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Pain referral
Trigger points
Cranial nerve
Spinal nerve
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If lasting relief of
myofascial pain syndrome is to be achieved, nutritional deficiencies must be
assessed. There are three stages to be considered: Vitamin inadequacy, vitamin
deficiency and vitamin dependence. To determine the amount of nutritional
deficiency, a serum vitamin level must be checked. If the individual has a low
serum level but within the normal range this would be considered a vitamin
inadequacy. A deficiency of vitamins
and/or minerals can directly or indirectly effect the function of nerves and/or
muscles aggravating a myofascial pain complaint by impairing the energy
metabolism needed for the contraction of muscles and by increasing irritability
of the nervous system. Chronic pain complaints with fatigue and
depression may result. Seldom does metabolic dysfunction affect just one system.
The symptomatology usually is gradual in onset and diffuse. Metabolic
change secondary to nutritional inadequacy is frequently easy to target. However,
when this metabolic change is secondary to a diseased state it can be quite
stealth like in quality. Just as the aging process can transform an inadequacy
into a deficiency, the practitioner will note a more rapid degenerative
dysfunction with the progression of a disease. Frequently the cardinal indicator
of this is the exacerbation of myofascial pain. However, many weeks may pass
before additional clinical indicators will appear. Only a few individuals
will be observed with vitamin dependence. This may require pharmaceutical or
mega doses of vitamins to compensate. Recommended levels and
daily requirements have the tendency to be somewhat controversial. Therefore, we
will refrain from stating specific values as they frequently vary significantly
from one authority to another.
Vitamin A (Retinol) Most Retinol is stored in the liver and is essential in the utilization of
protein in the body, for repair and maintenance of epithelial tissue, for new
cell growth and normal growth process. Retinol is needed for normal vision,
healthy skin, and protecting against infections of the linings of the digestive,
respiratory and urinary tract. It is being studied for its effectiveness as an
antioxidant against cancer and other diseases. Deficiency: The primary
reason for deficiency of Vitamin A is diet. While deficiency is rare in
developed countries, a secondary reason for deficiency can be malabsorption and
distribution due to diseases such as cystic fibrosis, celiac disease (typified
by fatty stools), pancreatic disease, and duodenal bypass, to name a few.
Certain drugs such as antibiotics, laxatives and cholesterol reducers may also
interfere with absorption. Deficiency can cause weak bones and teeth; dry, rough
skin, dryness of the eyes with inflammation , night blindness, susceptibility to
colds and infections, poor appetite; diarrhea, and in severe cases, corneal
damage that when untreated can lead to blindness or sometimes death.
Toxicity: Excessive
intake of Vitamin A over a prolonged period may cause hypervitaminosis A. These
symptoms include bone pain, headache, fatigue, and nausea, hepatomegaly,
splenomegaly, diarrhea, benign intracranial pressure, alopecia, rash, dry skin,
and hair. In pregnant women, birth defects are possible. Ceasing intake of
Vitamin A will diminish and resolve all symptoms without adverse conditions.
...consists of B1, B2, B6, pantothenic acid, niacin, folic acid and biotin,
described in detail below.
Vitamin B1 (Thiamine) This vitamin is
essential for the muscle tone of the heart, intestines and
stomach, as well as optimizing brain and nerve function and cognitive activity.
It is necessary for assisting in blood formation, circulation and proper
digestion. Vitamin B1 also acts as an antioxidant against the effects of alcohol
consumption, aging and smoking. Lack of this vitamin can cause Beriberi,
constipation, GI dysfunction, fatigue, agitation, memory loss, ataxia, shortness
of breath, paresthesia in hands and feet, generalized myalgia, hypoesthesia,
general weakness, severe weight loss, edema, hepatomegalia, anxiety, and muscle
atrophy. Deficiency: Frequently
observed causes of deficiency are directly related to lack of thiamine in diet;
secondary causes are increased need due to pregnancy, lactation, fever,
hyperthyroidism, impaired absorption or utilization, and alcoholism. Toxicity: There are no
known harmful effects of excessive intake of Thiamine.
Vitamin B2
(Riboflavin) This vitamin is
essential in the utilization of vitamin A as well as the other B vitamins.
Riboflavin assists numerous enzymes in the breakdown and absorption of
carbohydrates, fats, and proteins. Production of antibodies, hormones, red blood
cells, and oxygen being absorbed by tissue are also assisted by Riboflavin.
