Frida Kahlo, the Mexican Heroine of Pain (La Heroina del Dolor)

This Feature Image depicts the beautiful and talented painter, Frida Kahlo (on left).  It also shows one of Frida’s famous paintings called ‘The Broken Column’ that embodies her own severe pain and suffering (on right).

Feature Image sourced from:


Dear Pain Matters blog readers,

I was first ‘introduced’ to the famous Mexican artist, Frida Kahlo, by my own beautiful daughter, Sarah, who invited me to watch the movie ‘Frida’ with her.

Diminutive in stature, Frida was larger than life itself.

Known for her talent as a Surrealist painter, Frida is a beloved cultural icon in Mexico.

Sadly, Frida endured a spate of tragedies that resulted in lifelong chronic pain including excruciating back pain.

Born to a German father and a mestiza* mother on 6 July 1907, Frida was stricken with polio when she was about 6.  Polio caused her right leg and foot to be severely damaged and left her with a permanent limp.

Sadly, polio was not the only tragedy in Frida’s life.

Quoting Frida:   

‘I suffered two grave accidents in my life.  One involved a bus, the other is [husband] Diego.’


In addition to polio, tragedy struck on 17 September 1925 when Frida was only 18.  While returning home from Mexico City with her then-boyfriend, the wooden bus that they were travelling in crashed into a tram.

During this bus accident that involved multiple fatalities, a steel handrail smashed Frida’s pelvis and was impaled through her left hip, belly and womb, exiting through her genitals.

Needless to say, Frida’s injuries were severe and horrific and included fractures in her back, collarbone and two ribs.  Her lower spine and pelvis were both broken in 3 different places while her left shoulder was out of joint.  Frida’s polio-deformed right leg had eleven (11!) fractures and her right foot was dislocated and crushed (Rogers, 2009).  (Wow!  Imagine going through all that!!)

Amazed that Frida barely survived this terrible bus accident, doctors (correctly) predicted that she would never have children.

Instead, chronic pain would become her ultimate companion.

To distract herself from the boredom of 2 years of bed rest including months in a plaster corset to hold her body in place, Frida started to paint extensively and with great passion.

It was at this stage in her life when Frida decided to become a painter instead of a doctor.


On 21 August 1929, Frida married Diego Rivera, a chronic cheater during his previous relationships.  At 42, Diego was 20 years older than Frida, overweight and very big.  Diego was also a well-travelled and famous painter whose friends included Picasso, Modigliani and Trotsky.


Wedding photo of Frida and Diego

Source of Image:

Pinterest and

Whilst in love, their relationship was a turbulent one that included a year-long divorce.  Diego continued with his many extramarital affairs.

Deciding to ‘fight fire with fire’, Frida indulged in her own extramarital affairs (including an affair with her husband’s friend, Trotsky) while also exploring intimacy and sexuality with other women.

While trying to have a baby with Diego, Frida had to abort a pregnancy because of health issues pertaining to her bus crash in 1925.  She also suffered a miscarriage in 1932 (Espinoza, 2007).

(Whilst it would be interesting to explore Frida’s vivacious and colourful love life, this is outside the scope of this blog.  See references below including Lisa Waller Rogers for further details.)


Frida endured more than 30 operations after her severe bus accident until her death in 1954.  This included 7 spinal operations, one that involved a 2nd spinal fusion because the wrong vertebrae were fused during an earlier operation.  Frida also had her right leg amputated (see below).

Frida’s increasing pain levels meant that she could only paint for short periods of time.

Frida’s health issues only worsened with time.  Her rigid medical corset no longer supported her failing spine and she had to undergo radical spinal and leg surgery.

In 1953, her right leg had to be amputated below her knee due to gangrene that may have resulted from a previous surgery.

Sadly, Frida, the Mexican Heroine of Pain (La Heroina del Dolor), died on 13 July 1954, having turned 47 only one week earlier.


‘The Broken Column’ (1944)

When looking at her painting, ‘The Broken Column’ (shown earlier and below), people often assumed that Frida was a Surrealist painter.  In actual fact, Frida expressed her own reality that included severe pain in the ‘The Broken Column’.

In her words,

‘They thought I was a Surrealist, but I wasn’t. I never painted dreams. I painted my own reality.’

‘My painting carries with it the message of pain.’

Thus, Frida used her painting, The Broken Column’, to express her own excruciating pain and suffering.


‘The Broken Column’ (Frida Kahlo, 1944)

Source of Image:

As seen here, repeated spinal surgery had confined her body in a rigid corset apparatus.  Despite holding her broken body together, her corset appears very tight, uncomfortable and restrictive.

Frida’s spinal column appears to be cracked, broken and injured in many places.

The nails embedded throughout her body clearly show the severity of her pain and suffering.

Frida shows herself as being alone in a barren wasteland.  This further adds to a sense of hopelessness, helplessness, emptiness and despair.

Despite all her pain, suffering, sadness and vulnerability, Frida exudes beauty, elegance, femininity and dignity in ‘The Broken Column’ (Peters, 2002).

‘Tree of Hope’ (1946)


‘Tree of Hope’ (Frida Kahlo, 1946)

Source of Image:

Despite bed rest and wearing a steel corset for 8 months following yet another spinal surgery, Frida’s health issues including sharp pains in her back became worse.

In response to her severe back pain and deteriorating health, Frida painted the ‘Tree of Life’.      

Although Frida is seen weeping in this painting, she is hopeful for a recovery from her recent spinal operation.  The Spanish words ‘Cielito Lindo’ (‘Tree of Hope, keep strong’) appear on a flag in her right hand.  This flag has a red tip that looks like a surgical instrument stained with blood.  Frida holds a pink orthopaedic corset in her left hand.     

Frida is also seen under anaesthetic in hospital and bleeding from fresh surgical wounds following her spinal operation.

In the background, the landscape looks forlorn and barren without a trace of hope.  There are 2 large fissures in the dry earth that mirror the 2 gaping wounds in Frida’s back.

Quoting Frida, this painting was ‘nothing but the result of the damned operation!’


Frida leaves behind a legacy of her paintings despite suffering, and perhaps because she suffered, from chronic pain during most of her life.

I hope that you find Frida’s story inspirational, in particular, her passion for art, life and love despite enduring severe and debilitating chronic pain.

Sabina Walker

Blogger, Pain Matters (in WordPress)

* A mestiza is a person with indigenous and European ancestry.


Peer-Reviewed Articles

(1) Courtney, Carol A et al; Frida Kahlo: Portrait of Chronic Pain. Physical Therapy (1 January 2017); 97(1): 90–96.

doi: 10.2522/ptj.20160036

(2) Antelo, Fernando. Images of Healing and Learning- Pain and the Paintbrush: The Life and Art of Frida Kahlo. American Medical Association Journal of Ethics – Virtual Mentor(May 2013); 15(5): 460-465.

doi 10.1001/virtualmentor.2013.15.5.imhl1-1305

Media, Blogs and Newspaper Articles

(1) Courtney, Carol A. Frida Kahlo’s life of chronic pain.

