I. Introduction

1. Dr. Fors, Thank you for taking the time to do this interview. Could you take a moment to let our viewers know who you are?

I am a doctor of chiropractic, a graduate of Northwestern Health Science University, and a Board Certified Neurologist (IBCN). I am on the post graduate faculty of Chiropractic Colleges, and I lecture to doctors and therapists around the country on chronic myofascial pain disorders, and fibromyalgia syndrome. In these seminars I educate doctors on the latest research findings on the causes of, and the most effective natural treatments for chronic myofascial pain. I am a nationally certified Diplomate in Acupuncture (NCCAOM) and certified in Botanical Medicine (NHSU).

I am the inventor and developer of the Fenix Rehab Systems for the self-treatment of pain-causing myofascial trigger points. These are self-care devices that allow individuals with chronic pain to effectively deactivate there pain-causing myofascial trigger points through a program of various myofascial therapies.

I have also created the company FRE, Inc. which provides the public with an on-line store with a very select line of pain-relief and wellness nutritional and physical fitness products. It turns out that programs designed to bring you relief from chronic myofascial pain disorders also promote wellness. To truly rehabilitate your myofascial pain, and not just cover it up with drugs, FENIX Rehab programs include: self-care trigger point therapy to normalize muscles, stretching for increased flexibility, resistance exercises to strengthen muscles, aerobic exercise to increase cardiovascular efficiency and nutraceutical supplements to provide anti-oxidant protection, increase cellular energy production, enhance detoxification, normalize gastro-intestinal function and assist stress reduction. FRE, Inc. provides exceptional quality products on-line through its on-line stores at fenixstopspain.com and 4naturalpainrelief.com, to assist you in your quest for pain-relief and wellness. FRE, Inc. also manufactures the FENIX Rehab Systems.

2. That's one of the primary reasons for our interview, your creation of the Fenix Rehab Systems. Where did you get the idea for this innovative self-care program?

Tensa Fascia Latae >> Gluteus Minimus >> << Longissimus << Multifidus << Levator Scapulae

Well there are many reasons; some of them involve my own personal struggle with chronic myofascial pain, but mostly from treating thousands of individuals in my clinical practice that suffered with chronic pain disorders.

Every patient was different and I would try every possible way to help them overcome their chronic pain: traditional Chinese acupuncture, electro-acupuncture, various physical therapies devices such as traction and ultra-sound, nutritional support and dietary changes, rehabilitative exercises, botanical medicines and chiropractic adjustments. All these approaches were helpful, but nothing was as effective as making sure all the active and hidden or latent myofascial trigger points were completely removed in the individual experiencing chronic pain.

However, I found it very exhausting work for me and my therapists to apply pressure therapy to all these myofascial trigger points day in and day out. I soon developed chronic upper extremity repetitive stress injuries. This is exactly why many clinicians no longer do comprehensive myofascial treatment; because the strain of trigger point therapy and myofascial release causes a high incidence of practitioner injuries.

Many times patients will only get a couple of major TPs treated by the clinician because it is so labor and time intensive. This short changes the individual with chronic myofascial pain and leaves them suffering. Unless you release all active, latent, and satellite myofascial trigger points, and there are many in a chronic pain condition, the myofascial pain will keep recurring.

Another problem I found is that many individuals with chronic myofascial pain cannot afford either the money or the time to keep coming back for repeat office visits to get rid of all their myofascial trigger points.

Because of this they would get part way through their care program and quit. As a result the pain would not entirely clear up or it would all come back.

The Fenix ~ Still Point Full-Size Fenix Rehab System

In my clinical practice I discovered that there was no a real substitute for the physical effort and time involved in comprehensive trigger point therapy; if you wanted to truly rehabilitate a chronic myofascial pain syndrome. Research bears this out, when different therapy techniques have been compared in studies, manual trigger point therapy always comes out on top for getting rid of chronic myofascial pain.

I myself had disabling low back pain and chronic shoulder-arm pain. I had access to all the best healthcare could provide; however nothing helped. Out of necessity I kept creating ways to treat my own trigger points, as many others have done in chronic pain. Finally, after trail and error, I created a treatment platform with interchangeable therapeutic digits to apply effective trigger point therapy through out my body. With this device I could over time release all my active and latent TPs. I also found that I could find all these trigger points on me easier then trying to direct some other clinician to them.

I clinically found that patients with chronic myofascial pain disorders of the back, neck, and extremities got better quicker when they had the ability to self-treat their own myofascial trigger points, clinical studies bear this out. Because of this it became my goal to put a Fenix Rehab System into the hands of the 86 million American adults suffering from chronic myofascial pain and the 10 million who suffer with Fibromyalgia. It is my desire to alleviate the pain and suffering of those affected with treatable chronic pain, without relying on dangerous drugs and surgery. As a chiropractic neurologist who specializes in chronic pain disorders, I have seen too many lives destroyed from chronic pain: drug addiction, careers ruined, families torn apart and even suicide. That's why I invented the Fenix Rehab System and created FRE, Inc. to bring quality products and information to the millions who suffer from chronic myofascial pain and fibromyalgia syndrome.

Chronic myofascial pain became even more painful for me when my oldest daughter developed severe fibromyalgia. When it first hit her she had to crawl up the stairs on her hands and knees to her bedroom. Standard medicine had no answers for her, only dangerous drugs with severe side-effects.

So using my knowledge and doing more extensive research I put her on a program of care using the Fenix Rehab System to gently treat her myofascial trigger points, and a program of specific nutraceuticals and herbs to help in her recovery, more about this later. This nutritional and physical care program has brought her back to a normal life once again.

Through this personal experience and the numerous patients I have treated through the years with chronic myofascial pain and fibromyalgia, I have developed an effective physical and metabolic approach to chronic pain. Later in the interview I hope to explain the many metabolic cause's of chronic pain syndromes and what individuals can do nutritionally to support their own recovery from these debilitating disorders.

3. Dr. Fors, how common then are these chronic myofascial pain disorders?

Because of the way we put distress on our bodies, from the way we sit, stand, lift, work and, from the hectic way we live, they are very common! The National Institute of Neurological Disorder and Strokes has stated that 85% of all Americans will develop in their lifetime at least one episode of chronic myofascial pain of the back, neck, or extremities. In a recent study reported in the Journal of the American Medical Association, November 12th, 2003 issue, it was found that more than one-third of all adults in the U.S. suffer with some form of chronic musculoskeletal pain on a daily basis, conditions such as chronic: back pain, neck pain, hip-leg pain, sciatica, and fibromyalgia. Even though these conditions are not life threatening, they were shown to have tremendous negative impact on an individual's life and they plague our society. In this study it was found to cost society $61 billion dollars annually in lost productivity because people are on the job but hurting.

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II.The Underlying Cause of Chronic Pain

4.You stated that these are not generally life-threatening conditions, are there painful conditions that can be dangerous or life-threatening?

Great question! That's why anyone who has pain, acute or chronic, must have a proper physical exam and work-up by a qualified physician to rule out any 'red flags' in these conditions. Red Fags that may indicate fractures, tumors, or infections that may be at the source of their pain.

It has been estimated that less then 5% musculoskeletal pain arises from fractures, tumors, and infection, while another 5% of musculoskeletal pain cases are caused by nerve root problems such as disc herniations. If you are in this 10% of musculoskeletal cases you must find out the actual cause and have it properly treated. However, this leaves over 90% of musculoskeletal pain arising from a mechanical origin, that of a myofascial (muscle and tendon) and joint (ligamentus) dysfunction.

5. What then is the cause of this myofascial dysfunction that accounts for 90% of the musculoskeletal pain and suffering in the U.S.?

Physical, chemical, and emotional distress overtime causes specific changes in muscle and tendons known a myofascial trigger points; these myofascial lesions are commonly known as "muscle knots." Myofascial trigger points are hyperirritable tissues in muscles and tendons that cause three things to happen. First, the tissue becomes painful and/or tender, second they cause the myofascial tissues to shorten, and third they cause the muscle to weaken. These three changes cause alteration in our patterns of movement causing more stress to our muscles, tendons, and ligaments causing more myofascial trigger points. This leads to a vicious cycle of more and more recurrent pain in an individual, until all the active and latent trigger points are released and removed.

6. What then is the difference between an active and a latent trigger point?

Let's get our terms established here for a better understanding. As previously mentioned, any severe acute or chronic recurrent physical, stress, such as an injury, chemical stress, such as toxin exposure or nutritional deficiency, or emotional stress can lead to the formation of taut bands in muscle tissue. These at first are painless, but eventually they will begin to shorten muscles and alter our movement patterns. Further physical, chemical or emotions stress will cause these taut bands to begin to form pain-causing trigger points.

An active trigger points is myofascial trigger point that spontaneously causes local pain and/or pain referred to a distal area, for example pain down the arm, leg or into the head. Patients who have experienced pain due to a heart attacks, broken bones, or kidney stones, have reported that their myofascial pain from trigger points can be just as severe these ailments. So we should never underestimate the suffering someone is going through with Myofascial Pain Syndrome or Fibromyalgia.

Now a latent trigger point is defined as a focus of hyperirritability in muscle or its fascia, that does not cause spontaneous pain, it is only painful when it is pressured or distressed. However, it will cause the other characteristics of TPs such as a shortening and weakening of the muscle.