Deficiency: Causes of
deficiency are usually from an insufficient dairy intake, chronic diarrhea,
chronic alcoholism, liver disease, antipsychotic drugs, some antidepressants,
and oral contraceptives containing estrogen. Early signs of deficiency would
show as red blood cell enzyme reduction. Other signs could be paleness,
dermatitis, lesions, ariboflavinosis, amblyopia, and photophobia. Toxicity: There are no
known harmful effects of excessive Riboflavin in the diet.
This vitamin is
essential for the functioning of the nervous and digestive
systems, circulation, assisting numerous enzymes in the breakdown and absorption
of carbohydrates and fats, the manufacturing of sex hormones, and healthy skin
and lowering of cholesterol. According to some authorities it is believed to be
a memory enhancer and helpful in mental disorders. Deficiency: A diet low
in niacin or malabsorption diseases are the primary reasons for a deficiency.
Pellagra is the main symptom of deficiency, although, other vitamin deficiencies
can mimic the symptoms. Pellagra involves the central nervous system, skin
lesions, the digestive tract, and mucous membranes. The CNS symptoms range from
rigid extremities to disorientation, confusion, memory impairment, depression,
delirium, and paranoia. Differentiating the CNS symptoms from Niacin or Thiamine
deficiency is difficult. The skin lesions have varied appearances while the
digestive tract disorders include burning sensations of the throat and mouth,
abdominal pain and distention, nausea, vomiting and bloody diarrhea. Toxicity: Although most
experts agree that excessive niacin intake is not harmful, others believe that
when taken excessively for prolonged periods of time it may cause liver damage.
Vitamin B5 (Pantothenic
Acid) This vitamin like B2 & B3
is essential for assisting numerous enzymes in the breakdown and absorption of
carbohydrates and fats. Needed for normal growth and development, it is also
necessary for production of neurotransmitters and the functioning of the nervous
system and adrenal glands. It also helps in the manufacture of sex hormones &
corticosteroids. Pantothenic Acid is believed to help reduce stress, depression,
anxiety, enhance stamina and help prevent anemia. Deficiency: Usually
deficiency is rare. Most foods contain Pantothenic Acid. However, deficiency may
occur from serious illness, malabsorption disorders or severe alcoholism.
Symptoms of deficiency involve muscle cramps; tingling in the hands; numbness;
burning feet; fatigue; headaches; nausea; abdominal pain; respiratory infections
and peptic ulcer. Toxicity: There are no
known harmful effects of excessive intake of Pantothenic Acid. This vitamin is
required for the nervous system and is critical in lipid metabolism, aids in the
absorption of vitamin B12, and in immune dysfunction and antibody production.
Normal brain function depends on Pyridoxine as well as the formation of red
blood cells and the synthesis of nucleic acids. It aids in maintaining sodium
and potassium balance, activates many enzymes and acids, and some authors are of
the opinion that it plays a major role
in immunity to cancer and prevention of arteriosclerosis. It also inhibits homocysteine, which allows the deposition of cholesterol by attacking the heart
muscle. Pyridoxine reduces the symptoms of PMS, is a diuretic, valuable in the
treatment of asthma, allergies and arthritis, and absorbs fats and proteins.
Deficiency: Frequently
observed causes of deficiency are rare as it pertains to dietary intake.
However, secondary causes are malabsorption, alcoholism and pharmaceuticals such
as antidepressants, oral contraceptives and estrogen therapy as well as
diuretics and corticosteroid drugs. Lack of this vitamin can cause sore tongue,
inflammation of the mouth and gums, oily facial skin, acne, dermatitis,
alopecia, impaired wound healing, nausea, vomiting, anorexia, arthritis,
conjunctivitis, learning difficulties, hearing problems, anemia, lymphopenia,
myelin degeneration, paresthesia, peripheral neuropathy, retarded growth,
fatigue, headaches, irritability, vertigo, depression and convulsions. Toxicity: Mega dosing of
Vitamin B6 can lead to neurogenic dysfunction, ranging from inflammation to
ataxia and loss of positional sense of the extremities. Sensory depravation of
touch, temperature and pain is less frequently encountered. However, withdrawal
of this excessive intake frequently does not lead to complete recovery.
