While there are many perpetuating factors for myofascial pain due to trigger points, we are going to focus on factors that go outside the normal blood profiles performed on most patients. All information here is considered current by the respective governing body of such information. All citation is included and links to more detailed information are included on the Links page.
Many times patients are told they are just “getting old” as a reason for their pain. In posting this information we hope to provide further reason for pain along with medical testing and treatments for those who suffer with myofascial pain. It is in our hopes that doctors will become aware of this information and investigate these factors in their myofascial pain patients.
Thyroid [TSH, FT3, FT4, Thyroid ABS]
Because myofascial pain patients tend to have other symptoms that are concomitant with their trigger points, such as lethargy, depression, and dry skin, it is important to consider a comprehensive thyroid panel as part of the medical screening. It is also important to realize what suboptimal TSH ranges are and how a person who is still within the normal reference range may still have a thyroid condition.
Medical professionals will look to a full thyroid profile to determine a thyroid disorder. Tests will include TSH, Free T3 and Free T4. Sometimes doctors will even consider screening for thyroid antibodies as well.
Also important in diagnosing a thyroid condition is to know how to read in between the lines, or the reference range, in this case. The average reference range used by laboratories in the US to determine a “normal” thyroid is 0.5 to 5.5. The AACE (American Academy of Clinical Endocrinologists) released a January 2003 statement that would narrow the reference range to 0.3 to 3.0 and also mentioned the upper end of the range may drop to 2.5 in coming years.1
What this means is that millions of Americans who are in the “questionable range” of 3.0 and 5.0 will potentially be diagnosed as hypothyroid. In the above AACE statement, practitioners are urged to consider treatment of clinical symptoms for the patients that fall into the 3.05 to 5.0 TSH range.
Risk Factors for Hypothyroidism
| • Family history of thyroid disease |
• Previous history of Graves’ Disease |
| • Previous thyroid monitoring | • Autoimmune disease |
| • Previous diagnosis of goiter OR current goiter | • Recent child birth |
| • Previously treated for hypothyroidism | • History of miscarriages |
| • Previous post-partum thyroiditis | • Thyroid surgery |
Symptoms of Hypothyroidism
| • Unable to lose weight with diet and / or exercise |
• Carpal tunnel syndrome |
| • Inappropriate weight gain |
• Infertility |
| • Cold hands/feet |
• Depression |
| • Feel colder than others | • Restlessness |
| • Low body temperature |
• Moodiness |
| • Lethargy, weakness, and exhaustion |
• Feelings of worthlessness and sadness |
| • Dry, brittle, and breaking hair |
• Distractibility |
| • Hair loss |
• Loss of interest in things that normally provide joy |
| • Dry, scaly, thick, and coarse skin |
• Impaired memory |
| • Puffiness in the eyes and face |
• Muscle pain |
| • Joint pain |
Other Symptoms (less frequent, but possible)
| • Lower libido |
| • Have infections that are more frequent and last longer, particularly in the respiratory tract and sinuses |
| • Snoring |
| • Sleep apnea |
| • Shortness of breath and chest tightness |
| • Dry eyes |
| • Sensitivity to light |
| • Motor symptoms of the eye, such as jumpiness and tics that cause dizziness, vertigo, and headaches |
| • Strange sensations in the neck/throat |
| • Tinnitus (ear ringing) |
| • Lightheadedness |
| • Severe menstrual cramps |
Vitamin D [25(OH) Vitamin D]
One of the new buzzes in prevention is the idea that Vitamin D, which is actually not a vitamin at all but a secosteroid hormone, can prevent some major cancers such as colorectal, prostate, and breast as well as help with unexplained muscle and bone pain. Vitamin D is also essential in helping the body uptake calcium.
In a recent study, Gregory A. Plotnikoff, MD, of the University of Minnesota Medical School found a much higher incidence of vitamin D deficiency in those with unexplained muscle and bone pain than was expected – despite ages of the patients.2
Vitamin D is the generic term used to describe all substances that have the biological effects of cholecalciferol. Vitamin D2 is the supplement that is usually added to foods and some dietary supplements, but is only about 20% effective as vitamin D3.
Be sure to measure 25 hydroxy vitamin D and NOT 1,25(OH)2 Vitamin D. When a person is D deficient, the parathyroid hormone increases and drives the renal 1-alpha-hydroxylase, so that 1,25 (OH)2 vitamin D levels increase, making this test unreliable.3
The nomenclature for the blood test should look like one of the following:
- 25-hydroxyvitamin D
- 25-OH vitamin D
- 25(OH)D
Please visit this site for a plethora of information regarding Vitamin D, written by Stewart Leavitt, MA, PhD. His article has also been featured in Practical Pain Management.