Another important distinction to be made, and the reason will come clear soon, is that of satellite trigger points. By definition satellite trigger points are those that form in muscles that are in the referral pain zone of primary active trigger points. Remember a primary active trigger points are usually where the problem began, they produce spontaneous pain tenderness and restriction of movement, and they produce referral pain. This referral pain is felt at a distance, often entirely remote from its source, and usually happens in a pattern that can be seen in books and TP charts. For example TPs in the Quadratus Lumborum muscle of the low back will refer pain into the hip and buttocks. The muscles in this referral pain zone, such as the Gluteus Medius and Minimus, will then form numerous satellite trigger points, which may be latent or quiet TPs, or active TP causing severe pain in the low back and legs.

8. Many individuals with chronic pain know about their active trigger points, but why is it helpful for then to know about and identify latent and satellite TPs?

Many times an individual with chronic myofascial pain will be lucky enough to find a doctor or therapist who knows something about trigger point therapy. However, usually only a few of the primary active trigger points get treated. Why? First, of all primary TPs are very easy to identify, the patient is usually pointing right to them. Secondly, many clinicians do not realize the importance of finding all satellite and latent trigger points and releasing them.

In the previous example of the low back, if only the primary trigger points in Quadratus lumborum muscle of were released, the low back the pain would return. If satellite TPs of the Quadratus lumborum which are usually found in the Gluteus Medius, remain in the buttock, these satellite TPs would reactivate the Quadratus Lumborum and subsequently the low back pain would return. Individuals then think that trigger point therapy didn't work.

Also surrounding primary TPs there are usually many nested latent TPs or quiet "muscle knots" that many times go untreated. When a clinician finds a painful primary TP there are, many latent trigger points in that muscle or in surrounding muscles close by. Time must be taken to release all these nested latent TPs in the region of the primary active TPs. If they are not released, just as with satellite TPs, these regional latent or quiet TPs will reactivate the primary TPs and the chronic pain will eventually return through a neurological reflex. This is why it is so important to perform a comprehensive "search and destroy mission" of all the myofascial trigger points in the region.

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III. Proper Treatment of Musculoskeletal Pain

8. Aren't clinicians properly treating these chronic myofascial pain syndromes and releasing all the satellite and latent trigger points?

First of all, if the clinician has the knowledge and ability to identify and treat all primary, latent and satellite TPs it is very time and cost intensive. If the individual with chronic myofascial pain is lucky enough to find a clinician who can properly treat myofascial TPs that individual many times can not afford either the time or the cost to completely release all the primary, latent and satellite myofascial trigger points. So the patient's pain continues to recur. I have clinically found, as research has shown, that to successfully treat chronic myofascial pain syndromes; whether of the back, neck, extremities and especially in Fibromyalgia, you must take the time to consistently over a period of time remove or at least control all the primary, latent and satellite myofascial trigger points.

9. So how does the person with chronic myofascial pain or fibromyalgia overcome this time and cost obstacle to finally become pain free?

Again this question focuses right on the primary reason I invented and developed the Fenix Rehab Systems: The Fenix ~ 'Still Point,' The Fenix ~ 'Lotus Point,' and the Comprehensive Fenix Rehab System. The Fenix Rehab Systems and its support products allow individuals with chronic myofascial pain to properly treat their condition for about the cost of one visit to their doctor or therapist for trigger point therapy. The savings on health care costs is tremendous! The products also facilitate a slow and methodical deactivation of all active, latent and satellite myofascial trigger points over time. This way an individual can rehabilitate the myofascial pain over time and finally become pain free once and for all.

David G. Simons, M.D., one of the co-authors of "The Book" on myofascial pain "Myofascial Pain and Dysfunction - The Trigger Point Manual" Vol. 1 and Vol. 2, said it best: "There is no substitute for learning to control your own musculoskeletal pain. Treating myofascial trigger Points yourself addresses the source of that kind of common pain and is not just a way of temporarily relieving it."

In other words taking the time to properly treat your all trigger points not only active, but latent, satellite TPs will do more then just temporarily relieve pain over time it will rehabilitate the underlying problem. This is particularly true if you take the time to stretch and strengthen the muscles involved in your myofascial pain syndrome. The Fenix Rehab Systems include specific stretches and there are support products to help individuals lengthen and strengthen their muscles after releasing the involved TPs. Numerous studies have proven that individuals with chronic myofascial pain do better and recover quicker if they are involved in their own recovery. The more responsible an individual is in their care the more successful they are in achieving a pain-free life.

10. Why is trigger point therapy be more effective in treating chronic pain than vibrating massagers or heating products that are sold everywhere?

Whether have regional pain of the back or the global pain of fibromyalgia, trigger point therapy gets directly to the source of your chronic and recurring pain, the myofascial trigger point! The respected pain researchers Melzack and Wall stated that '.myofascial trigger points are often the major factor in the cause and/or maintenance of chronic pain states.' The researcher Dr. Hong said that, "The myofascial trigger point is the major cause of muscle pain in clinical practice."

However, everybody loves vibrating massagers, expensive chair massagers, heating devices because they make us feel good for a moment, but they do nothing to really fix the underlying problem, the myofascial trigger point.

Vibrating massagers work by tricking our nervous system, here's how it works; chronic pain can be fired off by the myofascial trigger points in our back muscles, causing us low back pain. In another case trigger points in our neck and shoulder can create chronic shoulder/arm pain. These pain impulses from our deep myofascial tissues are carried to the spinal cord through sensory nerves.

In these examples, when we vibrate the surface overlying our back or shoulder, we stimulate surface nerves that carry impulses of the vibration to our spinal cord. These surface nerves carry the vibration impulses much faster to the spinal cord than the sensory nerves that carry the pain impulses from our painful deep myofascial tissues. So the surface vibration nerve impulses get to the spinal cord and override or block the incoming pain impulses.

This is a very simple explanation of the Melzack and Wall "Gate Phenomenon" of Pain. But, most important to realize is that this vibrating massager does not change the underlying problem it only covers it up for a short period. People love these vibrating massagers, buy them by the millions, but no real change in myofascial trigger points is achieved.

This is also what takes place when we use vibrating loungers that cost thousands of dollars, we feel good for a short while but nothing is really getting fixed. This same "Gate Phenomenon" or momentary blocking of pain impulses happen with heating devises, or even with a light surface relaxation massage. A relaxation massage improves blood flow and helps us relax, as does heating devices, but it does not change the myofascial trigger point. Therefore the mechanisms that cause our chronic and recurring pain are left to continue to plague us.

11. How does trigger point therapy overtime, as with The Fenix Rehab System, actually correct the problem of chronic pain?

I will try to keep this as simple and straight forward as I can. First of all myofascial trigger points start with "taut bands" in muscles. These bands are contracted shortened muscle cell that squeezes out the blood and obstructs good blood flow.

This lack of blood to the muscle tissue means there is a lack of oxygen and nutrients. With a lack of oxygen and nutrients the taut band runs low on energy. This low energy state, and any added physical, chemical or emotional distress causes the formation of the myofascial trigger points in that taut band.

These myofascial trigger points in the taut bands are created by dysfunction of sensory and motor nerve endings. This dysfunction of nerve ending is what creates the painful nerve reflex of trigger points in muscles and tendons. Furthermore, with this lack of energy the taut band can not relax because it actually takes energy to relax contracted muscle tissues. This way the taut bands with myofascial trigger points become a self-sustaining vicious cycle.

Our muscles are made of myofascial tissues composed of three components: collagen, elastin, and ground substance. Collagen is a tough as steel and in trigger points these fibers become shortened and form cross-links. Also the all important ground substance in the myofascial trigger point becomes more gelatinous, like concrete. So the myofascial trigger point is a region of congealed gummed up, shortened and contracted tissue with irritated nerve endings firing pain impulses to our spinal cord.

When you apply sufficient deep sustained digital pressure to this knotted up trigger point you actually change these three tissue components. You stretch the collagen, release its cross-linkages. Also with about a minute of sustained pressure you change the ground substance from a gelatinous state to a more fluid state.

Research has shown that these physical changes in the tissue, achieved with sustained deep pressure on the point, allows you to then stretch the muscle and actually release the taut band. This is why it is vital to stretch the tissue after applying trigger point therapy, more on this later.

12. I beginning to see why trigger point therapy can be so effective, but how does it help with the lack energy in the muscle?

Research has shown that by creating these changes in the taut band, by utilizing sustained pressure, and then stretching you will substantially increase blood flow in and metabolic toxins out of the myofascial tissue. One primary way this happens is by creating a more fluid or soluble state in the ground substance allowing oxygen and nutrients to move into the myofascial trigger points. The muscle tissue can then produce more energy allowing it to relax. You can now possibly see why rubbing the surface with a massage lotion, a vibrating massager, a heating device or even an expensive vibrating lounger is not going to change the tissue of a single trigger point. Let alone change the numerous primary latent and satellite trigger points involved in chronic pain states.

As effective as trigger point therapy is, to truly be effective, it takes repeated treatments over time with stretching of the myofascial tissue after each treatment. The problem with this is that it is very expensive to have someone properly do this for us over many treatment sessions. Especially if they were to release all primary, latent, and satellite trigger point involved in a chronic back pain, neck pain, or shoulder-arm pain case.

The answer is to turn this amazingly effective therapy into a home care program with a comprehensive self-treatment system. This is where the Fenix Rehab Systems really excel. They can reach virtually anywhere on the body, create heavy or light pressure depending on the area and the individual and they come with comprehensive instructions: guidebook, video, and website. So for less then one office visit for trigger point therapy an individual can have a complete self-treatment system with complete instructions to treat them anytime and anywhere they are hurting.