Vitamin B12 (Cyanocobalamin) Vitamin B12
(Cobalamin) works in conjunction with folic acid and iron. Cobalamin
deficiency can be diagnosed as a folic acid deficiency, since the cobalamin is
not available to change inactive folic acid to active. This theory is referred
to as the “Folic Trap”. B12 is vital for producing red blood cells in bone
marrow, the functions of the nervous system, preventing anemia, helping in
utilizing carbohydrates and fats, absorption of foods and proper digestion,
synthesis of protein, production of materials for DNA, maintaining fertility,
and is believed to assist in the production of neurotransmitters that aid memory
and learning ability. Deficiency: Frequently
observed causes of deficiency are vegetarian or fad diets, and sometimes, but
rarely, alcoholism. Lack of this vitamin can cause abnormal gait or spastic
ataxia, muscle pain due to susceptibility of TrP’s, proprioceptive deficit with
diminished reflexes, spinal cord degeneration, constipation with occasional
diarrhea, abdominal pain, various digestive disorders including anorexia,
splenomegaly, hepatomegaly, pernicious anemia, postural hypotension, labored
breathing, dizziness, ringing in the ears, inflammation of the tongue, eye
disorders, depression, chronic fatigue, drowsiness, irritability, headaches,
memory loss, moodiness, nervousness and easily startled, paranoia and
hallucinations. Toxicity: There are no
known harmful effects of excessive vitamin B12 in the diet. This vitamin is
essential for the functions of a coenzyme for carbon dioxide
transfer, metabolism of carbohydrates, fatty acids, and the excretion of waste
products caused by protein breakdown. Some experts agree that Biotin is needed
to help relieve muscle pain, promotes healthy nerve tissue, bone marrow and
sweat glands, as well as healthy hair and
skin.
Deficiency: Biotin is
produced in the intestines therefore deficiency is rare. However, the excessive
intake of raw egg whites depletes biotin absorption as well as prolonged use of
antibiotics and sulfa drugs. When this occurs the symptoms include dermatitis,
hair loss, weakness, fatigue, depression, and poor appetite.
Toxicity: There are no
known harmful effects of excessive intake of Biotin.
Folic Acid As stated above,
works with Vitamin B12 for the synthesis of DNA and RNA. It
is vital for the healthy function of the nervous system and brain, red blood
cell formation, formation and functioning of white blood cells (which aids in
immunity), prevention of anemia, energy production, alleviating depression and
anxiety, and is very important during pregnancy. Deficiency: Lack of this
vitamin can cause: muscular irritability, generalized muscle pain with
susceptibility to TrP’s, peripheral neuropathy, “restless” legs at night, spinal
cord degeneration, insomnia, fatigue, weakness, depression, apathy, paranoia,
forgetfulness, glossitis, anemia, pallor, digestive disturbances, graying hair,
growth impairment, labored breathing, and birth defects in offspring. Frequently
observed causes of deficiency are diets that have been overcooked or secondary
to alcoholism, malabsorption syndrome, or as a side effect of the chemical
breakdown caused by oral contraceptives, primidone, phenytoin, barbiturates, and
cycloserine. Toxicity: Most
authorities do not attribute any side effects to folic acid toxicity. However,
some report that mega dosing on folic acid over a persistent period of time
should be discouraged with individuals who either have convulsive disorders or a
hormone related form of cancer. This vitamin is needed for
the metabolism of folic acid. It is also essential in the production of certain
neurotransmitters, adrenal hormones, in the deposition of calcium to form bones
and teeth, in the production of collagen, increases absorption of iron, promotes
wound and burn healing and helps prevent bruising and blood clots. As an
antioxidant it helps to protect against infections, the effects of pollution and
prevents post exercise muscle soreness or stiffness. It is also believed that
when Vitamin C and Vitamin E work together,
they may increase their antioxidant activity. Deficiency: Lack of this
vitamin can cause Scurvy, anemia, joint and muscle pain, fatigue, weight loss,
poor digestion, prolonged healing time, tendency to bruise easily, bleeding
gums, nose bleeds, and tooth loss. Frequently observed causes of deficiency are
smoking, alcohol, antidepressants, anticoagulants, oral contraceptives,
steroids, and analgesics. While commonly thought that a lack of vitamin C
increases susceptibility to common colds and that increased usage diminishes
this risk; vitamin C is also thought to aid in, arthrosclerosis and serve as a
means of combating malignant carcinoma. The Merk Manual, Seventeenth Edition,
however, states that these reports are unproven. Toxicity: Mega dosing on
Ascorbic Acid causes diarrhea, acidic urine, urinary calculi, and promotes iron
overload. Rather than taking one mega dose of vitamin C, it is advised to take
several smaller doses throughout the day due to our inability to store it. This
is especially essential for smokers. Utilizing Vitamin C simultaneously with
aspirin therapy has a tendency to cause gastric inflammation. Therefore we
recommend coated aspirin and Ester-C. Chewable C can damage tooth enamel. Esterified C seems to be more effective in rapidly metabolizing in the body,
storing longer in the cells, which results in less excretion and the preferred
choice in its application of chronic disease.