(2) Espinoza, Javier. Frida Kahlo’s last secret finally revealed. The Guardian – Australia Edition (12 August 2007).

(3) Walter, Natasha. Feel my pain. The Guardian – Australia Edition (21 May 2005).

(4) Sykes, Alan. Frida Kahlo and Diego Rivera at the Bowes Museum. The Guardian – Australia Edition (11 May 2012).

(5A) Frida Kahlo and Diego Rivera – Love and Pain.  Art Gallery of NSW (25 Jun – 23 Oct 2016).

(5B) Verghis, Sharon. Frida Kahlo: artistic genius and queen of pain. The Weekend Australian (18 June 2016).

(6) Mantalvanos, Soula. Frida Kahlo: Portrait of Chronic Pain. Pudental Nerve – Soula’s Chronic Pelvic Pain Story (25 August 2016).

(7) neurophilosophy. Frida Kahlo’s life of pain. Science Blogs(24 January 2008).

(8) Siqueira-Batista, Rodrigo et al.Art and pain in Frida Kahlo. Rev. dor – São Paulo (April/June 2014); 15(2).

(9) Peters, Katie. Frida Kahlo’s Self-Portraits – The Broken Column (1944). Virginia Commonwealth University(2002).

(10) Kelley, Wes. The Painful Life of Frida Kahlo: How Injury Led to Inspiration.

Medium(14 Oct 2016).

(11) Medrut, Flavia. 17 Frida Kahlo Quotes to Inspire You to Turn Pain Into Beauty. Goalcast (28 November 2017).

(12) Exploring Frida Kahlo’s Relationship With Her Body

(13) Brown, Amy. Frida Kahlo – An Amazing Woman (1907-1954)


(14) Collins, Amy Fine. Diary Of A Mad Artist. Vanity Fair (3 Sept 2013).

(15) Frida Kahlo

(16) Frida Kahlo Corporation

(17) Frida Kahlo – Paintings, Biography, Quotes

(18) Katz, Neil. Frida Kahlo Biography: Medical Mystery, Controversial Death. CBS News (6 July 2010).

(19) Rogers, Lisa Waller. Lisa’s History Room – Where the Past is Always Present (26/27 May 2009).

Frida’s First Bad Accident.

Frida Kahlo’s Other Accident.

Frida Kahlo: A Few Small Nips.

Many other fascinating blog posts by Lisa Waller Rogers are offered here:


(1A) Frida. A Hollywood production by Miramax directed by Julie Taymor (2002; 123 minutes).

(1B) Frida, Naturaleza Viva. A Mexican film directed by Paul Leduc (1983).


(1) La heroine del dolor (heroine of pain).

Article in German

(1) Rothenfluh, Anna. Frida Kahlo: Die Frau, die den Tod auslachte. Watson (14 Jan 2018). 



What Do Three Wise Men Bearing Gifts Have In Common With Pain Relief? (The Answer: Frankincense/Boswellia.)

Feature Image sourced from:


Dear Pain Matters blog readers,

After a close friend credited Boswellia and targeted exercise for complete relief of his severe acute back pain, I was inspired to blog about this amazing pain-relieving extract.

Boswellia serrata extract is widely appreciated for its therapeutic effects on inflammation, arthritis and pain.

Also known as frankincense oil or olibanum, the Boswellia serrata extract is produced from gum resin (a.k.a. oleogum resin) obtained via incisions in the trunk of the Boswellia serrata tree that commonly grows in India.

Most people are familiar with the story of the three wise men bearing gifts of gold, frankincense and myrrh for the Baby Jesus on the eve of his birth in Bethlehem.

In addition to Christianity, frankincense is also highly regarded by other religions and cultures including by Jewish, Muslims, Indians, Egyptians and Greeks.

But did you know that the Boswellia serrata extract can also offer significant pain relief?  Specifically, the resin from the Boswellia serrata tree may be effective in treating chronic pain including osteoarthritis, soft tissue rheumatism, low back pain, gout, rheumatoid arthritis and inflammatory bowel disease.

Boswellia treatment can lead to enhanced movement and mobility as well as reduced inflammation.  Reduced leucocyte infiltration in the knee joint and decreased release of pro-inflammatory mediators occurs following daily Boswellia intake.

Boswellia serrata extract may be a viable alternative to non-steroidal anti-inflammatory drugs (NSAIDs), with fewer severe side effects (Abdel-Tawab et al, 2011; Pawar et al, 2011).


(1) A Study Involving Boswellia-Treated Knee Osteoarthritis Patients

A study involving 70 knee osteoarthritis patients was done to evaluate the effectiveness and safety of a Boswellia serrata extract called 5-Loxin®.  Specifically,  5-Loxin® (100 mg or 250 mg) or a placebo was offered daily for 90 days.  Pain and physical function assessments were made on Days 0 (baseline), 7, 30, 60 and 90.

Pain levels and physical function were significantly improved in treated patients regardless whether 100 mg or 250 mg 5-Loxin® was offered.  It is noteworthy that patients who received the higher dosage enjoyed substantial pain relief and other benefits within only 7 days of treatment.

Boswellia serrata-treated patients also had decreased levels of the cartilage-degrading enzyme, matrix metalloproteinase-3.  Reduced pro-inflammatory mediators in the synovial fluid may lead to improved knee joint health including less cartilage damage in osteoarthritis patients (Sengupta et al, 2008).

(2) A Second Study Involving Boswellia-Treated Knee Osteoarthritis Patients

An Indian study involving 30 knee osteoarthritis patients was done to ascertain the efficacy, side effects and safety of Boswellia serrata extract.  Specifically, 15 patients were offered Boswellia serrata while the remaining 15 patients were given placebo treatment for 8 weeks.  The second half of the study involved switching the 30 patients to the opposite intervention for a further 8 weeks.

All Boswellia serrata-treated patients enjoyed decreased knee pain, reduced knee joint swelling, enhanced knee flexion and increased walking distance.

While minor gastrointestinal side effects may arise in some patients, Boswellia serrata extract may be an effective treatment option for knee osteoarthritis and other arthritic conditions (Kimmatkar et al, 2003).

(3) An Indian Study Involving Boswellia For Osteoarthritis  

An Indian trial led by Raychaudhuri and her colleagues evaluated the efficacy of the Boswellia serrata extract enriched with a form of boswellic acid in osteoarthritis patients.  The researchers concluded that Boswellia serrata can reduce pain and improve knee joint function in as little as 7 days (per Indian newspaper article).


Boswellia serrata extract may be effective in treating chronic pain, arthritis and osteoarthritis.  Its therapeutic effects are achieved via dampening of the inflammatory response.  

Boswellia serrata extract may be a viable alternative to NSAIDs, with fewer severe side effects.

What could be better than this??