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IV. Advantages of Self-Care with the FENIX Rehab Systems

13. Dr Fors what makes the Fenix Rehab Systems different from other trigger point products on the market ?

That's an important question that I am glad you asked. First and foremost, the Fenix Rehab Systems have a patented therapeutic application you can't get anywhere else. Most other products are some form of a hand-held device. This is counter-intuitive to anyone who understands proper trigger point therapy. To apply these products you have to tighten muscles to brace yourself, and then you have to contract muscles to apply the product. However, to properly and efficiently deactivate myofascial trigger points you need to completely relax the myofascial tissues. How can you do this if your tighten muscle to brace yourself and then pull with other muscle to apply pressure? There are also limitations with these products for individuals who have arthritis of their upper extremities. Arthritis of the hands makes these products difficult to hold, or arthritis of the elbow or shoulder makes it difficult to pull to apply these products.

With the Fenix Rehab System patented therapeutic application, you have a stable treatment platform with interchangeable soft tipped digits of various sizes. With this design using a small portion of your passive body weight you can apply trigger point therapy virtually anywhere you have pain-causing TPs.

Second the design of the Fenix Rehab Systems allows individuals to apply a variety of myofascial techniques. With hand-held devices not only do you have to strain and pull to apply the devise, also you are very limited in techniques you can utilize. With the Fenix Rehab Systems: it's easily to apply deep muscle therapy in tough cases of low back pain in heavily muscled males, or very light techniques in small females with fibromyalgia. The instruction materials and the Website will show you how to apply various techniques such as Variable Therapeutic Compression, Myofascial Release, and Position Release.

14. Dr. Fors could you briefly explain why there are different models of the Fenix Rehab System, and how they differ from another?

As previously mentioned we are now offering three version of the Fenix Rehab System. The Fenix ~ 'Still Point,' The Fenix ~ 'Lotus Point' and the Full-Size Fenix Rehab System professional model.

The advantages of the 'Still Point' are its size, cost and its simplicity of use. The Fenix ~ 'Still Point' is our economy travel model and sells for under $50.00. The 'Still Point' treatment platform is approximately 7 3/4" wide by 9 1/4" long, small and light enough to fit into a large purse or briefcase. It comes with ix therapeutic digits of various lengths. Put a digit in and begin to pressure massage away your trigger points. It does not do all the varied special techniques of the Lotus Point or Full-Size model.

The Lotus Point and Full-Size model perform various techniques especially effective in self-treating chronic spinal pain problems or the low back, mid-back, and neck. Because of this The Lotus Point and Full-Size models come with extensive self-treatment instructions: a 20 page pictorial guidebook and a 90 minute instructional video on DVD. This video is chaptered by problem area, so all you do is click on your area of complaint and follow to self-treat your specific area of interest, for example, Low Back Pain, Shoulder/Arm Pain, Neck Pain, and Chronic Headaches. There are also extensive self-care instructions available on-line at fenixstopspain.com under Self-Treatment Training.

Because of its simplicity and ease of use The 'Still Point' does not include this 20 page guidebook or the 90 minute video. The 'Still Point' comes with a four page instruction guide. However, you can utilize the on-line training to learn how to perform many effective self-treatment techniques, such trigger point therapy, myofascial release, or position release for very tender muscle knots. If you are looking for economy and the ability to bring your pain relief with you, this is the Fenix for you.

The Fenix ~ Still Point

Full-Size Fenix Rehab System

15. Could you briefly describe The Fenix ~ 'Lotus Point' and what are its advantages and features?

The Fenix ~ 'Lotus Point' comes with a 9" wide by 11 1/2" long treatment platform with 8 soft-rubber tipped therapeutic digits of various lengths. The Lotus Point also comes with extensive instructions, a 20 page pictorial guidebook, and a 90 minute video on DVD, as previously described. It generally sells for under $80.00, about the cost of a single visit to a therapist or chiropractor for treatment. The cost savings and convenience are tremendous for the chronic pain patient.

The 'Lotus Point' comes with larger treatment platform with a handle yet it's small and light enough to still make it easy to bring along wherever you go. Also the 'Lotus Point' does most of the special techniques that the Full-Size professional model performs.

You can see these special spinal techniques demonstrated by going on-line at www.fenixstopspain.com and click on the menu link, Articles by Dr. Fors and then go to Low Back Pain. Or got to Self-Treatment Training menu link and then click on the Special technique for Spinal Pain. Through reviewing these on-line instruction see how extremely innovative the Fenix-'Lotus Point' and Full-Size Fenix Rehab System are in effectively treating chronic back pain. There is nothing else available for self-treatment like the Fenix Rehab System.

16. How do individuals know which model to choose between Then Fenix ~ 'Lotus Point' and the Full-Size Model?

In general The Fenix ~ 'Lotus Point' fulfills most individual's needs and is an excellent choice. However, the Full-Size professional model of the Fenix Rehab Systems gives you the most for your money. The Professional Fenix comes with a large stable9" wide by 19" long treatment platform which will allow you to self-treat with The Fenix Rehab System on soften or less stable surfaces, such as your bed or couch. The Full-Size System also comes with 16 different soft-rubber tipped therapeutic digits of various lengths and diameters.

The Full-Size professional model comes with 32 different treatment holes in the platform; sixteen paired 90o holes and sixteen angled holes in various patterns. These 32 different treatment holes and 16 therapeutic digits of various sizes give you the widest possible self-treatment options. The full possibility of these self-care techniques can again be found on-line at www.fenixstopspain.com, either through the articles I have written or by clicking on the menu link Self-Treatment Training. You can keep your large treatment platform at home and carry the small platform in your purse or brief case. The Full-Size system comes with the 20 page pictorial guidebook and 90 minute chaptered video on DVD. These comprehensive instructional materials train you in the wide variety of self-care technique available with the Full-Size Fenix Rehab System.

17. Dr. Fors would you describe the special techniques the Fenix Rehab System can do for the overwhelming problem of chronic back pain and headaches?

This is one of the most unique aspects of the Lotus Point and Full-Size Fenix Rehab Systems. Using paired therapeutic digits in sets of two or four you can apply a variety of techniques specifically for spinal pain syndromes. For example, using four angled digits you can apply low back and mid-back traction and decompression. This special technique will stretch the paraspinal muscles that cause pain, and lift separate the small joints of the spine relieving pain and pressure in these facet joints. The guidebook, video, and website for the Fenix Rehab Systems give explicit instructions on how to accomplish this technique. The Fenix ~ 'Still Point' does not have the ability to perform this and other spinal techniques.

There are also paired digit treatment to treat the paraspinal muscles that commonly cause deep spinal pain, the Multifidi and Rotatore muscles. The paired digits angle in at 65 degrees to treat these muscles on either side of the spine. This technique is also completely described in the guidebook, video, and website.

Another special technique especially helpful to those with chronic myofascial headaches is the Suboccipital Lift. Using two angled digits applied to the Suboccipital area this technique lifts and stretches the Suboccipital muscles. When these muscles contain myofascial TPs they refer pain into the head. They also shorten and contract and put traction on nerves at the back of the head. They also shorten and contract and put traction on nerves on the back of the head, thus causing many headaches. This technique is an excellent way to deactivate these myofascial TPs; it is well described in the guidebook, video, and website. The full-Size professional model also has the unique ability to utilize two therapeutic digits in a crossed pattern to actually stretch the myofascial tissue housing the trigger point.

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V. Self-care for Chronic Myofascial Pain of the Back, Neck, and Extremities

18. Dr. Fors could you demonstrate for us how to utilize the Fenix Rehab Systems to treat specific myofascial pain syndromes?

For specifics on treating the trigger points of various myofascial pain syndromes with the FENIX Rehab Systems click on the condition that is of interest to you below.

Myofascial Pain Syndrome Low Back Pain Neck Pain & Chronic Headaches

Shoulder & Arm Pain Hip Pain & Sciatica Fibromyalgia Syndrome

19. Dr. Fors, now that you have shown us how to self-treat our pain causing active and latent trigger points; is there more we can do to overcome or rehabilitate our chronic pain?

Well, the one thing I have kept emphasizing throughout the demonstration was the importance of stretching the tissues after applying any pressure massage techniques. We demonstrated many of those important stretches as we went through each area of the body in the previous demonstration. Also there is a pictorial display in the back of the Fenix Rehab System's 20 page guidebook that shows you how to stretch each area after trigger point treatment.

20. Why is it so important to stretch myofascial tissues?

Because trigger points shorten and weaken muscles, it is vital to stretch the tissues after each pressure treatment session. Each stretch should be held for 1 to 1 1/2 minutes, go slow and don't over do it. As explained earlier properly applied trigger point therapy with the Fenix Rehab Systems you actually change the myofascial tissue. You actually stretch the collagen fibers and release its cross-linkages that form in the trigger point region. Also with sustained pressure you change the ground substance from a gelatinous state to a more fluid soluble state.

All these tissue changes with trigger point therapy allow you then to slowly release the contracted muscle fibers in the taut band of the trigger point with a sustained stretch. It is this combined effort of applying trigger point therapy to all the active and latent trigger points in a muscle region, followed by a sustained stretch of the myofascial tissue that actually will rehabilitate a chronic myofascial pain syndrome.