Vitamin D Made of two substances, ergocalciferol (found in irradiated yeast) and
cholecalciferol (formed in human skin by ultra violet rays), this vitamin is
essential for normal development of teeth and bones, protects against muscle
weakness, regulates the balance and absorption of calcium and phosphate,
protects against osteoporosis, and enhances immunity. Deficiency: Balanced
diet and normal sun exposure provides the small amount of vitamin D required by
the body. However, deficiency can be caused by lack of ultraviolet rays, poor
diet, liver and kidney disorders, and prolonged use of some anticonvulsants.
Conditions of deficiency are osteomalacia and rickets. Toxicity: Mega doses of
vitamin D may cause weakness, depression, anorexia, nausea, vomiting,
nervousness, pruritus, impairs renal function, impairs calcium and phosphate
blood levels, excessive urination, polydipsia and metastatic calcifications. While well known
for its usefulness in repairing scar tissue and burns, Vitamin E is also
renowned for its ability to relax leg cramps, and enhance athletic and sexual
performance. It is essential for normal cell structure, the formation of red
blood cells, maintaining certain enzyme activity, promotes normal blood
clotting, reduces blood pressure, improves circulation, and helps in treating
fibrocystic breast disease and premenstrual syndrome. It also helps in
preventing destruction of red blood cells by poisons in the body, protects lungs
and other tissue from pollution damage, maintaining nerve and muscle function,
prevents red cell damage and subsequent anemia, as well as promoting healthy
hair and skin. As an antioxidant, Tocopherol helps prevent cataracts, cancer,
cardiovascular disease, neuromuscular impairment, as well as retards the aging
process and aging spots. Vitamin E appears to be more effective when working
synergistically with vitamin C and aids other vitamins in their utilization.
Deficiency: Lack of this
vitamin may cause anemia, infertility in both sexes, neuromuscular dysfunction,
and is associated with heart disease. Some reports also associate lack of
vitamin E compound with breast and bowel cancer. Toxicity: Usually
adults can take large amounts of vitamin E over a prolonged period of time
without side effects. However, excessive intake can cause muscle weakness,
fatigue, diarrhea, nausea, abdominal pain, and vomiting. It may also retard the
absorption of vitamins A, D and K.
Vitamin K ...is a generic term for derivatives of 2-methyl-1, 4-naphthoquinone. This
vitamin is essential for the production of substances in the liver which causes
the blood to clot. Some experts believe vitamin K may help prevent osteoporosis
and some cancers. Deficiency: Since the
body produces some vitamin K, a normal balanced diet should keep a deficiency
from occurring. However, malabsorption disorders and prolonged antibiotic
treatment, chronic diarrhea and some liver disorders can cause deficiency.
Symptoms of deficiency are internal bleeding, nosebleeds and bleeding of the
gums. Intracranial hemorrhage can result in extreme cases. Toxicity:
Mega doses of vitamin K usually have no toxic effect, however, flushing and sweating can be a
side effect. Its precursor, Menadione, can cause hemolytic anemia and
hyperbilirubinemia (jaundice).
Sodium (Na) The effects of the sodium/potassium pump are well acknowledged as it
pertains to the contractile response of muscle. While most individuals have an
adequate if not excessive amount of sodium in their system, some individuals do
experience sodium deficiency (Hyponatremia). When this is observed, it usually
results from lack of dietary intake, excessive physical activity or in
individuals who use diuretics, which also depletes potassium levels. Deficiency:
Deficiency of this mineral can cause
muscular
weakness or spasm, headache, anorexia, nausea, vomiting, vascular collapse, and
mental confusion or convulsions. (Sodium Potassium Pump
–Na+,K+-ATPase ion pump) This pump requires the energy of Addison Triphosphate
(ATP) to transport sodium extracellular while transporting potassium
intracellular. This osmotic transportation is conducted through the semi
permeable membrane of the cell and controls the water balance.
