Bottleneck

On a scale of one to 10, my pain, which originated in the region of my left scapula, was at five. Self-medicating intermittently with paracetamol, which provided temporary relief, I went on with my daily activities until the pain became so excruciating that I couldn’t think clearly. A trip to the neighboring employees’ clinic yielded a prescription for a muscle relaxant, a transdermal patch and stern advice to seek consultation with a rehabilitation specialist. Brandishing my prescription to my colleagues, one suggested that it would only take a single massage session to solve the problem, while another spoke about the wonders of muscle relaxants. Over the next two weeks, true to the nature of physicians being poor patients themselves, my adherence to the prescription was on a “PRN basis,” meaning I took it only when I felt I needed it. Compliance was so poor mainly because I was still functional and able to meet the demands of my job. But that nagging, almost daily pain was bothersome. A mentor, noticing the pinched look on my face, pushed me to have an appointment with the rehabilitation specialist. By that time, I was also having pain in my neck and shoulder, together with numbness in my fingers.

“You have myofascial pain syndrome.” That was the doctor’s working impression after taking my history and doing a series of maneuvers that elicited pain. A little nervous about how this consult would turn out, I asked her if it was serious. She looked at me squarely and said, “Let’s see how we will proceed after six occupational therapy sessions.” She wrote out the prescription and requested a neck and shoulder X-ray. This time, I took the medications religiously and bought the patches that were prescribed. While the latter did give some soothing relief, I was so conscious of its smell, which made me feel ancient. Definitely, in circumstances such as these, the promise of a cure overrides any form of vanity, so I had to tell myself to deal with it.

On the first day of my session, my teacher and therapist walked me through what was to be expected. The series of exercises brought not only pain relief but a sense of calm. While the intensity has remarkably diminished, to the point of having pain-free days, the experience has brought about so many learning points. The number one lesson: follow doctor’s orders.

Myofascial pain syndrome is defined as a recurrent or chronic musculoskeletal condition that manifests as localized or referred pain, associated with hyperirritable trigger points within taut bands of skeletal muscle. The exact cause and pathogenesis, along with the lack of diagnostic criteria, not only bring about overlap or even confusion with other musculoskeletal pain disorders but also contribute to the lack of standardized management. Perusing current literature identified risk factors include muscle overuse brought on by manual labor, poor posture from prolonged periods of driving or being in front of a computer or doing desk work, sports-related strain, trauma, or osteoarthritis. The presence of systemic conditions, such as vitamin deficiency disorders, particularly vitamin D deficiency, iron deficiency anemia, and hypothyroidism, have also been implicated. In addition, psychological and emotional stress, lack of proper sleep, and exercise can be causative factors. Management is directed toward pain relief and involves both pharmacologic and non-pharmacologic means.

I am on my fifth session, and the prognosis seems excellent. My therapist says that the taut bands of muscle she encountered when we started are no longer there, and I told her that the numbness had improved. Lying on my back, with pillows supporting my left shoulder and arm, has been of immense help—it prevents the pressure that comes from favoring my left side, which used to shift my weight and trap my arm in place. This is complemented by taking 20-minute breaks while working at the computer and performing targeted exercises. Her assessment: my pain is mostly brought on by poor posture.

Lastly, I am taking to heart the meaning of the Japanese idiom “ichigo ichie.” Last Thursday, after a scheduled meeting, I took the rest of the day off to spend time with two women I love: my mother and my aunt. We had a relaxing time people-watching in a provincial mall, sharing a meal, shopping for kitchen tools, and making plans to get together more regularly. On that particular afternoon, nothing else mattered, and that bonding moment will forever be a treasured memory.

May this sharing of experience be of help to those who might be in a similar situation. The causes of myofascial pain are multifactorial, and it pays to get a second opinion—even if you are a physician yourself. We should practice what we preach.

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timgim_67@yahoo.com