21.If someone has myofascial pain what usually happens when someone goes to a clinician for care?

If an individual in pain is lucky enough to find a clinician who does myofascial therapy generally the following happen: The doctor or therapist will generally go in and find one or two major trigger points, pressure treat them somehow and than move on to other aspects of their care. The patient tends to feel better immediately, but because all the latent and satellite trigger points are not methodically searched out and released, their continued presence reactivate the primary active trigger points again causing the pain and stiffness to return.

There are very few clinicians that actually take the time to have the patient stretch each muscle they have released trigger points in. It is time consuming to have the patients stay in a room stretching each muscle. That's if the clinician is even aware of the importance of stretching the tissue after trigger point therapy.

22. If trigger point therapy to active and latent TPs; combined with sustained stretching of the treated myofascial tissue is so effective, why is it not utilized more?

There are many reasons as explained before; first most clinicians do not understand the full power of properly done trigger point therapy. Second, in this era of managed health care about the only way for a healthcare provider to make a good living is to see a high volume of patients. Also insurance generally does not pay much or at all for extensive myofascial therapy. So economically a doctor or therapist can not spend a great deal of time searching and treating all the active, latent, and satellite TPs and then take time to have their patients sustain stretch each muscle treated.

But, you as an educated individual utilizing an effective self-care system, such as the Fenix Rehab Systems, can take the time to properly self-treat yourself over a period of time. This is exactly why I invented this system of self-care and feel so passionate about getting it out to the 86 million adults in the U.S. suffering with chronic myofascial pain.

Its just too easy to hand out and take drugs for myofascial pain, but over 17 million are hospitalized and 17, 000 bleed to death from NSAIDs drugs. Why not start a program of self-care with one of the Fenix Rehab Systems, a program of proper trigger point therapy and sustained stretching.

23. Dr. Fors are there products out there to help people effectively stretch their myofascial tissues and relieve their chronic pain?

One very helpful product that can make your sustained stretch more effective is Biofreeze. Biofreeze works best when used after applying trigger point therapy or pressure massage to pain-causing trigger points. Either spread the greaseless, stainless gel over the muscle or utilize the spray formula to apply a mist over the muscle. Once the Biofreeze has been applied and begins to cool the tissues employ a sustained stretch to the involved muscles as per instruction included with the Fenix Rehab System.

Biofreeze is a fast-acting, deep-penetrating lone lasting herbal formula that gives pain relief from arthritis, sore-muscles, back pain and stiffness. Biofreeze contains the pain relieving exotic herb Ilex from a South American holly shrub. So effective is Biofreeze for chronic muscle pain, that FRE, Inc has included samples with each purchase of a Fenix Rehab System. For around $10.00 to $12.00 you purchase a 3 oz Roll-on Biofreeze, 4 oz tube or a 4 oz spray bottle.

There are also a couple of products that I recommend to help you fully stretch involved myofascial tissues. The StretchRite product allows you to control the tension in each stretch and adjust length to accommodate your body's length and flexibility. The StretchRite comes with an instructional manual with 20 different stretches and stretching guidelines that help you stretch safely and efficiently.

Another product called the Stretch-Out Strap with multiple position grips allow deep, gradual stretching of major muscle groups with greater safety and effectiveness. It comes complete with illustrated guide booklet of 30 stretches. I personally like the design of the Stretch-Out Strap, but I recommend both of them. They both sell for under $30.00.

 

 

 

24. Dr. Fors, you have mentioned that myofascial trigger points not only cause pain, but also weaken muscles. Is it important to strengthen these muscles?

Yes, many times if the myofascial trigger points in a muscle are multiple and long standing it may be necessary for the individual to re-strengthen the muscle; after a program of trigger point therapy and sustained stretching. Usually, I have found that once you release the active and latent trigger points in a muscle, its strength returns. But if an individual finds they are having a hard time rehabilitating their long standing myofascial pain; it may be helpful for them to re-strengthen the muscles. As always home care is only done after you have had a qualified physician rule out fractures, tumors, infections, and other pathologies as a possible cause of your chronic pain.

25. Are there also products that can assist individuals with strengthening their muscles?

There are many products on the market today called resistance tubing or exercise tubing kits. These products usually come with a flexible rubber tube of various lengths with handles attached at each end. The kits generally come with a video and/or instruction sheet showing you how to strengthen a shoulder, elbow, hip or knee joint by exercising the muscles around that joint. These products run anywhere from about $20.00 all the way up over $100.00.

There are a couple of products that I recommend for muscle rehab that are of good quality and reasonably priced. One I like that has been around about the longest, is the "Lifeline Deluxe Gym in a Bag." It come complete with a lifting bar, cable with rotator handles, door attachment, treadmill belt, carrying case, instructional poster and award-winning video. It can be purchased for around $55.00.

You can get just resistance tubing with cushioned handles and a simple instruction sheet for joint exercises made by Valeo, video instructions are not included. Not as complete a system as the Lifeline Deluxe Gym but generally sells for around $20.00, making it more affordable for those on a tight budget.

So let's say you have had a very long standing rotator cuff shoulder problem, or a chronic hip problem. You would acquire one of these exercise kits and familiarize yourself with their instructions for strengthening your shoulder or hip point. Its best to begin this strengthening program after you released most of the active and latent trigger points in the muscles involved.

26. Well, that's sounds good for extremity problems, like shoulder, elbow, hips, and knees, but what about the huge problem of chronic low back pain?

In chronic low back pain there is usually a problem with the "core stability" of the lumbar spine and pelvis. With poor core stability the muscles that need to be strengthened are the quadratus lumborum, and erector spinea muscles of the lumbar spine, along with the abdominal muscles in front. Also included in your core stability are the pelvis muscles, primarily the gluteal muscles.

The best way to strengthen these core muscles is to utilize the ever popular exercise ball with an instructional video. One of the products I recommend is the Dynaflex Exerflex Kit. This product comes with a durable exercise ball, air pump and extensive exercise video that specifically targets the core muscles. The Dynaflex Exerflex Kit sells for around $30.00.

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VI. Drug Approaches to Chronic Musculoskeletal Pain

27. Dr. Fors, thank you for showing us how easy it is to rehabilitate chronic pain problems through effective home self-care products. However, the vast majority of people with pain turn to drugs. With the recent news about Vioxx and other NSAIDs health risks, is there a natural pain-relief alternative?

Yes, many well done scientific studies have shown that nutraceuticals are safe and effective in relieving chronic pain. These nutraceuticals are combinations of natural substances-botanical medicines, herbs, vitamins, minerals in high enough quantities to affect human physiology. Nutraceuticals are based on animal and human clinical trials that have proved their safety and effectiveness. There are excellent nutraceutical formulas that can help people lessen their pain while they release the underlying myofascial trigger points with the Fenix Rehab System. These nutraceuticals can help individuals reduce or eliminate their reliance on pain meds and NSAIDs, and lower their risk to possible side-effects or addiction.

28. Dr. Fors could you explain what NSAIDs like ibuprofen do, and what are there health risks?

NSAIDs are non-steroid anti-inflammatory drugs, for example Advil, Motrin, aspirin, Aleve, Vioxx, Celebrex, Bexstra and many other prescriptions and over the-counter drugs. They primarily work by powerfully inhibit an enzymes in the body called the cyclooxygense enzyme system, or the Cox 1 and Cox 2 enzymes.

29. How do these NSAIDs drugs like Ibuprofen cause problems?

The Cox 1 and 2 enzymes in our tissues are of course involved with inflammation, however the body also uses these enzyme to protect valuable tissues or in the healing of damaged tissues. For example, Cox 1 enzymes maintain the lining of your digestive tract. This is why NSAIDs that inhibit Cox 1 enzymes such as ibuprofen will cause GI distress, gastritis, and ulcers. In fact 17,000 American bleed to death on the inside from NSAID use!

Cox 2 enzymes have been found to help maintain the healthy lining of our blood vessels. This why Vioxx was taken off the market; use of Cox 2 enzyme inhibitors has been shown to greatly increase the occurrence of heart attacks. Recently it has also been established that our Cox 2 enzyme helps in the healing of GI ulcers. Its also turns out that Cox 2 tissue enzymes are important to our kidneys. This may explain why some patients on Cox 2 NSAIDs develop problems with high blood pressure.

More importantly, a recent study by Krause, reported in Arthritis Rheumatology , showed that Cox 2 inhibiting NSAIDs may actually decrease your energy production at the cellular level. When muscle cells have decreased available energy (ATP) , this can lead to trigger point formation, as previously explained. Over time these Cox 2 NSAIDs may lower energy production in muscle cells, causing more pain and fatigue. A vicious cycle then begins, a cycle of more pain and fatigue, GI bleeding, cardiovascular disease, hypertension, and the downward cycle of your health.

Many people may ask why? Its simple, its big money! There are drug commercials every 10 minutes on television for various pain relievers which have led to sky-rocketing profits. One manufacture of a Cox 2 NSAIDs had sales of 3.1 billion dollars in 2001, that's just one drug.

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VII. How to Choose Effective Nutritional Support

30. Well you convinced me, but what are the alternatives?

First you must rehabilitate your myofascial trigger points, as explained earlier in the interview, by using quality products for self-care like the Fenix Rehab Systems. Try to deactivate all active and latent trigger points in your area of pain. Then stretch and strengthen the muscles using products like the StretchRite, Lifeline Gym, and the Dynaflex Exerflex Kit.