Sabina Walker

Blogger, Pain Matters (in WordPress)

PS Please feel free to share your personal experience with Boswellia serrata extract via this blog.

Also feel free to share this post on Facebook and other social media.



(1) Schultz, Colin. There’s More to Frankincense and Myrrh Than Meets the Eye. (24 Dec 2014).

(2) Blanco, Julia. Boswellia New Studies Show Effective Pain Relief. Life Extension Magazine (December 2014).


Clinical Cases and Studies 

(1) Sengupta et al. A double blind, randomized, placebo controlled study of the efficacy and safety of 5-Loxin for treatment of osteoarthritis of the knee. Arthritis Res Ther. (2008); 10: R85.

(2) Kimmatkar et al. Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee–a randomized double blind placebo controlled trial. Phytomedicine (Jan 2003); 10(1): 3-7.

(3) Indian herb hope for arthritis relief. The Telegraph Calcutta. (4 Aug 2008); Page 7.
(4) Not discussed in this blog post:

(A) Kizhakkedath et al. Clinical Evaluation of an Herbal Formulation, Rhulief®, in the Management of Knee Osteoarthritis. Osteoarthritis and Cartilage; 19 (Supplement 1): S145-S146.

(B) Kizhakkedath et al. Clinical evaluation of a formulation containing Curcuma longa and Boswellia serrata extracts in the management of knee osteoarthritis. Mol Med Rep. (Nov 2013); 8(5): 1542-8.

Underlying Mechanisms

(1) Pawar et al. Physico-chemical standardization and development of HPTLC method for the determination of β-boswellic acid from Boswellia serrata Roxb. (exudate). Int J App Pharm (2011); 3(1): 8–13.

(2) Hamidpour et al. Frankincense (乳香 Rǔ Xiāng; Boswellia Species): From the Selection of Traditional Applications to the Novel Phytotherapy for the Prevention and Treatment of Serious Diseases. Journal of Traditional and Complementary Medicine (2013); 3(4): 221-226.

(3) Ammon. Modulation of the immune system by Boswellia serrata extracts and boswellic acids. Phytomedicine (Sept 2010); 17(11): 862-867.

(4) Siddiqui. Boswellia Serrata, A Potential Antiinflammatory Agent: An Overview. Indian J Pharm Sci (May-June 2011); 73(3): 255–261.

(5) Abdel-Tawab et al. Boswellia serrata: an overall assessment of in vitro, preclinical, pharmacokinetic and clinical data. Clin Pharmacokinet. (June 2011); 50(6): 349-69.

Hyperbaric Oxygen Therapy for Pain

Feature Image sourced from:

Dear Pain Matters blog readers,


Hyperbaric oxygen therapy (HBOT) involves the delivery of 100% oxygen at increased atmospheric pressures inside a pressure chamber.

Pressures greater than normal air pressure (i.e. 1 Atmosphere Absolute, or 1 ATA) may be offered by trained personnel.  Many patients are exposed to 2 to 2.4 ATA per session.  Each session may last 1.5 to 2 hours and patients may complete a total of 20 to 30 HBOT sessions.

For those of you who have scuba dived, free dived or snorkelled, 2 ATA is the pressure that one would feel 10 meters (33 feet) under the ocean.  Thus, every 10 meters (33 feet) of sea water is equivalent to an increase of 1 ATA of pressure.



Also called hyperbaric medicine or hyperbaric treatment, HBOT can increase oxygen concentration, reduce inflammation and decrease the number and sensitivity of tender and painful points.

This is a cute 2-minute video of a dog inside a pressure chamber (with great background music):

Hyperbaric oxygen therapy can alleviate chronic pain in:

  • Complex regional pain syndrome;
  • Fibromyalgia;
  • Myofascial pain syndrome;
  • Idiopathic trigeminal neuralgia;
  • Migraines and cluster headaches; and
  • Other pain conditions (Yildiz et al, 2006; Yildiz et al, 2006; Efrati et al, 2015)

as well as reduce pain following crush injuries.



A 41-year old man, ‘G.G.’, suffered from Complex Regional Pain Syndrome Type 2 (CRPS Type 2), left foot, caused by a traumatic ‘Weber B’ left ankle fracture that occurred more than a year ago on 21 February 2014.  Specifically, G.G. slipped and fell on ice in a parking lot at the end of a working day.  He immediately suffered severe pain in his left ankle and foot.

Two days later, on 23 February 2014, G.G. had surgery involving open reduction internal fixation of his ankle.  Complications set in including a cellulitis infection that was treated with antibiotics.

Post-surgery, G.G. endured ongoing and severe pain including intermittent shooting pains and severe electric shocks in his left ankle and foot.  Other symptoms included allodynia, swelling, temperature changes and discoloured skin in the left lower limb.

Despite undergoing a rehabilitation program and taking pain medication including pregabalin (75 mg twice daily), acetaminophen and NSAIDs (as needed), multivitamins, calcium, magnesium and glucosamine, G.G.’s severe pain persisted.

A diagnosis of CRPS, left foot, was made in April 2014.

On 5 February 2015, almost one year after his injury, G.G. had surgery to remove the plateau in his left lower limb in an effort to relieve his pain.  Sadly, G.G.’s symptoms including pain and allodynia, swelling, purple discolouration, lower skin temperature as well as muscle weakness in his left lower leg and ankle continued.  With average pain levels at 6 that often rose to 8, G.G. described his pain as (quoting) ‘constant, dull, aching pain with intermittent shooting sensations’.   

Desperate for some pain relief, G.G. decided to try HBOT for his CRPS in his left foot.

After 15 HBOT sessions over 3 weeks, G.G. had significantly less pain and allodynia, reduced swelling, enhanced skin colour and improved range of motion in his left foot.  Following 3 weeks of HBOT, G.G. was able to return to work after more than a year off due to severe left foot pain.

Hyperbaric oxygen therapy may be a valuable therapeutic option for treating chronic CRPS (Katznelson, 2016).


A 44-year old woman had CRPS, left foot and ankle.  Her foot and ankle had restricted range of motion, appeared cyanotic and was tender and cool upon touch.

Within only 15 minutes of her first HBOT treatment, she enjoyed complete pain relief in her foot!  Furthermore, her foot felt warm on palpation and (quoting her) ‘pinker than it’s been in years’.  The foot remained pink and warm for 8 hours.  Best of all, she enjoyed nil pain for 18 hours after her first HBOT treatment!

Following amendments to her second HBOT session on the following day, her foot became pink and warm for 1 hour as well as painless for 2 hours.

Further adjustments made to her third HBOT protocol in the following week resulted in her foot remaining painless, warm and pink for 30 hours (!) (Peach, 1995).


A double-blind, randomized, placebo-controlled study compared 37 CRPS patients who had HBOT treatment against 34 CRPS patients who received normal air (Control Group).  All 71 CRPS patients underwent 15 sessions inside a hyperbaric chamber.

