Question
I have had back pain since May 2005.  I can't narrow down the injury to a specific day or event, but I can narrow it down to a 2 week period.  I am in the USAF, and I was training for the Fitness test- lots of running, push-ups, and crunches.  When it happened, it felt like a pulled muscle, and I wasn't very worried about it.  The pain has never gone away, and has progressively gotten worse.  The pain starts in a small area between my spine & right scapula, and will spread 1)up to my rt shoulder joint 2)straight down to my lumbar and 3)along my side near my lower ribs.  

I initially saw a Physical Therapist for heat/ultrasound treatment, was give strengthening exercises, and prescribed Motrin.  The heat/ultrasound relieved pain temporarily.   

I passed my Fitness test, and decided I needed to rest, and stopped seeing the PT about the same time.  I spent about 6 months with no strenuous activity- when I resumed my workouts, the pain returned immediately.  So, back to the doctors...

A quick summary of what went next:
-TENS, helped when turned on, pain immediately returned
-Same PT regimen, no help.  the strength exercises knotted my muscles so badly I needed Lidocaine injections to relax the muscles.
-X-ray & MRI show no damage/injury
-Orthopedics says I'm straight
-Have been prescribed along the way Motrin, Flexoril, Feldane, Elavil, Neurontin, & Methocarbomaol, with varying combos & success on each.  I started on Effexor yesterday, I will be weaning off the Elavil, and continuing with the Methocarbomol.

My doc has given me a tentative diagnosis of Myofascial pain, which sounds to me like "I don't know, we can't find anything else so we're making up a name".  My pain has had a very negative impact on my military career, and on my personal life, I need to do something to "fix" it.  I have been seeing a counselor for depression issues (the anti-depression meds are for pain treatment though, not the depression).  I'm just waiting, and it's getting progressively worse.  

I'm obviously past the expertise of my local doctor- what sort of referral or specialist should I be asking for?  He wants to get me the care I need, but doesn't know where to go from here.

Answer
Hi, Erik.

Here's the bottom line:  muscular spasms that produce the type of symptoms you're describing are controlled from the brain level, the brain being the master-control center for the muscular system.  Spasms come either from overconditioning or injury, which train the brain to tighten and hold muscles contracted.

Neither drugs, TENS, nor manipulation can change that conditioning; it must be trained out.  The kind of training involved, called somatic training, is one that improves muscular control (at the brain level), not strengthening or stretching, but full-spectrum control over contraction and relaxation.

I've done articles on pain management that are relevant.  They exist at somatics.com/page4b.htm and they give options for relief.

Myofascial pain is a generic term for pain with its origin in soft-tissue, particularly, muscle.  In this case, it sounds like the contractions are along your spine into your neck and in your waist.

If you were my client, we would be doing sessions involving movements that use that musculature to bring them under your voluntary control (rather than involuntary, reflexive control, only).

Interestingly, I get a fair number of inquiries from people in the military.

with regard,
Lawrence Gold