Bernard E. Filner, M.D., Pain Medicine, Rockville, MD


The following alphabetical list of terms is meant to offer brief descriptions of pains and conditions for general understanding. It is not meant to take the place of a personal medical examination as given by a physician, as a true evaluation of symptoms and conditions are subject to each person’s unique experiences, practices, and personal physical health.

Back pain afflicts four out of five people in the U.S. at least once in their lives, according to the Mayo Clinic, and is the most common reason for a visit to the doctor. While not always the case, the most common cause of back pain is muscular injury or dysfunction. Most cases are not correctable with surgery. Studies by a local HMO and other organizations have shown that nearly 70% of back surgery patients are the same or worse after surgery. Our approach to muscular pain may help you avoid surgery or help ease pain after surgery.

Carpal tunnel syndrome is caused by the compression of the median nerve at the wrist, which may result in pain, weakness, or numbness in the hand and wrist. Dr. Filner has had excellent results in diminishing pain and improving mobility and strength by using a MicroLight laser treatment approved by the FDA in 2002.

Diabetic neuropathy refers to nerve disorders caused by diabetes. Symptoms can include pain, tingling, or numbness in the hands, arms, feet, and legs. Nerve problems can occur in every organ system, including the digestive tract, heart, and sex organs. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health estimates that up to 70% of diabetics have some form of neuropathy. Risk rises with age, duration of diabetes, and poor maintenance of blood sugar. The pain can be eased significantly, however, if diagnosed and treated early.

Facial pain or temporomandibular dysfunction (TMD) is often enigmatic and requires trying different treatment approaches until the best is found. We have found that our medical approaches combined with working with knowledgeable dentists, who can create and adjust a proper splint, have been the most successful in relieving many TMD problems. TMD problems should be distinguished from temporomandibular joint (TMJ) problems, which involve the internal function of the jaw joint, rather than the muscular mechanisms outside the joint. The following are frequent symptoms of TMD:

  • stiff jaw muscles
  • pain that travels through the face, jaw, or neck
  • limited movement or locking of the jaw
  • painful clicking or popping in the jaw
  • a change in the way the upper and lower teeth fit together


Fibromyalgia syndrome (FMS) is a severe musculoskeletal pain and fatigue syndrome that afflicts approximately 3 to 6 million Americans. FMS is now believed to be a disease of the central nervous system. In susceptible individuals, the thalamus (located in the brain) processes pain differently, causing the sufferer to develop an excess sensitivity to even normal stimuli, which are perceived as pain (turning over in bed, a brief hug, etc.). All FMS patients have myofascial pain (MFP), although not all MFP patients have FMS (Wallace and Clauw, 2005; Simons, Travell, and Simons, 1999; Lichtbroun, Raicer and Smith, 2001).

The Pain Center uses specialized treatments to reduce both the myofascial pain and the thalamic hypersensitivity to allow FMS patients to function more fully, sleep better, and exercise—all of which help to reduce FMS.

Headache and migraine pain have similarities and differences, but not all severe headaches are migraines. Headaches are frequently myofascial in nature and there is also a myofascial component to migraine pain. Any type of severe headache can cause nausea and/or vomiting, as well as sensitivity to light and/or sound (like migraines). True auras, however, are limited to migraines. Migraine pain can be reduced in frequency and severity by treating the myofascial component.

Heel pain is sometimes associated directly with plantar fasciitis, an inflammation of the plantar fascia at the bottom of the foot. True plantar fasciitis can be treated with the posture control inserts discussed on the Postural Modifications page of this site. However, heel pain often can be referred pain from muscles in the back of the calf or occasionally from the hip area, and is not actually plantar fasciitis or heel spurs. These referred pain cases should be treated with appropriate therapy, such as low-level laser or microcurrent, for trigger points in these involved muscles. A careful evaluation is required to determine the actual cause, as an incorrect diagnosis may lead to unnecessary, and unhelpful, treatment, such as steroid injections into the foot for pain originating in the back of the calf or the hip. Foot exercises and the use of posture control inserts we describe can help minimize a recurrence.

Myofascial pain syndrome accounts for a vast majority of soft-tissue pain conditions. (see chapter 2 of David G. Simons, Janet G. Travell, and Lois S. Simons, Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual, Volume 1: Upper Half of Body (2nd Edition, 1999, Williams & Wilkins).