The HBOT-treated patients enjoyed significantly less pain and edema as well as enhanced range of motion of the wrist. 

Hyperbaric oxygen therapy may offer pain relief, decreased swelling and improved range of motion in CRPS patients (Kiralp et al, 2004).


A study involving 60 women aged 21 to 67 who suffered fibromyalgia for more than 2 years underwent 40 HBOT sessions.  These 90-minute sessions were offered 5 days a week and each session involved 100% oxygen at 2 ATA.  Hyperbaric oxygen therapy led to significant improvement in all fibromyalgia symptoms including improved quality of life (Efrati et al, 2015).


A study evaluated the effects of HBOT on 20 patients with myofascial pain syndrome (MPS) compared to 10 patients in the control group.  The patients in the HBOT group were offered 10 HBOT sessions over 2 weeks.

There were no complications following hyperbaric oxygen therapy.  The pain threshold was significantly improved as were visual analogue scale (VAS) scores in patients in the HBOT group.  

The researchers concluded that HBOT may offer benefits for patients with MPS (Kiralp et al, 2009).


Patients with severe nerve facial pain (i.e. idiopathic trigeminal neuralgia) were offered HBOT sessions for 10 consecutive days.  Specifically, 42 patients aged 40 to 70 (8 men, 34 women) who suffered trigeminal neuralgia for 2 to 20 years were selected for this study.

The researchers concluded that HBOT treatment offered quick, dose-dependent and lasting pain relief.  Thus, HBOT may be an effective treatment for some nerve pain conditions including trigeminal neuralgia (Gu et al, 2012).


Female migraine sufferers were offered either:

  • 100% oxygen and nil pressure (control group); or
  • Hyperbaric oxygen therapy comprising 100% oxygen and pressure.

The HBOT-treated migraineurs enjoyed some pain relief.  Pain levels remained unchanged in the control group.  

Hyperbaric oxygen therapy may reduce the intensity of migraines and headaches (Wilson et al, 1998).


Due to their traumatic nature, crush injuries can result in severe injury and pain to various body regions.  Crush injuries can range from minor contusions to limbs facing amputation due to tissue necrosis.

Crush injuries may affect different tissue regions including skin, subcutaneous layers, muscle, tendons, ligaments, cartilage, vasculature including capilliaries, nerves, bones and joints.  Physical trauma can lead to prolonged swelling and edema, stasis and/or internal bleeding including bleeding within myofascial envelopes.  The latter may lead to increased tissue fluid pressure in the skeletal muscle compartment.

Affected tissues may become ischemic due to hypoxia if the tissue fluid pressure (edema) exceeds the capillary perfusion pressure to the muscles and nerves inside the skeletal muscle compartment.

Ongoing edema may result in increased pressure as well as severely compromised microcirculation and limited or nil oxygen transfer across the capillary endothelium.  This may ultimately lead to ischemia and hypoxia.

Complex regional pain syndrome, skeletal muscle compartment syndrome and other painful conditions may develop and/or limb amputation may occur if urgent and effective treatment to prevent hypoxia and ischemia following crush injury is not provided.

Thus, time is of the essence that appropriate treatments are undertaken to reduce localised inflammation and swelling.

Importantly, hyperbaric oxygen may be used as an adjunct treatment to reverse ischemic and hypoxic conditions in crush injuries.


Note:  This section is written for scientifically-minded readers, and may be skipped altogether by others who may not be so inclined. 

Animal research shows that HBOT blocks the production of tumor necrosis factor (TNF)-α in rats with chronic constriction injury.  Reduced TNF-α levels may lead to decreased nerve pain (Li et al, 2011).  Local overproduction of TNF-α, on the other hand, may play a role in promoting CRPS (Walker and Drummond, 2011).

Many chronic pain conditions include an inflammatory component that may lead to tissue hypoxia, ischemia and microvascular deficits (i.e. inflammatory hypoxia).  Re-oxygenation of injured or diseased tissues is a prerequisite before regeneration can occur.  Therapies such as HBOT may promote tissue re-oxygenation, reversal of inflammatory hypoxia and regeneration (Perdrizet, 2017) that may lead to pain relief.

Ten divers (9 males, 1 female) underwent pressures of 1, 2, 3 and 4 ATA in a supine position for 10 minutes per pressure in a hyperbaric chamber.  The Spanish study found that as the pressure increased, heart rate (HR) decreased and heart rate variability (HRV) moved into the high frequency range, especially after 2, 3 and 4 ATA.  Pressure-evoked increased HRV is indicative of enhanced parasympathetic (vagal) activity  (Barbosa et al, 2010).  Increased parasympathetic activity including enhanced vagal tone may lead to reduced pain, decreased inflammation and other medical benefits (Walker and Drummond, 2011).

Researchers recently suggested that nerve cells may actually communicate via mechanical pulses instead of electric pulses (Fox, 2018).  If true, is it possible that increased atmospheric pressures via HBOT inside a pressure chamber may lead to increased mechanical pulses?  If so, could this result in increased cutaneous sympathetic vasoconstrictor activity?  If yes, could this induce tissue re-oxygenation and reversal of inflammatory hypoxia in some pain patients including CRPS patients?  Research is warranted.


Hyperbaric oxygen therapy may offer pain relief for some pain patients.

Please ensure that HBOT is done under medical supervision only and by trained personnel.  Refer to References for complications that may arise from HBOT. 

Sabina Walker

Blogger, Pain Matters (in WordPress)

PS Please feel free to share your personal experience with HBOT via this blog. 



(1) Undersea and Hyperbaric Medical Society (UHMS). Hyperbaric Oxygen Therapy Indications, Thirteenth Edition (April 2014).

ISBN 978-1930536-73-9


Complex Regional Pain Syndrome

(2A) Katznelson. Successful Treatment of Lower Limb Complex Regional Pain Syndrome following Three Weeks of Hyperbaric Oxygen Therapy. Pain Research and Management (2016); Volume 2016, Article ID 3458371, 4 pages.

(2B) Peach G. Hyperbaric oxygen and the reflex sympathetic dystrophy syndrome: a case report. Undersea Hyperb Med. 1995; 22(4): 407–8.

(2C) Kiralp et al. Effectiveness of hyperbaric oxygen therapy in the treatment of complex regional pain syndrome. J Int Med Res. (May-June 2004); 32(3): 258-62.


(3) Efrati et al. Hyperbaric Oxygen Therapy Can Diminish Fibromyalgia Syndrome – Prospective Clinical Trial. PLoS ONE (26 May 2015); 10(5): e0127012.

Myofascial Pain Syndrome

(4) Kiralp et al. A novel treatment modality for myofascial pain syndrome: hyperbaric oxygen therapy. J Natl Med Assoc. (Jan 2009); 101(1): 77-80.

