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Doctors' Answers to "Frequently Asked Questions" - Myofascial Pain Syndrome

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Myofascial Pain Syndrome [posted 1/6/99]
Question:  I have been seeing my primary care doctor for over a year now trying to determine why I am getting daily headaches and extreme neck pain. Over the last year I have been on Trazadon, Flexeril, Relafen, Paxil and Pamelor. I have tried three months of chiropractic care, which was great, but did not alleviate the pain. I also suffer from migraines on a monthly basis during my cycle. I have tried Immitrex and Zomig, but unfortunately, I usually still end up in the urgent care to get a shot of toredol and phenergen. I just recently I had a MRI and the only thing that showed up as in my previous CAT scan was chronic sinusitis. I have had three sinus surgeries over the last six years, with the most recent one being 3 years ago. So my primary care physician sent me to an ENT specialist. The ENT suggested that I may have Chronic Myofascial Pain Syndrome. I have now started taking neurontin 300 mg, 200 mg at night and 100 mg in the morning. I am now also in physical therapy, 2 times a week for four weeks. I have been taking vicodin and ultram for the pain, sometimes up to 6 a day, depending on the intensity of the pain on any given day. My primary doctor is concerned about this usage. I feel like she doesn't believe that I have this kind of pain on a daily basis and is questioning me. I also am question her as to why it took an ENT to diagnose me with myofascial pain syndrome. I have done a lot of reading on the internet on myofascial pain and it appears to me that this is a life long problem that I may never be able to get rid of. Is this true? What are your reactions to the pain medication usage and the neurontin? I feel like the therapy maybe helping, but the pain is still here and what happens when the physical therapy sessions are no longer covered (maximum of 30 per year)? I now have a small understanding of MPS, and I have changed a few things. I sleep with a rolled up towel behind my neck, I no longer read in bed, I use mostly heat at work two to three times a day, and ice at home. I am doing my neck exercises as instructed every four hours, and I am really making a conscious effort to work on my posture. I have also requested an ergonomic specialist to come out to look at my workstation. Since I started taking the neurontin, I have noticed I haven't waken up with as many headaches, but by mid day, the pain is here. I am open to any other suggestions anyone has to offer.

Answer: I'd see a pain specialist and see if they concur in the diagnosis. myofascial pain syndromes are characterized by several areas the size of a dime that is very painful to palpation. Sometimes, injections or acupuncture will be helpful. Sounds like you need a diagnosis to start with, maybe myofascial Pain, but see if you have these trigger points.

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