercise, immediately after getting up from sitting or lying, immediately after using your cold packs, and about every ten minutes during the day. You will have to work at developing good habits, bad habits seem easy enough to develop.

C. EXERCISE PROGRAM: Your exercise program, in the long run, may be the most important aspect of your program. Until muscle healing occurs, however, your must approach it with caution so that it does not aggravate your condition.

You have upper and lower limits of tolerance, and stretching these limits will work against you, causing the cycle of muscular deterioration to continue. At first, start your exercise sessions of three to ten minutes about every 30 to 40 minutes or so. Gradually progress the duration and intensity of your sessions, and as you do, you may gradually decrease the frequency. Remember, more frequent, low intensity exercise is better tolerated and better for you than trying to push too

D. ACTIVITY PROGRAM: Any activity you do, physical or mental, that is not injurious to you in any way and that does not aggravate your muscular condition, probably has at least some therapeutic value.

Keeping your mind and body focused on activity has important effects on control of discomfort and on your general well being. You must not allow daily activities to cause recurrent aggravation. Structure is very beneficial. If you are not currently working at a regular, full-time job, you should start structuring your day around your rehabilitation program and your activities. Volunteer at a local hospital or senior citizen center. Get out of the house on a regular basis, don't let the television control the structure of your day. Find new hobbies, things you can enjoy and find self-satisfaction in. Don't just let the world go by, or it will, leaving you behind.

E. MEDICATIONS: Take an anti-inflammatory medication or acetaminophen on a time schedule.

F: TREAT EXACERBATIONS IMMEDIATELY AND EFFECTIVELY: If you make a mistake and have an aggravation, even if you don't think it was your fault, start treatment immediately, then think about it. Use cold pack therapy, short rest/relaxation, and a gradual return to stretching, exercise and activity. Learn from your mistakes, but don't delay treatment.

IV. OTHER: Your must accept the fact that you have chronic pain and do the best you can with it. Start setting goals for yourself, in terms of your rehabilitation program, work, recreation, social activities and hobby or avocational interests. If your pain is getting to you, get angry at it to blow off your frustration and get back to your program. Your ultimate goal should be to get into the best physical condition that is possible and stay that way. Optimize your relaxation response
by practicing relaxing several times each and every day.

Instruct your family and close friends to reinforce only well behavior. They should pat you on the back for acting normally, not fuss over you because you are having discomfort or acting
sick and disabled. Make a partnership with your doctor, use but don't abuse him or her. Be motivated and determined to persist in your own rehabilitation. If you quit, no matter where along the path, then you lose. The biggest difference between the successes and the failures, is persistence and positive thinking.
If you follow the guidelines in this book you will be helping yourself. It is a great feeling to help yourself, a sense of accomplishment. It increases self-esteem and self-worth. There isn't anything in this book that you cannot understand and do
if you will persistently try. Now, go do it for yourself, you will be grateful to yourself for the rest of your more enjoyable life if you do.


Copyright 2002, E. Franklin Livingstone, M.D.

Permission is granted to use this information for personal use. Any other use requires expressed written permission from the author.