Idiopathic Trigeminal Neuralgia

(5) Gu et al. Hyperbaric oxygen therapy attenuates neuropathic hyperalgesia in rats and idiopathic trigeminal neuralgia in patients. Eur J Pain. (2012); 16(8): 1094–105.


(6) Wilson JR, Foresman BH, Gamber RG, Wright T. Hyperbaric oxygen in the treatment of migraine with aura. Headache. 1998; 38(2): 112–5.

Crush Injury

(1) Crush Injury, Compartment Syndrome and Other Acute Traumatic Ischemias. Undersea and Hyperbaric Medical Society (UHMS).

Other Pain Conditions

NB The following 2 papers are not discussed in this blog post:

(7A) Yildiz et al. Hyperbaric oxygen therapy in chronic pain management.  Curr Pain Headache Rep. (May 2006); 10(2): 95-100.

(7B) Yildiz et al. Pain management and hyperbaric oxygen therapy. Therapy (2006); 3(5): 597–603.

Possible Complications

(1) Complications of Hyperbaric Oxygen Treatment.  Johns Hopkins Medicine,148

Why Might Hyperbaric Oxygen Therapy Offer Pain Relief? 

(1) Li et al. Hyperbaric oxygenation therapy alleviates chronic constrictive injury-induced neuropathic pain and reduces tumor necrosis factor-alpha production. Anesth Analg. (Sept 2011); 113(3): 626-33.

(2) Perdrizet. Chronic Diseases as Barriers to Oxygen Delivery: A Unifying Hypothesis of Tissue Reoxygenation Therapy. Adv Exp Med Biol. (2017); 977: 15-20.

(3) Barbosa et al. Effect of hyperbaric pressure during scuba diving on autonomic modulation of the cardiac response: application of the continuous wavelet transform to the analysis of heart rate variability. Mil Med. (Jan 2010); 175(1): 61-4.

(4) Sabina Walker, Peter D. Drummond; Implications of a Local Overproduction of Tumor Necrosis Factor-α in Complex Regional Pain Syndrome [Review Paper, 24 pages]; Pain Medicine (Dec 2011), 12 (12), 1784–1807.

(5) Fox, Douglas. The Brain, Reimagined. Scientific American (April 2018); 318(4): 60-67.


Can the Butterfly Enzyme (ie Serrapeptase) Reduce Chronic Pain, Swelling and Inflammation?

Feature Image sourced from:

Getty Images and

Dear Pain Matters blog readers,

A couple of years ago, I sat next to an elderly lady in her 80’s during a flight between Los Angeles and San Francisco.  The woman told me that she used to have severe pain in both knees.

Then one day, the woman heard about serrapeptase for chronic pain.  After taking serrapeptase on a daily basis, she no longer has knee pain.  Because there were no side effects, she intended to take serrapeptase for the rest of her life.  Since no prescription was required, serrapeptase can be purchased online or in specialty health shops.

Struggling to keep up with her as I said goodbye (and I jog daily!), I took notice of her fast stride as she quickly walked out of the airport terminal.  She said she was in a big hurry as her friends were waiting for her at the cruise ship terminal!

After listening to her amazing story about serrapeptase’s beneficial effects on her knee pain and after watching her race out of the airport terminal, I decided to dedicate a blog post to her favourite pain medicine, serrapeptase.


So what exactly is serrapeptase?

The saliva of silkworms contains an enzyme called serrapeptase.  This enzyme is secreted by friendly bacteria called Serratia sp. E-15 that live in the intestines of silkworm.

The serrapeptase enzyme is sometimes called the silkworm-butterfly enzyme, silkworm enzyme or (my personal favourite) butterfly enzyme.  Scientifically, it may also be called serrapeptidase, serratiopeptidase, serratiapeptase, serralysin and serratia E-15 protease (the latter named after the bacteria from which it was first isolated).

Serrapeptase’s principal function is to break down and dissolve dead cocoon tissue during the silkworm’s transformation into a butterfly.  Serrapeptase plays a significant role in dissolving the non-living (‘avital’) proteins that make up the strong silk threads of the dead cocoon.

Serrapeptase’s strong protein-dissolving capabilities enables the silkworm-turned-butterfly to finally break loose from its old cocoon tissue (instead of remaining stuck in there forever).




Researchers found that when taken orally on an empty stomach, serrapeptase is absorbed by the small intestine where it enters the bloodstream.

Serrapeptase facilitates the breakdown of cellular debris and dead proteins within the bodily fluid and certain biofilms (via proteolysis).  It can dissolve proteins including fibrin in blood clots, arterial plaques and scar tissue.  Excess scar tissue near injury sites can often lead to pain, limited range of motion and nerve blockages.

NB Research is warranted whether serrapeptase’s deleterious effects on fibrin could alleviate certain painful conditions including endometriosis.

It reduces swelling, inflammation and pain as well as enhances tissue repair and regeneration.

The enzyme promotes the drainage of excess fluid including mucous via its anti-edemic effects hence improving sinusitis and other mucousal conditions.  It can reduce or eliminate cysts (e.g. breast cysts, ovarian cysts).

Serrapeptase does not target proteins in living tissue.  As such, it does not pose any risk to healthy tissue or cells.

There are no known side effects pertaining to serrapeptase intake (unlike non-steroidal anti-inflammatories that often causes gut wall damage and other adverse effects).



More details on serrapeptase are provided in the following video:


(1) Amba Carrington 

Amba Carrington (28) suffered severe stabbing pain in her lower back following a motorbike accident 6 years earlier.  One day, Amba’s doctor suggested that Amba try serrapeptase (SP-Zyme).  Six (6) weeks later, Amba was completely pain-free.  Quoting Amba:

‘For years, I took strong prescription painkillers and had injections to relax my back muscles, but nothing cut out the pain effectively … I was unable to drive, walk long distances or exercise. The pain was crippling and wiped me of energy. It was horrible – I felt like an old woman.’

‘… after a few days, I felt my back pain easing off, and after ten days, it had gone completely. I can barely believe it, but today I am free from chronic pain.’

(2) Jann Barry

A patient named Jann suffered ongoing pain and stiffness due to rheumatic arthritis (RA)  diagnosed 2 years earlier.  

Jann started taking Serraenzyme (250,000IU) 8 months ago.  His dose during the first 2 months was 6×250,00IU daily.  This was decreased to 4×250,000IU/day during the next 2 months, and further reduced to 2×250,000IU/day for the last 4 months.

Quoting Jann,

‘The change in me is nothing short of miraculous. Apart from a bit or morning stiffness, I have no pain what so ever.  A fungal infection in both my big toenails, which [until now had] responded to nothing … , disappeared within the first month.  My nails, which spent 80 years splitting, peeling and breaking, are now like steel tallons – well almost! I actually have to file them down every day.

I now have 5 friends on Serraenzyme and I’ll be on it for the rest of my life.’

(3) Other Serrapeptase Stories

Chronic Pain Relief – Serrapeptase Testimonial Video (3-minutes)

This patient’s back pain as well as neck and shoulders pain is now ‘dramatically reduced … feels better’ (quoting patient) after only 1 week of serrapeptase (refer to 1:14 minutes on).