While your doing this self-care program start on some nutraceuticals to help you with the pain and inflammation, and lower your reliance on NSAID drugs and addictive pain medication.

31. How does an individual with chronic pain choose a nutritional supplement and why do some individuals not get the relief they seek when they try nutritional products?

First, you must be purchasing and consistently taking high-quality pharmaceutical grade nutritional supplements that have a written guarantee of their purity and potency. This guarantee of purity and potency must be stated on the label and there must be an independent third party assay that certifies the label's claims. These independent labs check for contaminants and potency of ingredients on each batch supplements manufactured. Second, the nutraceuticals you take must have been demonstrated to be effective in solid double-blind placebo controlled scientific studies please don't rely on hear say. Third, to get the relief you desire, the nutritional supplements you take must have adequate levels of the nutrients that were indicated by this research to be effective. Some individuals do take nutritional supplements and don't get the pain relief or wellness they desire. The primary reasons for this are: the levels or potencies of the nutrients in the formula are not adequate or high enough in quantity, and/or there is no scientific basis for the use of that nutrient in chronic pain conditions.

32. Dr. Fors can you give us some examples of the importance of utilizing pharmaceutical grade nutraceuticals?

Co-enzyme Q10 (CoQ) has been shown in numerous studies to be very helpful in fibromyalgia and chronic fatigue cases by improving energy production in muscle tissue. However, the studies have shown that the dosage of a highly absorbable CoQ10 supplementation needs to be at least 60 to 120mg per day. Because CoQ10 is so expensive to manufacture many formulas have less than 5mg of poor quality CoQ10, meaning many individuals would need to take 24 tablets a day to get adequate levels. So it is vital you get quality supplements with adequate levels in each tablet that can raise tissue levels to proper levels on a daily basis without having to swallow handfuls.

Another huge problem with nutritional care is that many supplements do not actually have the amount of the nutrients listed on the bottle. Glucosamine sulfate has been shown, is numerous studies, to be effective in the treatment of osteoarthritis. Because of this, this nutraceutical has become very popular. However, one recent study found that when 15 different supplement companies had their products pulled from store shelves and tested for potency, the result was dismal! Only 2 companies out 15 actually had the full amount of Glucosamine sulfate in their tablets that was indicated on their bottle label. So, unless a supplement company is a registered pharmaceutical grade, manufacturer, and they test each product leaving the plant for guaranteed potency and purity, you as the consumer have no idea if you're getting adequate levels to get the relief you desire.

33. I imagine that these Pharmaceutical grade nutraceuticals with guaranteed potency and purity cost more to manufacture?

Quality nutritional supplements can sometimes be more expensive. However, buying a supplement that does not have guaranteed potency and purity may mean your saving money by buying something that not only doesn't have adequate levels to help you but may contain contaminants. Now that's really expensive, paying for something and getting nothing or worse!

With the high cost of drugs and their potentially dangerous side-effects, your best alternative is to find nutraceutical formulas based on sound scientific research with guaranteed potency and purity. This is why I suggest pharmaceutical grade companies such as Metagenics and Vital Nutrients, which have independent third party assay's on all their products proving actual potency and purity.

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VIII. Nutrition and the Underlying Physiology of Chronic Pain

34. How do these nutraceuticals help individuals overcome the musculoskeletal pain of osteoarthritis, fibromyalgia or plain old chronic back pain?

First we need to understand what causes muscle and joint pain to become chronic in the first phase. Throughout our body in the muscle, tendons, and ligaments, we have special nerve receptors call nociceptors. These special receptors monitor these tissues and send signals to our spinal cord; if strong enough these messages are then sent on to our brain. These nociceptors signal any problems or damage in our tissues. However, it is only when these messages reach the cortex of your brain do you experience pain.

If you experience recurring chronic back or neck pain, you would have numerous trigger points in and around the muscles of your spine. When you have trigger points in muscles, tendons, and ligaments in a region, these tissues become abnormal and certain inflammatory like chemicals are released by these peripheral tissues. These noxious chemicals released by these tissues cause them to become more sensitive or "inflamed." Therefore, these trigger points are constantly sending signals to your spinal cord, but most of the time these messages do not reach your brain. Therefore, you do not experience constant active pain.

However, when you do something, lift to much, sit or sleep wrong, or come under a great deal of stress these latent or quiet trigger points become worse and actively send signals that reach the sensory cortex of your brain. When this happens you would then perceive pain. You can see now why it's so important to take the time to search out and remove all the quiet or latent trigger points in a problem area, before some physical, chemical, or emotional stress cause them to become active and create pain again.

The best way to remove these active and latent trigger points is to normalize muscles, tendons, and ligaments in problem areas. Do this by physically working on the myofascial trigger points with a Self-care Fenix Rehab System, and by helping to normalize the tissues with effective nutraceuticals. In other words, work on correcting the underlying problems instead of just covering them up with drugs.

35. Does this process relate to the problem of pain all over in fibromyalgia syndrome?

Recent research reveals that many times the pain begins in a region or two, and then by this process it will spread throughout their body. Some studies have stated that as much 45% to 60% of fibromyalgia cases started with a whiplash injury. The more sensitized peripheral tissues become the more signals the nociceptors send into the spinal cord. The more signals sent into the spinal cord, the more noxious chemicals such as Substance P are released in the spinal cord. The greater the release of noxious chemicals in the spinal cord the more sensitized your spinal cord becomes. The greater your spinal cord becomes sensitized the greater your perception of pain becomes, this is called Central Sensitization.

This Central Sensitization of the nervous system may be the underlying cause of the global pain of Fibromyalgia Syndrome. The causes of this Central Sensitization are usually a combination of genetics, physical injury, decreased energy production, exposure to stress, toxins and poor detoxification function, more on this later. These multiple causes of Central Sensitization of the nervous system are what make Fibromyalgia Syndrome so difficult for doctors to understand and treat.

There are many inflammatory chemicals that are released in painful muscles, tendons, and ligaments and released in the spinal cord in chronic pain states. A few of the primary ones are: Substance P, and the pro-inflammatory prostaglandins PgE2, and LTB4. There are nutraceuticals that can lower these noxious chemicals in chronic pain states, and help normalize pain-causing musculoskeletal tissues.

This is a very simplistic explanation of the most recent research defining what actually happens when a person develops chronic musculoskeletal pain disorders or fibromyalgia syndrome. In research it is referred to as Peripheral and Central Sensitization of the nervous system. Recently our understanding of this process has been well developed by the work of DF. Woolf and M.W. Salter, their studies can be found on a PubMed search.

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IX. Nutritional Supplements for Relief of Muscle and Joint Pain

36. Okay, now that we have a basic understanding of the cause of chronic pain, what nutraceuticals can be utilized to lessen these pain-causing chemicals, like Substance P and inflammatory prostaglandins like PgE2 and LTB4?

Again, the most important thing you can do is remove all active and latent myofascial trigger points so your myofascial tissues and spinal cord do not over produce these pain-causing inflammatory-like chemicals. This is why I emphasize Self-care with the Fenix Rehab Systems.

To assist your rehabilitation of chronic muscle and joint pain, whether osteoarthritis or fibromyalgia you can utilize high quality nutraceuticals that contain standardized extracts of the herbs like Ginger, Curcumin also called Tumeric, Hops and Rosemary.

Numerous studies have found elevated levels of Substance P in the cerebrospinal fluid of fibromyalgia patients. Substance P has been found to cause excitation of the neurons in the spinal cord leading to Central Sensitization and increased pain, according to studies by Larson (2000) and Wu (2004) . A study by Ongi (1992) found that a component of standardized Ginger naturally inhibits Substance P. Research has also found that Ginger naturally lowers PgE2 and LTB4 the noxious chemicals that cause pain.

One study by Srivastava and Mustafa (1992) on 56 patients with chronic pain found 1,000mg to 4,000mg of standardized Ginger extracts to be very helpful. Of these 56 pain patients, 28 had rheumatoid arthritis, 18 osteoarthritis, and 10 with chronic muscular pains. Of the muscle pain patients 100% experienced pain relief and 75% of the osteoarthritis patients got relief with standardized extracts of Ginger. With these results it behooves chronic pain patients to try standardized Ginger. However, remember these studies were using high dosages of 1 to 4 grams, so make sure you are getting adequate levels of guaranteed potency products.

Another highly effective nutraceutical for herbal relief of minor pain is standardized extracts of Curcumin. Research has found the herb Tumeric or Curcumin (curcuma longa) to be a strong antioxidant and the most powerful natural anti-inflammatory agent. A study for Jobin reported in The Journal of Immunology (1992) found that standardized Curcumin actually decreased nociceptor sensitization and thus reduce chronic pain.

In these studies it was found to take effect in two weeks to one month. So don't give up to early, give it time to take effect.

An excellent nutraceutical product containing Curcumin and Ginger with guaranteed potency and purity is Biospec Inflam~Rx. Each tablet contains 250mg of Tumeric, which is Curcumin and 600mg of Ginger. For chronic musculoskeletal pain or fibromyalgia usually two tablets twice daily. Remember though to give it time, two to four weeks to be fully effective. Metagenics also has a product call Inflavonoid Intensive Care, which adds the herb Boswellia another good "natural anti-inflammatory."

37. You also mentioned that herbal extracts of Hops and Rosemary were helpful in chronic pain; could you tell us more about these herbs?

