Muscle has been considered as an ‘also ran’ structure amongst pain generators in pain literature. So much so, David Simmons who along with Janet Travell has done seminal work on myofascial trigger points and taut bands had to lament that “Muscle is an orphan organ, and no medical specialty claims it “As a result muscle pathology has been largely ignored by doctors who deal with pain and worse still, it is simply outsourced to physiotherapists.

This is because inordinate importance has been given to the nerves and nervous system in pain literature regarding the causation, transmission and perception of pain. While the nerves sense and conduct pain impulses to the central nervous system for the pain to be perceived, they are not primary pain generators. As such, the sensory nerves are just passive conduits of pain, but most of the interventions in pain management target the nerves of somatosensory nervous system or the sympathetic ganglia of the autonomic nervous system. This is the reason why currently, pain is only “managed” rather than being relieved in “Pain management centers” across the globe.

The epidural steroids, nerve blocks and radiofrequency procedures address nerves which are only the pain messengers, to relieve only one half of pain. The other half of pain resides in the damaged tissues mainly muscles and is left untreated allowing the pains to return after the respite from neural procedures wears off.

After 20 years of relieving chronic pain conditions, Ashirvad understanding is that muscle is nature’s building block of pain expression and is the final common expressor of ALL chronic pains.

1. Neuropathic pains are all neuromyopathies and express themselves as muscle knots
2. Joint pains express themselves via muscle knots because joint and muscles have reciprocal innervation (Hilton’s Law)
3. Visceral organic pains are expressed via the knots in muscles of abdominal oval formed by muscles of the back and abdominal wall.
4. Bone and meningeal pains are expressed by forming knots in surrounding muscles.
5. Finally, muscles are themselves vulnerable to injury and inflammation to cause myofascial pains due to overuse, abuse, disuse and nutritional deficiencies.

Thus, muscle treatments like ultrasound guided dry needling and Botox are essential if one wishes to relieve pain rather than just manage it. When these treatments are combined with nerve and sympathetic ganglion blocks for somatic and visceral pains, radiofrequency procedures for nerves, joint injections, the 2 important contributors to pain, the muscles causing the pain and the nerves that carry the pain information to brain both get addressed to achieve lasting pain relief. Muscle currently the blind spot of chronic pains is actually the philosophers stone that reverses all pains