Benefits of Serrapeptase – 3 Amazing Serrapeptase Testimonial Videos (3-minutes)


Given its anti-inflammatory, anti-edemic, proteolytic and fibrinolytic effects, serrapeptase is increasingly being considered as a safer alternative than non-steroidal anti-inflammatories by patients suffering from pain and inflammation.

Serrapeptase can reduce swelling and fluid (edema) at wound and infection sites as well as decrease mucus and other secretions at mucosal membranes (e.g., ear, nose, throat).

Athletes often take serrapeptase as a supplement to treat injuries and prevent swelling after surgery.

Subject to medical supervision, pain patients including patients with arthritis and localised edema are encouraged to try serrapeptase for pain relief (given very little or nil side effects).

Could the silkworm become one of humankind’s new best friends??

Sabina Walker

Blogger, Pain Matters (in WordPress)

PS Please feel free to share your personal experience with serrapeptase via this blog. 



(1) Tiwari. The role of serratiopeptidase in the resolution of inflammation. Asian Journal of Pharmaceutical Sciences (May 2017); 12(3): 209-215.

(2) Al-Khateeb and Nusair. Effect of the proteolytic enzyme serrapeptase on swelling, pain and trismus after surgical extraction of mandibular third molars. Int J Oral Maxillofac Surg. (March 2008); 37(3): 264-8.




Many science papers are provided in this link.


(1) Amba Carrington – Lower Back Pain Patient 

Stephens, Anastasia. How silkworms can end back pain. Daily Mail.

(2) Jann Barry – Back Pain Patient

(3) Lea Verity – Tempero-Mandibular Joint Patient (not described in blog) 

Hilary Freeman speaks to Lea Verity whose life has been transformed by Serrapeptase. Daily Express (5 February 2002 – extracts).


(1) Tehrani, Mona. Das Schmetterlings-Enzym: So gut ist Serrapeptase für deine Gesundheit. Elle ().

(2)  Serrapeptase



‘The Biggest Health Scandal Affecting Women Since Thalidomide’ – Can Surgery to Remove Vaginal Mesh Reduce Severe Pain Following Failed Mesh Implants?

Feature Image of an assortment of implantable pelvic mesh devices sourced from:

Dear Pain Matters blog readers,

This blog post aims to offer hope, inspiration and courage to those women who suffer from severe and ongoing pelvic pain due to failed vaginal mesh implant surgery.

Pelvic mesh implant surgery was often recommended when conservative treatments for prolapse, incontinence and other pelvic conditions failed.


Source:  Stocktrek images via Getty Images

Many women were ill-advised of the high risks associated with mesh implant surgery including severe and disabling pelvic pain.

In November 2017, the Therapeutic Goods Administration (TGA) in Australia finally banned 45 pelvic mesh devices including vaginally-implantable prolapse mesh devices and certain mesh slings following the international pelvic mesh fiasco (McCarthy, 2017).


Patients suffering from severe pain and other serious complications due to failed mesh implants may explore whether mesh removal surgery (i.e. mesh excision) is a viable option to remove all or part of the mesh implant.

A French Mesh Removal Study

A French mesh removal study revealed that mesh can be removed both safely and efficiently in many patients, with operating times averaging only 21 minutes.  (NB Some mesh removal operations may require several hours to perform.)

Specifically, 61 of 83 mesh patients underwent complete mesh removal.  Fifty-eight (58) mesh excisions were done more than 2 years after the mesh was implanted in the first place (Marcus-Braun and von Theobald, 2010).

A Dutch Mesh Excision Study

A Dutch study analysed 73 patients who underwent partial or complete mesh excision.  Seventy-seven percent (77%) suffered severe pain including vaginal pain, pain during intercourse and abdominal, back, buttock and/or leg pain prior to mesh removal.

Thirty (30) patients had complete mesh removal while the remaining 43 patients underwent 51 partial mesh operations.

Positive outcomes were achieved for most of the 73 patients.

Specifically, 70% of the patients who underwent complete mesh excision and 60% of those who had partial mesh excision enjoyed COMPLETE RELIEF from mesh-related symptoms (Tijdink et al, 2011).

Catie’s Story

The following is a story about Catie in New Zealand who underwent 3 operations in an effort to remove all mesh.

Catie’s pelvic mesh was initially implanted without incident.  However, 2 years later, (quoting Catie) ‘[the mesh] was rotting and eroding inside …’, causing pain and discharge.  At first, Catie was treated for a potential STD (which wasn’t the case at all) via ‘many courses of metronidazole’, an antibiotic with terrible side effects.

Several years later in March 2011, Catie finally underwent her first mesh removal surgery.  The partial mesh excision took 5 hours because (in Catie’s words) ‘[the mesh] was so ‘stuck’ on in bits and the surgeon had a lot of difficulty getting it out’.

By August 2012, Catie had 2 more excision surgeries.

After her third (and hopefully final) excision surgery that involved ‘a good clean out’ and a D&C, (quoting Catie) ‘there [was] no revolting discharge and … no pain’.

In Catie’s view, it may be another year or more before she will have fully recovered.  She credits her mesh removal surgeon for being wonderful.

Formerly a triathlete, Catie is struggling to become active again.  Nonetheless she is grateful for feeling better after a very long and painful journey.

Catie’s Story:


ALL WOMEN, both young and young-at-heart, should be DISCOURAGED from undergoing surgical mesh implants in the first place.  Full stop.  End of story.

The high risks and serious complications can be catastrophic, post-mesh implant surgery.  Mesh implants can cause permanent, disabling and incapacitating pelvic injuries as well as severe, intractable pelvic pain.

Quoting Jan Wise (who now suffers from back and leg pain thanks to a botched implant surgery involving a pig intestine pelvic mesh device in 2012):

‘[I am] rotting from the inside … shooting electrical shock pain from my lower body up through to my head … hoping the thoughts of the nightmare won’t take up too much of [every] day. I allow myself only one period of sadness and crying per day’ (McCarthy, 2017).

Post-implant, in addition to severe pain, Jan suffers ongoing incontinence, a collapsed vagina, (quoting Jan) ‘putrid seroma discharge’ and ‘pelvic discharge with a foul smell’ as well as loss of intimacy with her husband.  In her words, It’s a dreadful mess down there.’

Some women require pain killers and benzodiazepines as well as regular catheterisation (due to a lost ability to urinate following a failed implant).  Many suffer chronic incontinence together with ongoing urinary tract and vaginal infections, discharge and granulomas.  Others require enemas for chronic bowel problems.  Punctures or lacerations of vessels, nerves, bladder, urethra, bowel, organs and other structures may occur.  Mesh implants often erode into the vagina rendering sex impossible with their husbands or partners.  

