Muscle pain

Woof!

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Why aren't doctors, especially researchers, more interested in defining the different muscle pain qualities in more detail?
The answer lies in one particular word in your question, @Inara, and the word isn't "pain." It's "muscle."

I think most MDs (and for that matter, most DVMs) get little practical training in muscle physiology. They kinda skim over the topic and leave it to the physical therapists, occupational therapists, deep muscle therapists and sports physicians to address it. When it comes to muscle issues of any kind, the last person I want to see is my physician. Instead, I head right to a good physical therapist (one proficient in dry needling and one who works independently, not in a PT shop).

It is amazing what my favorite PT has taught me about my muscles, myofascia, posture, movement and even breathing (none of which my physician really understands), and when it comes to living more pain-free than painful, I owe her everything.
 

wabi-sabi

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And here's an interesting article implicating Purdue. https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC5878703/

I am drawn, however, to a quote pain being a vital sign "This declaration was not accompanied by the release of any device which could objectively measure pain, as was done with all previous vital signs, blood pressure, pulse, respiratory rate and temperature, making it the first and only subjective vital sign. "

Which speaks to the problem of confusing objective and subjective signs, and the inability to measure pain. If you don't know how much pain a patient is really in, how can you possible give them the correct dose of a medication? You can't. So while, yes, pharma deserves some culpability for offering opioids as a solution, there's still a much bigger problem than that. Pain itself.

Here I am ranting on, but whenever I hear anyone worry about the opioid epidemic, I wonder about the pain epidemic. If we knew how to control pain, opioids wouldn't be a tempting bandaid.
 

Wishful

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Why aren't doctors, especially researchers, more interested in defining the different muscle pain qualities in more detail?
I think no one has yet come up with a way to define it. Some types of muscle pain might be measurable via measuring nerve signals or maybe some chemical that might only be measurable via an expensive fMRI machine, but the perception of pain would still vary with the individual and the time of day, and diet, and various other factors. I wouldn't be surprised if there have been attempts at defining pain via questioning the patient, but that all of them ran into the 'garbage in, garbage out' problem. If you could induce an identical pain signal in different people, I expect you'd get wildly variable responses to questions about the perception of pain.

Pain perception evolved as a 'don't do that' survival tool. Nothing in its evolution guided it to be easily measurable by other people.
 

Inara

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Subjective things are the ones that are entirely dependent on a person's individual situation:
Although I agree overall, if subjective reports about a symptom repeatedly contain the same information, that's maybe something between subjective and objective. We can't measure pain today, but I think that may change some day. Pain is simply not understood, at all.
Take burning muscles when training at max strength, or muscle soreness after unusual exercise: Everybody who had it knows it, and knows exactly what is meant when mentioned. Everybody in sports medicine knows what it is.
Neuropathic pain has its own character, too, and it is very similar in different people according to their descriptions. The characteristics are part of the diagnostic process.

I simply have the impression important information is skipped, information that may define the problem more accurate. You can't solve a problem without understanding it.
 

Inara

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It is amazing what my favorite PT has taught me about my muscles, myofascia, posture,
That's true maybe.
The first thing I realized was that my PT knows everything about anatomy - and the orthopedist didn't. Thus, she was able to help me with some things.
 

SWAlexander

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My muscle pain comes from Tarlov cysts (MRI confirmed), oxidative stress, inflammation and ACTN3 Gene -(alpha-actinin-3).
 
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wabi-sabi

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if subjective reports about a symptom repeatedly contain the same information, that's maybe something between subjective and objective.
I may have explained the difference between objective and subjective badly. Subjective isn't just a matter of agreement or lack of agreement. Subjective speaks to a person's unique lived experience- and patient's lived experience is frequently missed or downplayed, and it's a very important lack of information, as you said.

Our experiences are similar because our disease process is similar. The idea i am trying to get at is that subjectivities are inaccessible to one another and that it why they are epistemologically suspect in medicine. We can work to empathize and understand each other's point of view (and should), but we can never share a person's internal reality. Thus a skeptical medical person can always convince themselves that a patient is lying or malingering, because they can't access a patient's consciousness- they must believe both the truth and accuracy of what a patient says.

Healthcare likes objective tests because they are incapable of lying. The thermometer always tells the truth unless it's broken, in which case you just get a new thermometer and try again. The corresponding problem is why medical people might want a test that can't lie, and what it says they believe about patients' truth telling.
 

hapl808

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Healthcare likes objective tests because they are incapable of lying. The thermometer always tells the truth unless it's broken, in which case you just get a new thermometer and try again. The corresponding problem is why medical people might want a test that can't lie, and what it says they believe about patients' truth telling.
This is one of the big problems in medicine. They are incredibly arrogant and think they can detect anything that's 'real', and yet that's so obviously light years from the truth that it's mind boggling.

We can't even really objectively measure or effectively treat pain, one of the most fundamental evolutionary biological processes in all higher life forms.

Yet doctors regularly dismiss all kinds of subjected patient accounts, because those accounts might force the doctor to admit they are not a brilliant all-seeing god.