Read Into the Ranges
The normal range for 25-hydroxyvitamin D is between 20-100 ng/ml (nanograms per milliliter). The OPTIMAL range, as agreed by most practitioners is 50-80 ng/ml, with symptoms being present below 32 ng/ml. Supplementation of vitamin D3 can take months to restore levels to a normal level and should be done while monitoring the serum level of the vitamin with blood testing. An upper limit of 10,000 IU of D3 per day has been proven safe for long term use. Consultation with a physician who is aware of the role of vitamin D and its involvement in muscle pain should be considered.
Symptoms of low vitamin D
| • Weak muscles |
• Muscle pain |
| • Muscle spasm due to low calcium levels |
• Hearing loss |
| • Pain in the legs |
• Weight gain/obesity |
| • Low back pain | • Aggravation of symptoms of inflammatory bowel disease |
Iron and Ferritin [Fe]
Patients low in iron are predisposed to many disorders due to the many factors iron is responsible for in the human body, including myofascial pain. Joint pain along with nocturnal calf cramps are other pain symptoms that are common with iron deficiency.4 Anemia is actually the last stage of iron deficiency. Look to the list of symptoms which can lead up to anemia below.
Testing
It is important to not only test for iron, but ferritin as well. Ferritin is the binding protein to iron, and can give an indication to the overall iron levels in the body. Low iron may also indicate a potential thyroid deficiency due to low hydrochloric acid levels (hydrochloric acid is needed to uptake iron) in hypothyroid patients. Remember that a patient need not be anemic to be considered for low iron.
Symptoms of Low Iron
| • Depression |
| • Fatigue |
| • Listlessness, weakness, decreased work productivity |
| • Impaired learning and cognitive function |
| • ADD and ADHD type behavioral disturbances |
| • Developmental delay in infants and young children |
| • Poor memory |
| • Decreased attention span and increased distractibility |
| • Impaired reactivity and coordination |
| • Irritability |
| • Dizziness |
| • Appetite loss |
| • Cravings for non food such as ice, dirt or clay |
| • Constipation |
| • Difficulty swallowing |
| • Joint soreness |
| • Night time leg cramps |
| • Asthma |
| • Sores on skin, or itching |
| • Poor wound healing |
| • Can cause excessive menstrual bleeding |
| • Hair loss (very frequently overlooked cause) |
| • Headaches |
| • Sore or burning tongue |
| • Soreness in corners of the mouth |
| • Brittle, flat, or spoon shaped nails |
| • Longitudinal ridges on nails |
| • Heart palpitations on exertion |
| • Shortness of breath |
| • Cold extremities, with decreased resistance to cold and poor regulation of body temperature |
| • Tendency to recurrent infections |
| • Chronic bladder infections |
| • Anemia (hypo chromic, microcytic) paleness, weakness, drowsiness, fatigue |
| • Numbness & tingling |
| • Night sweats |
| • Fragile bones |
| • Growth impairment in children |
| • Eye soreness |
| • Vague gastrointestinal symptoms: belching, gas, nausea |
| • Vitiligo (light blotches on the skin) |
| • Swelling in the ankles |
| • Bluish tint to the whites of the eyes |
| • Visual disturbances |
| • Papilledema (swelling inside the eye) |
| • Enhanced heavy metal absorption and risk for toxicity. |
Vitamin B12
B12 deficiency is usually indicative of other disorders, primarily those that inhibit or otherwise retard the absorption of the vitamin. Since B12 is an important factor in the production of red blood cells, a condition called pernicious anemia can develop.
Symptoms of B12 Deficiency
| • Fatigue | • Weakness |
| • Nausea | • Constipation |
| • Flatulance (gas) | • Loss of appetite |
| • Numbness and tingling in the hands and feet | • Anxiety |
| • Insomnia | • Restlessness |
| • Night terrors | • Insufficient equilibrium |
| • Forgetfulness | • Cognitive decline |
Severe Deficiency
| • Burning of the tongue | • Fatigue |
| • Weakness | • Loss of appetite |
| • Intermittent constipation and diarrhea | • Abdominal pain |
| • Weight loss | • Menstrual symptoms |
Footnotes:
1. Shoman, M. TSH Reference Range Wars: What’s “Normal”?, Who is Wrong, Who is Right…And What Does It All Mean For You and Your Health? About.com. 2006.
http://thyroid.about.com/od/gettestedanddiagnosed/a/tshtestwars.htm.
Accessed January 31, 2009.
2. Boyles, S. Lack of Vitamin D Linked to Pain-Study Shows Limited Sun Exposure Has Health Benefits. WebMD.com. 2003.
http://www.webmd.com/pain-management/news/20031210/lack-of-vitamin-d-linked-to-pain.
Accessed January 31, 2009.
3. Vitamin D. University of Washington. 2008.
http://courses.washington.edu/bonephys/opvitD.html.
Accessed January 31, 2009 Slagle, P. Iron Deficiency / Iron Excess / Hemochromotosis.
4. The Way Up Newsletter. 2004.
http://www.thewayup.com/newsletters/081504.htm.
Accessed February 1, 2009.