In some instances, exposed mesh may even cause pain and injury to the male partner during intercourse (McCarthy, 2017; Stern, 2017 – in German).

Sadly, the list of mesh-related severe complications seems to never end.

One Canadian mother of two young children has died at only 42 due to complications including heart failure and sepsis following pelvic mesh surgery to treat childbirth-induced incontinence (McCarthy, 2017).  


Chrissy Brajcic (deceased at only 42 following mesh implant complications)


Believing to be too great a burden to their family and friends and after giving up hope altogether, other patients commit suicide to end it all (McCarthy, 2017).

If chronic pelvic pain prevails, the only effective treatment may be surgery to remove the implanted mesh (see above).  Unfortunately, it may not always be possible to remove all of the mesh without damaging nearby organs and tissues.  In other words, there may be residual mesh that is too risky to remove.


Options to try before even thinking about the unthinkable vaginal mesh implant surgery include:

Non Invasive Options

  • Pelvic floor exercises, also known as Kegel exercises (named after Arnold Kegel, a US gynaecologist).  Kegel exercise can be taught and supervised by a physiotherapist, and done daily at home (Ward, 2018);
  • Yoga and pilates that aim to strengthen the pelvic regions.
  • Incontinence pads (many women opt for this non-invasive option);
  • Substitute action sports (e.g. soccer, tennis) for gentler physical activities that may lead to less ‘leakage’ … and don’t stress if there is residual ‘leakage’.  After all, that is what incontinence pads and showers are for; and
  • Maintain a healthy diet and ensure good quality of sleep.  This is important for optimum autonomic nervous system function including high vagal output throughout the body including in the pelvic region.

Surgery Without Mesh Implant

  • Surgery that does not involve mesh implants.

In conclusion, please avoid vaginal mesh implants altogether.  The risk is too high that severe pelvic pain and other serious injuries may result, post-mesh implant.


An Australian Senator, Derryn Hinch, stated that ‘Transvaginal mesh is one of Australia’s  greatest medical scandals’ (Marwick, 2017).  

Others call it ‘the new thalidomide’.

Legal class action suits all around the world including more than 100,000 American women clearly demonstrate the unacceptable risks of vaginal mesh implants, with legal bills expected to exceed $20 billion.

The risks of mesh surgery including disabling pelvic pain, compromised or non-existent sex life, loss of enjoyment of life, suicide and death certainly outweigh any possible benefits.

To protect all women in the future, mesh implant operations should be banned altogether (McCarthy, 2017).

Finally, women currently affected by pelvic pain caused by mesh implants should be considered for mesh reversal surgery (assuming this is in the best interest of the patient).

Sabina Walker

Blogger, Pain Matters (in WordPress)

PS If you believe that this information may help someone, please share this blog post via Facebook, etc.

And please tell this person to never, ever give up!


Hope for Mesh Patients

Medical Papers and Articles – Corrective Surgery to (Partly or Fully) Reverse Failed Vaginal Mesh Implants

(1) Marcus-Braun, N and von Theobald, P. Mesh removal following transvaginal mesh placement: a case series of 104 operations. Int Urogynecol J. (April 2010); 21(4): 423-30.


(2) Tijdink et al. Surgical management of mesh-related complications after prior pelvic floor reconstructive surgery with mesh. Int Urogynecol J. (Nov 2011); 22(11): 1395-404.


(3) Stetson, Diana. Vaginal Mesh Excision. Department of Obstetrics and Gynecology, von Voigtlander Women’s Hospital, Michigan Medicine (May 2018).

(4) Transvaginal Mesh Removal. Colorado Women’s Health, University of Colorado Hospital.

A Patient Who Underwent Several Excision Surgeries to Remove All Mesh 

(5) Catie’s Story:

Real Kiwis, Real Stories. New Zealand – Mesh Down Under

Media – Failed Vaginal Mesh Implant Stories  

Alison Blake (Suicided Following Botched Mesh Implant) 

(1) McCarthy, Joanne.’There was a look in her eyes’: Mother’s emotional torment at surgery nightmare. Sydney Morning Herald (20 December 2017).

Chrissy Brajcic (Deceased At Only 42 Following Failed Mesh Implant) 

(2A) McCarthy, Joanne. Canadian woman Christina Lynn Brajcic dies after receiving pelvic mesh implant. Sydney Morning Herald (4 December 2017).

Please watch 2-minute video of Chrissy’s sad surgical mesh story (now deceased at only 42 following mesh-related complications).

(2B) Marsden, Harriet. Vaginal mesh campaigner ‘dies of sepsis after antibiotic-resistant infection’. Independent (4 December 2017).

Jan Wise, A Mesh Implant Pain Sufferer  

(3A) McCarthy, Joanne. Pelvic mesh victim speaks out about ‘one of the greatest medical scandals in Australian history’. The Herald (23 March 2017).

Please watch 3-minute video of Jan’s tragic surgical mesh story.

(3B) McCarthy, Joanne. Pelvic mesh victim speaks out about ‘one of the greatest medical scandals in Australian history’. The Herald (23 March 2017).

Other Articles and Stories from Media

(4) Marwick, Jane. Why aren’t we talking more about one of Australia’s greatest medical scandals? The Daily Telegraph (29 August 2017).

(5A) Marsden, Harriet. The biggest NHS scandal you’ve never heard of only affects women, but men should be just as concerned. Independent (5 August 2017).

(5B) Marsden, Harriet. Panorama investigation reveals medical company failed to fully inform doctors of vaginal mesh risks. Independent (11 December 2017).

(6) Moss, Rachel. What is A vaginal mesh implant? Government to launch audit into complications. Huffington Post (30/1/2018).

(7) McCarthy, Joanne. Pelvic mesh left a man ‘stabbed’ during sex, regulator warned. The Herald (17 March 2017).

(8) McCarthy, Joanne. Australian pelvic mesh victims launch their case against Johnson & Johnson. The Herald (4 July 2017).

(9) Moodie, Claire. Vaginal mesh implants: Gynaecologist urges proactive response to health concerns. ABC News (4 July 2017).

(10) McCarthy, Joanne. Johnson & Johnson pelvic mesh doctor said he would not want his wife to undergo procedure, Federal Court told. Sydney Morning Herald (5 July 2017).–johnson-pelvic-mesh-doctor-said-he-would-not-want-his-wife-to-undergo-procedure-federal-court-told-20170704-gx4i27.html

(11) Sansom, Kath. Vaginal mesh left me in agony. When will women’s health be taken seriously? The Guardian (27 April 2017).

(12) Pelvic implant lawsuit underway in Sydney. 9 News (4 July 2017).

(13) Smith, Leesa. ‘Vaginal mesh implant has destroyed my life — it’s just so hard to go on’. News (11 May 2017).

(14) For Donna’s, Catie’s, Helen’s and other mesh victim’s stories, please see:

Real Kiwis, Real Stories. New Zealand – Mesh Down Under

Please note:  Catie’s story involving complete mesh removal may offer hope to other mesh patients.