Their amphetamine fueled selves managed to navigate medical school and put their kids through schools that even their bloated salaries can't technically afford. So everyone else should just stop questioning them or Googling things because the peasants and computers can't hope to understand what they committed to rote memory.
 

SWAlexander

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"The corresponding problem is why medical people might want a test that can't lie, and what it says they believe about patients' truth telling."

What about a patient telling the truth but doctors ordering the wrong test? For 59 years I was told there is nothing wrong with my headaches/migraines. I should take aspirin and stop whining. I had CT and MRI from my neck and it showed nothing significant. Until one doctor believed me and ordered a brain MRI. Result: Chiari Malformation.
 

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SWAlexander

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Anybody "low potassium"? It also contributes to muscle twitching and pain.

Most of the time low potassium levels appear after taking antibiotics. After I had Vancomycin (IV) for 6 weeks, the hospital ordered me to eat 2 bananas a day for one week and 1 banana a day for one month.
 

Inara

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the hospital ordered me to eat 2 bananas a day for one week and 1 banana a day for one month.
That is uninformed in my opinion. Reminds me of a "specialist" who recommended bananas in hypokalemic periodic paralysis.
There is a substantial amount of sugar (carbohydrates) in bananas. These lower blood potassium more than the potassium in the banana increases it. If you have hypokalemia or hypokalemic periodic paralysis, or your potassium level is sub-optimal, you need to take potassium.

Anybody "low potassium"? It also contributes to muscle twitching and pain.
Interesting. Thanks.
 

SWAlexander

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hypokalemia or hypokalemic periodic paralysis
This is exactly the case and is often misunderstood.
the possibility is: according to a paper from 2009
1. familial form of hypokalemic periodic paralysis that is due to mutations in one of the various genes for ion channels (Gene SCN4A and CACNA1S mutation)
2. due to hormone abnormalities or due to kidney disorders that result in chronically low potassium levels in the blood.
 

Inara

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1. familial form of hypokalemic periodic paralysis that is due to mutations in one of the various genes for ion channels (Gene SCN4A and CACNA1S mutation)
There are, in my view, many misconceptions in the periodic paralyses, like in hypoPP potassium is always low during an attack (the shift is relevant), or if no known mutation is found it's not primary PP (in ca. 30% of patients no mutation is found), or that in between attacks people with PP feel normal (some do, some don't), or that fatigue and other symptons are not part of PP (80% report that symptom). I also know sth. like PEM from PP.
Well, pwME know the thing with misconceptions very well.

due to hormone abnormalities or due to kidney disorders that result in chronically low potassium levels in the blood.
Yes, some traits can "imitate", or better: lead to secondary periodic paralysis, like thyrotoxic hypokalemic periodic paralysis (more often found in Asian males). There are several causes for hypokalemia.

The symptoms of hypokalemia/hyperkalemia can be found in PP, but in my experience, a person that has hypokalemia vs. hypoPP, severer symptoms (like paralysis) occurr at a lower potassium level, e.g. 2-2,5mmol/l, while in hypoPP you may be paralysed at 4-4,2mmol/l. Also, I have observed fatigue is linked to the potassium level (lower - more fatigue).

In general, people should be careful with potassium. In hypoPP, people can take potassium amounts that could probably kill others.

Anybody "low potassium"? It also contributes to muscle twitching and pain
By the way, how do you know?

I have hypoPP, and although I know one person with hypoPP who has the same muscle pain like I do, I don't hear it very often, and I am not always sure how much is hypoPP, and how much is sth. else.

I think potassium should be checked as a standard, its cost is irrelevant, but I heard of people whose hypokalemia was found very late. That's really... "unfortunate"...
 

SWAlexander

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There are, in my view, many misconceptions in the periodic paralyses, like in hypoPP potassium is always low during an attack (the shift is relevant), or if no known mutation is found it's not primary PP (in ca. 30% of patients no mutation is found), or that in between attacks people with PP feel normal (some do, some don't), or that fatigue and other symptons are not part of PP (80% report that symptom). I also know sth. like PEM from PP.
Well, pwME know the thing with misconceptions very well.


Yes, some traits can "imitate", or better: lead to secondary periodic paralysis, like thyrotoxic hypokalemic periodic paralysis (more often found in Asian males). There are several causes for hypokalemia.

The symptoms of hypokalemia/hyperkalemia can be found in PP, but in my experience, a person that has hypokalemia vs. hypoPP, severer symptoms (like paralysis) occurr at a lower potassium level, e.g. 2-2,5mmol/l, while in hypoPP you may be paralysed at 4-4,2mmol/l. Also, I have observed fatigue is linked to the potassium level (lower - more fatigue).

In general, people should be careful with potassium. In hypoPP, people can take potassium amounts that could probably kill others.


"By the way, how do you know?"

Hospital: 6 x blood test "critical potassium low" after Lumbar spinal hardware infection, Body fluid back lumbar spine superficial.
GS/CX: very rare growth: bacteremia: Staph epidermidis and Peptostreptococcus, Peptostreptococcus, one colony Staph caprae, Corynebacterium species,”
treatment: IV - 6 weeks antibiotics Vancomycin