“Someone is going to have to explain these patients to me someday.”

After years of exposure to an entire world full of patients reading this website, many of whom call and write to tell me their stories, it is obvious that the worst cases of muscle pain are very severe indeed. In a few unlucky patients, trigger points (muscle knots) seem to have taken over the whole body, and probably become something altogether different in the process — a whole that is greater and nastier than the sum of its parts.

In July 2009 in Las Vegas I encountered an interesting anology to this puzzle at the Science-Based Medicine Conference. Mark Crislip, MD, an Infectious Disease specialist from Portland (and podcaster: see Quackcast), gave a superb presentation about the hypothesis of “chronic Lyme disease.” He made a strong case that it is a misnomer, a meaningless diagnosis, an overconfident attempt to define a problem that cannot actually be defined.

Some patients do seem to have some kind of post-infection meltdown. They don’t still have an infection any more in any sense that we understand infection. But someone is going to have to explain these patients to me someday.

And that is precisely how I feel about patients with unusually severe chronic trigger point pain: I don’t think that they have myofascial pain syndrome in the same sense that we understand normal muscle pain, but they clearly have had “some kind of meltdown,” and “someone is going to have to explain” them to me someday. Although these cases clearly seem to have their origins in the same kind of myofascial trigger points that Travell and Simons described so thoroughly, it is equally clear that they led to a new kind of predicament in the body, one that is much more scientifically puzzling than muscle pain.