I am very excited about a specific formulation of Standardized extracts of Hops and Rosemary and its ability to safety lower pain and inflammation. The formula was developed and patented by Metagenics and is called Kaprex.

A recent double-blind placebo controlled study demonstrated the ability of this nutraceutical to reduce joint discomfort by up to 72%. This formula, even though natural and herbal based, was as effective as the best selling NSAIDs. Furthermore, in this study Kaprex safely lowered the pro-inflammatory PgE2 faster than the Cox 2 drug it was compared too. Also, and very importantly, Kaprex was found to deliver powerful joint relief without the potential adverse side-effect found with NSAIDs. Animal toxicity testing of Kaprex found no treatment related effects on major organ systems, including: heart, gastrointestinal, liver and kidney, unlike the commonly used NSAIDs for pain relief. These studies found that dosages of one Kaprex three times daily, had excellent effect on lowering the inflammatory chemical PgE2.

So with Kaprex an individual with muscle and joint pain problems, now has a fast-acting, long-lasting, effective natural pain-relief product that is easy on the stomach. Kaprex is now used by over 3,000 doctors nationwide. It is one of the best ways to can get a handle on your chronic pain and inflammation while you are working on releasing your pain-causing trigger points with a Fenix Rehab System.

However, as safe and effective as Kaprex it is not something someone wants to live-on, 30 tablets costs around $24.00. The goal is to lower your pain and inflammation short term with Kaprex while you rehabilitate the underlying muscle and joint problem. To maximize your pain relief take one Kaprex every 4 to 6 hours up to three caplets per day, for maximum benefits. Once your pain level is reduced try a less expensive nutraceutical for long term use such as Inflavonoid, which costs around $12.00 for 60 tablets.

38. Are there nutritional supplements that can specifically help with osteoarthritis?

Everything we have previously discussed is very helpful in cases of osteoarthritis and mild joint inflammation. It is helpful to have a diet that is rich in fruits and vegetables, low in saturated fats and red meat, and supplemented with 3 to 6 grams of EPA/DHA Omega-3 fatty-acids. For greater pain and inflammation control you can add Standardized extracts Ginger and Curcumin combinations, such as Inflavonoid at two caplets two times daily. Or for a more powerful nutraceutical that is GI friendly and gives you excellent joint relief use Kaprex at one tablet three times daily.

(The above program should begin to give you effective, safe, natural management of your pain. For a detail explanation on the mechanisms of chronic pain and how the above nutraceuticals can naturally relieve pain and inflammation please see questions 31 to 37).

However, you can improve your odds in improving your joint function and reducing your levels of pain by using cartilage protective nutrients such as Glucosamine sulfate or Chondroitin. Numerous well done studies have shown these nutraceuticals to be very helpful in the management of osteoarthritis. These studies have demonstrated that Glucosamine sulfate can decrease pain, improve joint function and improve joint integrity, demons ratable able on x-ray. In other words, in these studies they were able to find x-ray improvement of osteoarthritis joint with Glucosamine sulfate supplementation.

Not only were these nutraceutical amazingly effective they were also safe without any toxicity or severe side-effects. Research has found that it takes at least four weeks to take effect, so don't give up to early. In some test subjects it took 3 months for Glucosamine to take effect on painful osteoarthritis joints. If you have no benefit by 6 months than stop, your joints are probably just too severely deteriorated. However, one study found objective improvement in the joint space of the arthritic joint on x-ray, even though there was no relief in pain subjectively.

It's important that you take a high enough dosage of a guaranteed potency product to get the results you desire. The suggested dosage range between 1 to 2 grams per day of the Glucosamine sulfate or HCL form. Generally 1500mg per day has been found to be effective in most research studies.

A good source is the Biospec Glucosamine 1000 with guaranteed potency and purity. The suggested dosage is one tablet two times daily for a total for 2000mg daily.

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X. The Importance of Omega-3 Fatty Acids in Health

39. Are there other supplements that can help lower pain-causing noxious chemicals such as pro-inflammatory prostaglandins PgE2 and LTB4?

Very definitely, two of the best things you can do to lessen your pain and improve your overall wellness are to perform an "oil change" on yourself and add a good Magnesium Malate supplement to your diet. The Standardized American Diet (SAD) is deficient in many things, and two major nutrients high on that list is healthy fats, especially Omega-3 fatty-acid and Magnesium.

Your cells can actually take Omega-3 fatty acids, especially EPA and DHA and produce anti-inflammatory prostaglandins. These anti-inflammatory prostaglandins you create from EPA/DHA fatty acids help you relieve pain and inflammation, promote optimal joint health, and support proper cardiovascular, nervous and immune system function. For these reasons, Omega-3 fatty acids have become very popular in the press. This has only recently increased because of numerous well done studies that have shown Omega-3 fatty acids to lower the incidence of cardiovascular disease.

40. What is the best way for someone with chronic pain to get adequate levels of EPA/DHA Omega-3 fatty acid in there diet?

One of the best sources for adequate levels of Omega-3 fatty-acids are deep sea fish. But there's a problem here, concentrating the oils of fish concentrate the levels of toxic chemicals, dioxins, PCBs and heavy metals. So it is extremely vital you get pharmaceutical grade fish oils that have been thoroughly tested and guaranteed for purity and potency.

To properly impact your muscle and joint pain problems it is vital to add a concentrated supplement of EPA/DHA Omega-3 fatty acids. Studies by Donaldson (2001) and Karatiner (2000) found a primarily vegetarian diet rich in fruits and vegetables and supplemented with adequate Omega-3 fatty acids significantly improved the quality of life of fibromyalgia patients. These chronic pain patients increased their flexibility and significantly reduced their pain in this study.

Individuals in multiple studies for chronic pain and inflammation generally receive about 3 grams of actual EPA/DHA acids per day. In some studies it was found that individuals sometimes needed take up to 6 grams of the EPA/DHA Omega-3 fatty acids to receive benefit.

Biospec makes an excellent concentrated EPA/DHA Omega-3 fatty acid supplement containing 1 gram of EPA/DHA fatty acids per 2 soft gels ingested. Individuals with chronic muscle and joint pain can take 2 capsules three times daily with meals, for a total of 3 grams of EPA/DHA. Again you must give this time to really take effect, about four to six weeks at a minimum.

41. I have heard some people refuse to take Omega-3 fatty acids because they get a "fishy" after taste with supplementation?

If you have a real problem with a "fishy" after taste with Omega-3 fatty acid supplementation, then try an enteric coated EPA/DHA supplements or try Metagenics EPA-DHA Lemon soft gels. It is another highly concentrated soft gel EPA/DHA supplement, which features a natural light lemon after taste, again dosage is suggested at 2 soft gels three times daily with meals for chronic pain and inflammation. Once you have released a great deal of your active and latent trigger points and your pain level has gone down considerably, you can cut down your EPA/DHA Omega-3 fatty acid supplementation in-half to 1 capsule three times daily. The beneficial effects of EPA/DHA Omega-3 fatty acids behooves individuals to make it part of their wellness program. However, as with any self-care program individuals should always check with their doctor before they start, especially if they are on any medications.

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XI. Magnesium Malate and Herbs for Muscle Pain, Tenderness, and Insomnia

42. Dr. Fors you also mentioned that Magnesium was commonly deficient, and can be helpful in chronic muscle pain and tenderness, could you please explain?

An excellent and inexpensive place to start for anyone having chronic muscle pain and tenderness is Magnesium Malate, which also helps with chronic fatigue. This makes it an idea nutraceutical for Fibromyalgia Syndrome as well as chronic regional back and neck pain. It is especially helpful in Fibromyalgia when its complied with thiamine B1.

The reasons for its effectiveness are many, for example Magnesium and B Vitamins especially Thiamine, support enzymes in the cellular machinery that produce our energy, the mitochondria. Magnesium also has many other vital functions. It maintains the integrity of the energy producing inner membrane of the mitochondria. The work of Kalyan in 1984 found this energy producing mitochondria to be abnormal and distorted in the muscles of fibromyalgia patients. Magnesium has also been demonstrated by Iseri work to promote the relaxation of muscle knots.

Malate works hard to bring materials into your mitochondria to be turned into the energy molecule or ATP. Malate also has an oxygen sparing effect on muscle tissue short on oxygen, allowing the tissue to still produce energy. From our previous discussions on how pain-causing myofascial trigger points are formed and maintained by decreased energy production in the muscle cell; it's easy to see why Magnesium Malate with Thiamine has shown to be helpful in Fibromyalgia Syndrome and other chronic muscle pain and tenderness conditions.

In one study by Abraham and Flecha, they found that 1,200 mg to 2,400 mg of Malic acid combined with 300mg to 600mg of Magnesium reduced muscle pain and tenderness within 48 hours in Fibromyalgia Syndrome patients. Two months later these Fibromyalgia patients still had reduced tender point index scores. In their study Bilbey and Prabhakaran stated, "Magnesium deficiency should always be included in the differential diagnosis of patients who present with persistent or severe muscle pains."

One of the very best Magnesium Malate products out there for potency, purity and absorption is Biospec Fibro~Ease. The suggested dosage is two tablets two times daily. This would give you the recommended 600mg of Magnesium and 2,400mg of Malic Acid as indicated by various research studies.

For some individuals magnesium may cause loose stools, so build your dosage up slowly to see what your bowel tolerance is. It takes time to rebuild magnesium levels in your muscles so give it time.

