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Quadratus Lumborum.

Myofacial pain

Psychological issue

Psychological factors

Stress is the most important perpetuating factor. "Neuropeptides such as endorphins, are released during different emotional states. The neuropeptides bind to opiate receptors which have been found to be present on the surface of virtually every cell in the body, including the immune and endocrine system. High levels of endorphins promote well being and improve immunity." Ref: Healing and the Mind, B Moyers, Doubleday 1993.

Infections: These act as powerful perpetuating factors.. I ask the patients not to come in for injection therapy if they have an active upper respiratory tract infection or gastroenteritis.

Allergies: Both environmental and nutritional allergies can act as perpetuating factor. A good history is important to diagnose environmental factors. Elimination and challenge diet is the only reliable way to diagnose food intolerance.

Elimination Diet

Foods Allowed: Rice, Wholegrain or white. All fruit,Vegetables except uncooked tomato potato. Fish: Any fish, fresh / frozen cooked, tinned tuna, salmon, sardines prawns, lobster, crabs. Eggs,Any Herbs & Spices, Herbal Teas,Nuts- Except peanuts,Olive Oil for cooking Honey,Soy Milk- I recommend the brands Soy King or Australia's Own Malt free. Distilled Water

Foods Excluded: Dairy, Gluten- Grains, bread, cereals, pasta.Uncooked Tomato, cooked or tinned is OK.Potato.Meat-Including chicken,Tea & Coffee,Alcohol,Peanuts,Junk foods / Confectionery / Refined Sugar, Tap Water,Yeast.

Sleep disorders

Active myofascial trigger points produce sleep disturbance. Sleep disturbance increases trigger point activity and lowers general health. The problem will not resolve until the pain is removed. I prefer melatonin as an hypnotic. More aggressive pharmaceutical medications may be needed in some cases.

Age Dose of Melatonin

40-50 0.5 - 1mg

45-55 1 - 2 mg

55-65 2 - 2.5 mg

65-75 2.5 - 5 mg

75 plus 3.5 - 5 mg

Melatonin is a natural hormone that is produced by the pineal gland in the brain and is responsible for the sleep wake cycle. Under natural lighting conditions the pineal gland begins the production of melatonin when it becomes dark and when it becomes light the melatonin production ceases. Melatonin is produced by the pineal gland in large quantities during youth and this explains why teenagers can sleep for long periods of time. As we get older the production of melatonin decreases and it becomes more difficult to complete a full nights sleep without waking frequently in the second half of the night. People in their 60's and older often state that they only need 5 to 6 hours sleep per night. They need more sleep than this but are unable to get it because their melatonin levels are too low. It is possible to restore sleep to its natural youthful levels by taking a melatonin supplement. The dose for your age needs to be calculated. Once this has been done a prescription is written and this is then sent to a pharmacist in Sydney (details are listed below). The pharmacist will keep the prescription including the repeats and you can telephone for further supplies as needed. To get started taking melatonin you need to be advised of the correct dose for your age. Make contact with the pharmacist in Sydney and check the cost of the prescription plus freight. Make sure you sign and date the prescription and then mail it to the chemist in Sydney. There are considerable individual differences with regard to the tolerance for melatonin. If you find that the dose you are taking leaves you to sleepy in the first few hours of the following day then a lower dose may be required. If you are waking early in the morning with the dose you are prescribed it is quite safe to increase the dose in a trial and error basis to find the dose that suits you best. Any questions that you have can be directed to me at the clinic.

Richard Stenlake, Chemist, 169 Oxford Street, Bondi Junction, NSW. 2022 .Tel 02 9387 3205, fax 02 9389 3821

Dental perpetuating factors The medical practitioner's role is to physically treat the muscles of mastication using the procaine injection technique. The dentist's role is threefold. Occlusal adjustment, preferably with an electromyograph. Use of an occlusal splint where necessary. In my opinion splint therapy should not be the treatment of first choice and provided only for a short time while the muscles of mastication are injected. Removal of mercury amalgams. Mercury is a toxic substance. Mercury amalgams in a solution of saliva produce an electric current. This is even more prominent when a gold filling is also present. This electrical activity increases the sensitivity of the trigger points in the muscles of mastication.

On Monday almost every patient you see with pain will have myofascial trigger points.

Finding the clinical material is easy. What do you do with the jungle of information called perpetuating factors?

Myofascial Pain Syndromes:

Simple-Tend to begin treatment immediately and see what happens. Sports injuries.

Complex- Tend to examine perpetuating factors, first and prepare a good therapeutic environment before beginning physical therapy. Workers Compensation. Motor Vehicle Accidents. Migraines. Chronic Pain & illness.

Simple problems: Require 30 minutes , Inject/stretch/heat and home stretches. Most will fully recover within 1 to 3 sessions. If not it may be necessary to look for perpetuating factors.

Difficult problems: The first 5 minutes of the history tells the story. Mainly primary myofascial pain within a healthy person. Begin treatment immediately.

Myofascial pain with high probability of perpetuating factors- Careful history and examination looking for perpetuating factors.

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