This syndrome comes from active trigger points and their referred pain. Trigger points are painful areas along a taut band in an affected muscle that when palpated, usually produce a “twitch” response. Active trigger points are easily identifiable by patients and often refer pain to other areas, as well as cause tightness and decreased range of motion of that muscle. Latent trigger points cannot usually be identified by the patient. The affected muscle is tight, with a decreased range of motion, and predictable referred pain patterns can be seen. Once all trigger points in a functional unit (neck, shoulder, hip, etc.) are inactivated, use of moist, deep heat and appropriate stretching exercises will usually complete the treatment, leaving little or no pain. As the program proceeds, the muscles return to their normal resting length and the myofascial pain is resolved.

Neuropathic pains include trigeminal neuralgia, carpal tunnel syndrome, diabetic neuropathy, and pudendal neuralgia, as well as numerous entrapment syndromes (such as greater occipital neuritis, a cause of headaches and facial pain; and piriformis syndrome, a cause of sciatica; and others) in which all or part of a nerve is entrapped by a tight muscle with active trigger points. Sometimes the nerve pain goes away when the entrapment is relieved; other times medications are needed.


Overuse or repetitive motion injuries (RMI) are a family of muscular conditions that result from repeated motions performed during the course of normal work or daily activities. Examples of RMI include tennis elbow (tendonitis) and golfer’s elbow, among others. RMIs are caused by too many uninterrupted repetitions of an activity or motion; unnatural or awkward motions, such as twisting the arm or wrist; overexertion; incorrect posture; or muscle fatigue. RMIs occur most commonly in the hands, wrists, elbows, and shoulders. The disorders begin as myofascial pain and can be treated (before it becomes tendonitis) with the same treatment as other trigger points, that is, with heat and stretching, and the inactivation of the trigger points.

Pelvic pain includes pudendal nerve entrapment, vulvodynia, as well as generalized pelvic pain.

  • Pudendal nerve entrapment (PNE) or pudendal neuralgia is caused when the pudendal nerve in the pelvis is entrapped by tight muscles or ligaments. The pain, which can include prickling, stabbing, burning, and numbness, is worse while sitting. Patients often report a sense of a foreign object in the urethra, vagina, or rectum. In addition to pain, symptoms can include sexual dysfunction, impotence, and anal and urinary incontinence.
  • Vulvodynia literally means pain in the vulva. It is characterized by itching, burning, stinging, or stabbing in the area around the opening of the vagina. It may be related to pudendal nerve entrapment or myofascial trigger points of muscles in the upper thigh or lower abdomen.
  • Generalized pelvic pain is frequently related to myofascial trigger point pain and/or reference zone pain. Pelvic pain can also be caused by ovarian, uterine, or prostate pathologies that may need to be ruled out.

Don’t give up hope. Although these conditions are exquisitely painful, we have made significant progress in reducing the pain using microcurrent treatment, low-level laser light treatment, and/or trigger point injections. Surgery should be a last resort.

Shoulder pain or frozen shoulder frequently results from immobilization of the shoulder (e.g. when in a sling) and is rarely the result of adhesive capsulitis. It is most often the result of trigger points in the shoulder muscles. We have had success treating this condition, using our approach to treat myofascial pain, although it may take months to resolve.

Trigger points. The term “trigger point” was coined in 1942 by Dr. Janet Travell to describe a clinical finding with the following characteristics:

  • Pain related to a discrete, irritable point in skeletal muscle or fascia that is not caused by acute local trauma, inflammation, degeneration, tumor, or infection.
  • The painful point can be felt as a band in the muscle, and a twitch response can be elicited on stimulation of the trigger point.
  • Palpating the trigger point reproduces the patient’s complaint of pain, and the pain radiates in a distribution typical of the specific muscle with the trigger point.
  • The pain cannot be explained on the basis of standard anatomy or somatic nervous system findings on neurological examination.

There are two major types of trigger points:

  • Active, which are easily identifiable by patients, and often refer pain to other areas, as well as cause tightness and decreased range of motion of that muscle, and
  • Latent, which cannot usually be identified by the patient. The involved muscle is tight, with a decreased range of motion and predictable referred pain patterns can be seen.

For more information on trigger points, see myofascial pain syndrome.