43. Magnesium Malate sounds like it would really help with relaxing muscles and reducing tenderness is there anything else an individual can use for muscle relaxation or to help them sleep? Sleeplessness seems to be such a big problem for some Fibromyalgia patients.

There are herbs that have been used for centuries that help individuals to relax and even achieve a deeper sleep. Valerian is an herb that acts to reduce tension and anxiety in the body. It is also an effective aid in insomnia, producing natural healing sleep. Valerian also has anti-spasmodic properties which aid in muscle relaxation.

Valerian is especially effective when it is complied with herb Passion Flower. Passion helps you to transition into a deep restful sleep without a "narcotic" hangover the next morning. It also has the ability to be very effective in relieving minor pain.

Hop is an herb that has a marked relaxing effect upon the central nervous system. This may be very helpful in countering the effects of Central Sensitization in chronic pain states like Fibromyalgia. Hops are effective in easing tension and anxiety in the body. An excellent herbal formula for muscle relaxation is MyoCalm PM by Metagenics. This nutraceutical contains Magnesium, Passion Flower extracts, Valerian Root extracts, and Hops extract of the flower and cone. The recommended dosage is three tablets at bedtime. If used during the daytime for muscle relaxation and to relieve minor aches and pains carefully follow instructions on the label and do not operate machinery or operate an automobile.

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XII. Role of Environmental toxins in Chronic Pain and Fibromyalgia

44. Dr. Fors, earlier you stated that over time physical, chemical and emotional distress can causes these chronic myofascial pain syndromes; we seemed to have covered most of the physical aspects, what about toxic chemical distress?

We live in an environment inundated with industrial chemicals, there are more than 75,000 chemicals registered with EPA that are know to be hazardous to human health. Furthermore, we add about 1,000 new chemicals each year. These chemicals are rarely fully tested and never tested in combinations with each other, the way they appear in our environment and hence in our tissues. As of the year 2000, we were pouring over 10 million tons of toxic waste into our environment each and every day!

There are now more than 500 industrial chemicals that have been found in the tissue of humans. On any simple random assay, the average individual is found to have over 100 detectable industrial chemicals in their body. These are chemicals that were not found in human tissues before 1920. This means we are now in at least the third generation of humans exposed in utero and during their childhood to these synthetic toxic chemicals, no wonder we are seeing a rise in health problems. Between the years 1965 and 1990, birth defects more than doubled and the rate is continuing to worsen.

These cocktails of industrial chemicals in our tissues take their toll on our health. They tax our detoxification systems throughout our body, especially in the liver and kidneys! But also our detoxification pathways in our muscle and nerve cells can be overwhelmed, which especially important in chronic pain.

A study by Ursin in 2001 found toxin exposure from any source will cause pain-receptors in muscle tissues to fire for a more prolonged time, causing more pain. Another study done by Bell in 1998 found that even low level toxic exposure can cause the painful condition of fibromyalgia, or make it worse if you already have it.

45. Interesting, could then the increasing number of people with fibromyalgia be a sign that our environment is becoming more toxic?

Individuals with chronic myofascial pain disorders such as fibromyalgia syndrome may be the "canaries in the cage" of our environment. Many years ago the only way miners could tell if conditions were getting toxic in a mine was to bring a canary down with them. Because of the canary's genetics, their biology made them more susceptible to toxins in the environment of the mine. If a canary became ill or died it was vital for the miners to get out immediately.

In our post-modern toxic world it may be that the growing number of our fellow citizens with chronic myofascial pain and fibromyalgia, may be our warning that we must do something soon. It may be that their genetics make them more prone to environmental toxins. Research has found that the detoxifications systems in our liver can vary 700% from one individual to another it's sometimes referred to as the "Churchill Effect."

Winston Churchill drank, smoked heavily, and lived to his nineties possibly because his detoxification pathways could render these toxins harmless, before they could much damage to his tissues. Then there are other individuals who walk into a smoke filled room and get sick. These individuals may have 7 times less detoxification capability than say Winston Churchill. Because of our toxic environment allergies are sky-rocketing, for example asthma is near epidemic. Many disorders including cancer and birth defects are now being connected to the increase of toxic industrial chemicals and heavy metals in our environment.

46. How do environmental toxins make individuals more prone to chronic myofascial pain disorders?

Remember when we discussed the formation of myofascial trigger points. To review, taut contracted bands in muscles squeeze out the blood and obstructs good blood flow. This lack of blood creates a state of low oxygen and nutrients in the muscle tissues. This creates an energy crisis in the muscle tissue, and an inability to relax the contracted tissue.

Furthermore, this lack of energy does not allow the muscle tissue to produce the enzymes necessary for detoxification of the tissues. Also energy is necessary to produce vital antioxidants that protect the muscle against free radicals. This is important because any chemical toxins not detoxified produce more free radicals or act as free radicals, so antioxidant protection is also vital in chronic myofascial pain disorders.

47. How do environmental toxins specifically cause myofascial trigger points to form?

Toxins can damage the powerhouses of our muscles cells, the all important mitochondria. Our mitochondria produce ATP which is the energy currency we use to do virtually everything. Take a breath, hug our spouse, or think a thought, ATP is demanded. We actually produce our weight in ATP every day, but of course we consume as it fast as we produce it.

Because the way our mitochondria are structured they are very susceptible to damage from toxins in our tissues. Industrial chemicals do this directly or by promoting more free radicals. Either way, the only way our liver, kidney, muscle and nerve cells can protect themselves is by producing more antioxidants and by increasing their detoxification capabilities. Nutrients such as Co-Enzyme Q10, Alpha-Lipoic Acid, Vitamin E, Milk Thistle, and NAC are excellent ways to accomplish this, but more on that later.

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XIII. Specific Nutritional Supplements for Detoxification

48. So there are ways that individuals can increase the ability to detoxify and remove toxins from their body, is fasting one of them?

No, to detoxify at this cellular level we need vital nutrients. If we fast we may rest our digestive system, but vital enzyme pathways for detoxification in our liver, kidneys, muscles, and nerves are not getting the vital nutrients they need. Not only that but we need energy to run these detoxification pathways. Therefore, to produce ATP for detoxification and ant-oxidant protection we need vital nutrients and calories.

So fasting can actually make things worse, it can even upset the balance between Phase 1 and Phase 2 detoxification systems in our liver. This imbalance actually causes us to take toxins from our environment through air, food, and water; and create even more toxic metabolites so it's vital to keep Phase 1 and Phase 2 detoxification systems in our liver balanced. Milk Thistle and Green Tea standardized extracts are excellent for balancing out our Phase 1 and Phase 2 liver detoxification, more on this later.

49. Well, if fasting is not a good way to detoxify, how do we improve our ability to remove chemical toxins?

First it's important to clean up our diet as much as we can. Get rid of junk foods, they are mostly empty calories and filled with chemicals. Remove the stimulants, the highly sugared foods, drinks, and excessive caffeine. Eat lower on the food chain, the higher you go the more concentrated the industrial chemicals tend to become. In other words, a large mammal is generally going to concentrate more herbicides and pesticides than a soybean.

It is extremely important to eat as organic as you possibly can. The less pesticides and herbicides you bring into your body the sooner you can detoxify your tissues. Once you lower the influx of industrial and agricultural chemicals into your body, you can start to specifically improve your detoxification pathways.

50. What is the best way to improve these detoxify pathways to overcome chronic pain, fatigue and fibromyalgia?

By performing a metabolic tune-up through specific nutraceuticals, utilizing a mixture of vitamins, minerals, and herbs such as those previously mentioned. These specific supplements enhance detoxification pathways and act as powerful anti-oxidants in our mitochondria, helping to protect and promote energy production. As previously stated, increasing the available ATP in our tissues promotes detoxification pathways and helps clear toxins from our tissues. Of course more available ATP in our tissues assists in releasing pain-causing trigger points and gives us more energy in general.

51. For enhanced detoxification and pain reduction how does an individual perform a metabolic tune-up utilizing specific nutrients?

What's nice about this is you get two for the price-of-one; the same nutrients can be used for improving detoxification pathways as well as increasing mitochondrial energy production, when treating chronic pain. The primary nutraceuticals shown by research to be effective are Alpha-lipoic and (ALA) , Co Enzyme Q10 (CoQ) , and Vitamin E, N-acetylcysteine (NAC) , Silymarin from Milk Thistle seed extract, and Green Tea extract.

Research has established that these nutraceuticals used in combination act as powerful anti-oxidants protecting against free radical damage to the powerhouse of the cell, the mitochondria. This functions to improve energy production in the muscles. These nutrients also improve vital detoxification pathways such as sulfation detoxification and glutathione conjugation.

A study by Parker et al (1997) found alpha lipoic-acid (ALA) raises glutathione peroxidase enzyme production and protects the energy producing inner membranes of the mitochondria. ALA dosages in fibromyalgia and chronic fatigue should reach about 300mg per day.

An excellent formula combining many of the nutraceuticals we have just listed is Biospec Mito-Detox. It has specific vitamins and minerals and herbs to promote detoxification pathways, herbs such as Milk-Thistle seed extract and Green Tea extract. Suggested dosage is two capsules twice daily.

 

52. You have mentioned how ALA works but how do other nutrients help such as NAC, Co-enzyme Q10, Vitamin E, and herbs such as Milk-Thistle, and Green Tea extracts?