Potassium (K) This
mineral
affects the
nervous system in addition to skeletal smooth and cardiac muscle. Although
dietary deficiency is rare in developed countries, when it does occur excessive
vomiting, diarrhea, GI disorders, and some kidney diseases may result. Some
causes of potassium deficiency may be from excessive use of diuretics,
laxatives, sugar, coffee, and alcohol. Deficiency: Potassium
deficiency (Hypokalemia) can cause elevated sodium and cholesterol levels,
hypothyroidism, fatigue, muscle weakness, drowsiness, dizziness, arrhythmia, and
possible paralysis in severe cases.
Calcium (Ca) This mineral is
essential for muscle growth and contraction, the transmission
of nerve impulses to nerve endings to muscle fibers, prevention of muscle
cramps, functioning of cells, bones, teeth, gums, lower cholesterol levels, and
helps in preventing cardiovascular disease. Calcium deficiency is usually caused
by heavy exercise, high protein and fat diet, high sugar intake, alcoholic
beverages, coffee, excess salt and lack of vitamin D. Deficiency: Calcium
deficiency (Hypocalcemia) can cause aching joints, tetany, paresthesia,
rheumatoid arthritis, rickets, osteomalacia, osteopenia, osteoporosis, tooth
decay, hypertension, elevated cholesterol levels, heart palpitations, brittle
nails, pallor, eczema, nervousness, insomnia, convulsions, depression,
delusions, hyperactivity, and cognitive impairment. This
element is vital to prevent the calcification of soft tissue, muscle weakness,
twitching, PMS, assists in the transmission of nerve and muscle impulses, and is
a catalyst in enzyme activity, especially energy production. It also protects
the arterial linings and helps in the formation of bone as well as assisting
vitamin B6 in preventing calcium oxalate kidney stones. Alcohol, diuretics,
diarrhea, high levels of zinc, vitamin D, fluoride, foods high in oxalic acid
and fat-soluble vitamins can cause deficiency, which is rare. Deficiency: Magnesium
deficiency can cause chronic fatigue, chronic pain syndromes, generalized myalgia, insomnia, depression, confusion, anxiety, irritability, irritable bowel
syndrome, digestion dysfunction, tremors, seizures, hypertension,
heart palpitations, arrhythmia, sudden cardiac arrest, asthma, and pulmonary
disorders.
Iron (Fe) This mineral is
essential for oxygenation of red blood cells and production of
hemoglobin and myoglobin (found in muscle tissue), energy and a healthy immune
system. Deficiency may result from a lack of vitamin B6 or B12, a high
phosphorus diet, poor digestion, internal bleeding, menorrhagia (heavy menstrual
bleeding), long-term illness, and excessive amounts of antacids, coffee or tea.
Also, excessive amounts of zinc, vitamin E, rheumatoid arthritis and cancer may
also interfere with iron absorption and utilization. Iron is stored in the body;
therefore, excessive iron intake could also cause hemochromatosis (bronze
diabetes). Deficiency: can cause
anemia, which effects oxygen transport. This hypoxic state affects the energy of
the muscles, creates ischemic tissue and fatigue. Lack of iron can also cause
obesity, fragile bones, pallor, hair loss, misshaped or ridged nails, difficulty
swallowing, and inflammation of the tissues of the mouth, dizziness,
nervousness, and cognitive impairment.
Zinc (Zn) This trace element is
essential for the manufacture of nucleic acids and
proteins, wound healing, development of the sexual organs and hormones, normal
growth, prostrate gland functions, and controlling enzymes. Deficiency: A balanced
diet contains small amounts of zinc, and therefore, deficiency is rare in
western civilization. However, zinc deficiency can cause dwarfism, retard
development of the sexual organs, anemia, immune disorders, hypo spermia,
impaired taste and healing, night blindness, and dermatitis. Toxicity: Excessive
intake of zinc will interfere with the absorption of iron and copper. Symptoms
of excessive amounts of zinc can range from vomiting and diarrhea to RBC
microcytosis. © Copyright
Myofascial trigger point perpetuating factor: nutritional deficiencies