Well let's take them in order N-acetylcysteine or NAC acts as a direct precursor to glutathione peroxidase enzyme systems. This is probably one of the most important detoxification and anti-oxidant system in the body. When NAC is combined with the B vitamin niacinamide it is particularly helpful in promoting: cellular energy production, joint health, and anti-oxidant protection. Biospec Mito-Detox contains a blend of NAC and Niacinamide with excellent dosage when taking one tablet twice daily. Mito-Detox is an excellent formula to take when attempting to enhance detoxification and promote healthy energy production.

If you have Fibromyalgia Co-enzyme Q10 is a nutrient you may want to add to the above formulas, especially if you want to increase energy production. CoQ10 acts as a key co-enzyme in the mitochondria's production of ATP, our body's primary energy. Recent studies have shown CoQ10 to be effective in cases of fibromyalgia and chronic fatigue. Biospec Q-Sorb 100 is a highly absorbable CoQ10. Suggested dosage would be one soft gel per day along with Mito-Detox two times per day, to assist in detoxification and enhance energy production.

Vitamin E is an anti-oxidant that works in the cell membranes, especially in the energy producing inner membrane of the mitochondria. Suggested dosages run between 200IU to 400IU depending on the condition involved. Mito-Detox contains 400IUs Vitamin E and 200mcgs of Selenium at a suggest dosage of two tablets twice per day.

Milk-Thistle seed extract containing standardized levels of the active component Silymarin is one of the best herbs for detoxification. Wellington (2001) found that silymarin increases the all important glutathione peroxidase detoxification enzyme system previously discussed. Biospec Mito-Detox formula contains 400mg Milk-Thistle extract.

The last nutraceutical I want to discuss is Green Tea extract. This herb has become quite popular lately because of its "anti-aging" effects. This would primarily come from its anti-oxidants properties and its ability to balance Phase 1 and Phase 2 liver detoxification. These combined activities greatly enhance the body's ability to rid it of toxins. If you have chronic myofascial pain or fibromyalgia, this may help to lower your levels of pain, as based on the studies of Ursin and Bell.

The primary components of Green Tea that promotes these functions are Catechins. Bu-Abbas (1994) studies found Catechins in Green Tea selectively balancing Phase 1 and Phase 2 detoxification pathways. Mito-Detox has Catechins from Green tea, Silymarin from Milk-Thistle, along with other herbs, vitamins and minerals that help with detoxification pathways and promotion of good energy production.

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XIV. Toxic Bowel in Chronic Pain and Fibromyalgia

53. Dr. Fors, a lot of individuals with chronic myofascial pain disorders, like fibromyalgia, also have Irritable Bowel Syndrome, is there a correlation?

That's a great question, and you're actually on to something very important in chronic pain disorders. Research has shown that 70% of all Fibromyalgia (FMS) patients are also diagnosed with Irritable Bowel Syndrome (IBS), that's a very high correlation for any two conditions. Canataroglu's research in 2001 pointed out that there may be an underlying shared cause for both FMS and IBS.

A very important factor that maybe underlying IBS is an imbalance of bowel flora. In other words, there is a high growth of "bad" bacteria, yeast, and other microbes and a low population of healthy bacteria in the bowel. Many people do not realize it, but you gastrointestinal tract must be populated with a very high level of beneficial bacteria for you to be healthy.

In a healthy GI tract there are actually more beneficial bacteria than there are cells in the human body. Some have jokingly asked the question; being that beneficial intestinal bacteria out number us are they here to support us or we them? In actuality a normal healthy stool should be 2/3 dead beneficial bacteria.

54. Why is this imbalance of gut bacteria so prevalent in our society?

Because of our poor Standard American Diet (SAD) and high anti-biotic use, there is a very high incidence of dysbiosis or overgrowth of "bad" bacteria, yeast, and microbes in the human gut. Its important to realize that when we take an antibiotic we are killing off the beneficial bacteria in our gut. The normal beneficial gut bacteria keep "bad" bacteria, yeast, and microbes from growing in our gut and causing problems. These beneficial bacteria also help protect the intestinal lining keeping the mucous membrane healthy, and lessening the occurrence of irritability. These beneficial bacteria supports the absorption of nutrients and enhances our immune system function. Looking at our intestine is like looking at the root system of a giant oak. Remove the beneficial bacteria from the soil and you destroy the mighty oaks ability to thrive and survive. Eventually the tree becomes sickly for no outward reason, and topples over dead.

55. How does the overgrowth of "bad" bacteria and yeast cause problems like FMS and IBS?

It turns out that dysbiosis or overgrowth of "bad" bacteria, yeast, and microbes in our gut produces toxins that effect our sympathetic nervous system causing symptoms like that of FMS and IBS. Through affecting our sympathetic nervous system these toxins from bad bacteria and yeast cause pain, stiffness, headaches, insomnia, gut irritability, and fatigue. It turns out that these toxins, like those from yeast overgrowth, can also effect our cellular mitochondrial function causing inefficient energy production. As explained earlier in our interview a decrease in ATP production in our muscle cells can lead to an increase in pain-causing myofascial trigger point formation and fatigue. This decrease in energy production from "bad" bacteria and yeast toxins in our gut, is very similar to the process previously described involving environmental chemicals and industrial toxins we are exposed to. It's the same process with the same outcome of pain and fatigue, it's just that one exposure comes from inside of our self or endogenous toxins, and another exposure comes from our outer environment or exogenous toxins. Either way you need to improve liver detoxification systems, and protect mitochondrial production of energy, both previously described in our interview. However, with a growth of "bad" bacteria and yeast in your gut acting as a reservoir of endogenous toxins, you need to first remove these "bad" bugs from your gut.

56. You have convinced me, so how does an individual remove these offending "bugs" from their gastro-intestinal tract?

Anyone who thinks they may have dysbiosis, or an overgrowth of "bad" bacteria and yeast, can verify this with a comprehensive stool analysis through their health care provider. Common symptoms are bloating, gas, diarrhea, constipation, cramping of the bowel, abdominal discomfort, headaches, fatigue, insomnia, and a feeling of sick all over.

To remove these offending agents in your gut there are effective herbals such as berberine from barberry root, or extracts or Oregano and Red Thyme. Studies by Biedsall and Kelly (1997) found berberine to have significant activity against bacteria, fungi, parasites, worms, and viruses. Berberine also inhibits toxin formation by these microbes, and they block the absorption of these toxins. There is an excellent nutraceutical for this purpose from Metagenics called CandiBactin-BR.

CandiBactin-BR helps in the removal of the "bad bugs" from a toxic dysbiotic bowel. As you are removing unwanted pathogens from your gut you want to put back in or reinoculate your bowel with beneficial bacteria. An excellent guaranteed potency dairy-free probitiotic supplement is Ultra Flora Plus DF Capsules from Metagenics.

In the removal process with CandiBactin-BR it is usually best to start out with one tablet two times daily. If the overgrowth is severe you may need to increase dosage of CandiBactin-BR slowly until you reach a maximum of two tablets three times daily. With Reinoculation dosage of Ultra Flora Plus DF Capsules is usually one capsule two times daily.

57. This sounds like it gets at the cause of the problem, but is there a natural product that can help with the symptoms of cramping and intestinal discomfort?

If you have intestinal discomfort with bowel cramping, a nutraceutical that safely and effectively promotes relaxation of the bowel and relieves symptoms of indigestion is the Metagenics nutraceutical Intesol. Intesol is a good product to naturally relieve gastrointestinal disturbances and contains herbs that have been known since ancient times to relax a cramping bowel. It contains guaranteed potency of Chamomile, Peppermint, and Lavender extracts.

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XV. Stress in Chronic Pain, Fibromyalgia, and Fatigue

58. Dr. Fors, what about stress, does it play a role in chronic myofascial pain disorders and fibromyalgia?

Yes, it plays a big role, primarily through our sympathetic nervous system. Previously, we have discussed how toxins from "bad bugs" in our gut can stimulate the sympathetic nervous system and create all kinds of symptoms: pain, stiffness, headaches, bowel discomfort, insomnia, and fatigue. You can see how these symptoms parallel fibromyalgia, irritable bowel syndrome, or just being "stressed-out." That's because these conditions involve the over stimulation of our sympathetic nervous system and adrenal gland.

When we meet up with a dangerous or emotionally stressful situation we have to be able "to fight to take flight," this is how we evolved to survive. The problem is our sympathetic nervous system can not tell the difference a saber tooth tiger chasing us, our boss yelling at us, or grid-lock on the freeway.

When our sympathetic nervous system reacts to the tiger we can more effectively run away, however we can not physically fight or run from our boss or commuting to work each day. So in these chronic situations we just stew in our own "sympathetic" juices, epinephrine and norepinephrine.

Chronic stress that can not be discharged by a "fight or flight" response causes many things: increased blood pressure, increase inflammation, increased muscle tension etc, etc. all the ills of our modern society. So its definitely connected to conditions of pain, inflammation, and stiffness, as in myofascial pain syndromes of the back and extremities, as well as Fibromyalgia.

59. So what can an individual do who has chronic myofascial pain and stress is a factor?

Well the best advice is to practice meditation of some sort. There are many good books on this subject so avail yourself to them. But there are nutraceuticals that can help an individual deal with these stress more effectively.

If an individual is "stressed and tired" a good nutraceutical to help them along is Metagenics formula Adreset. The herbs in this quality formula help to support the adrenal gland, and is helpful for anyone dealing with chronic pain