Pelvic Mesh Support Groups

(1) Australia – Mesh Down Under

(2) New Zealand – Mesh Down Under

Kegel Exercises For Weak Pelvic Floor Muscles

(1) Ward, Mary. A weak pelvic floor can mean more than a little leakage. Sydney Morning  Herald (18 June 2018).

In German

(1) Wenn die Vagina plötzlich zubeißt. Stern (21 March 2017).–wenn-die-vagina-ploetzlich-zubeisst–7377994.html







The Colour of Pain

Feature Image sourced from:

Dear Pain Matters blog readers,

Here is some exciting news:

Neuroscientist Professor Mark Hutchinson at The University of Adelaide in Australia recently revealed that a novel blood test can diagnose chronic pain within minutes.


Professor Mark Hutchinson, The University of Adelaide

Called the ‘painHS’ test and available in 18 months, this novel blood test relies on hyperspectral imaging analysis (light measurement tools) to identify certain molecular structures and colour ‘biomarkers’ associated with ongoing pain.  Mark and his team observed that immune cells give off a different natural colour in the presence of chronic pain, compared to in its absence.


Credit: Haridy, 2018

Patients suffering from persistent pain and unable to communicate their level of pain (e.g. babies, dementia patients and severely disabled patients) may be amongst those who will benefit from this blood test.

Quoting Mark,

‘This gives us a brand new window into patients’ pain because we have created a new tool that not only allows for greater certainty of diagnosis but also can guide better drug treatment options.’

‘We are literally quantifying the colour of pain.’

Whilst this blood test will never replace valuable information obtained from pain questionnaires, self-resports and patient discussions, it will likely be a useful adjunct for pain diagnosis and treatment (ANZCA, 2018).

What an exciting development!!

Sabina Walker

Blogger, Pain Matters (in WordPress)


(1) Breakthrough Blood Test Reveals Colour of Chronic Pain. ANZCA (6 May 2018).

(2) Haridy, Rich. Revolutionary New Blood Test Can Instantly Identify Chronic Pain. New Atlas (7 May 2018).

(3) Snook, Julie. Breakthrough blood test reveals chronic pain in colour. 9news (6 May 2018).

(Includes a 2-minute video)



‘Poking Long Pointy Needles’ – Needling Including Ultrasound-Guided Needling of Myofascial Trigger Points for Pain Relief

Feature Image Credit: Studio Musculoskeletal

Dear Pain Matters blog readers,

Recently, I had the honour and pleasure of meeting one of Vancouver’s most respected pain clinicians, Dr Gillian Lauder, pediatric anesthesiologist, complex pediatric pain physician and director of the Acute Pain Service in the Department of Pediatric Anesthesia at BC Children’s Hospital.

I first heard about Dr Lauder’s work after reading an inspirational story about a young girl named Anaïs Poirier whom Dr Lauder had successfully treated for CRPS.  After a full recovery from CRPS, and in response to a question about who her hero was, Anaïs replied:

‘That’s an easy one! Dr. Lauder, because she saved my life. I know pain doesn’t kill you, but it takes everything away from you.’

Giving a Voice to Children who Suffer from Chronic Pain

Dr Lauder has also published a book called Complex Regional Pain Syndrome (CRPS) Explained – For Teenagers, By Teenagers (available in Amazon).

Over coffee, Dr Lauder and I discussed various topics including needling of myofascial trigger points for pain relief.

Inspired by Gillian’s comments, today’s blog post is dedicated to needling of myofascial trigger points – with or without medication or saline only injections – for pain relief.



The objective of needling of myofascial trigger points is pain relief as well as enhanced movement and mobility.

Needling techniques vary and may include:

  • Dry needling (aka non-injection needling);
  • Pharmaceutical injection needling including lidocaine and corticosteroid injection needling; and
  • Saline only-injection needling (see future blog post on myoActivation, developed by Dr Greg Siren).

Trigger points are identifiable via:

(1) Clinical examination including manual palpation – to feel densified tissue regions;

(2) Ultrasound imaging – to locate hypoechogenic areas in muscle (more later); and

(3) Thermal analysis (more later) (Cojocaru et al, 2015).

A study by Stecco et al (2013) suggested that excess hyaluronic acid may be a contributing factor for trigger points.

Presumably, needling of trigger points (that also leads to the ‘local twitch response’) results in release of excess hyaluronic acid as well as reduced pressure and inflammation in the immediate surrounding area.

Some definitions:

Dry needling (aka non-injection needling or nonacupoint needling) means that needles without saline or medical injections (e.g. without lidocaine and other anaesthetics, corticosteroids or botox) are used to target myofascial trigger points.

Myofascial active trigger points are sore, hypersensitive/hyperirritable, palpable hard nodules (‘tender points’, or ‘knots’) located within the myofascia that surrounds a taut band of skeletal muscle.  Compression of these trigger points may result in pain as well as motor and autonomic dysfunction.  Local pressure or stretch of tissue may also activate trigger points.

Referred pain is pain that may radiate from trigger points into larger areas that may even be remote to trigger points.

What exactly is dry needling of myofascial trigger points?:

Insertion of needles into palpable nodules (ie rapid, brief mechanical stimulation of active trigger points) in the myofascia results in an involuntary spinal reflex.  Specifically, trigger point needling elicits a sudden involuntary muscle contraction (local twitch response) in the taut band.

Local twitch responses in superficial trigger points can easily be seen while twitch responses occurring more deeply may only be visible via real-time ultrasonography.

Once a local twitch response is elicited, deactivation of the trigger point occurs and myofascial tension relief, reduced pain and improved musculoskeletal function result.  

Twitch responses may also be achieved during non invasive treatments including transcutaneous electrical stimulation, manual compression of trigger points and massage.

NB Twitch responses are not the same as muscle spasms.  Whilst the entire muscle is involved in both cases, the twitch response refers to a small spontaneous twitch only, and not an entire muscle contraction (as in muscle spasms).    


(1) Ultrasound-Guided Trigger Point Needling for Myofascial Pain  

A Ukrainian study involving 133 myofascial pain patients compared ultrasound-guided versus non-ultrasound-guided trigger point needling.  Average pain levels were 7.2 and 7.4, respectively, prior to dry needling treatment.

Ultrasound scanning was done to precisely identify myofascial trigger points.

Dry needling was performed over 2 – 4 session to inactivate all trigger points.  Steel acupuncture needles (28 gauge) were used during dry needling treatments.

This study found that ultrasound-guided trigger point needling led to enhanced pain relief by evoking a greater number of local twitch responses.  Specifically, pain levels dropped from an average of 7.2 to 1.1 within 24 hours following ultrasound-guided trigger point needling.  This compares to average pain level decreases from 7.4 to 2.7 in the non-ultrasound-guided dry needling group (Bubnov and Wang, 2013).

(2) Ultrasound-Guided Trigger Point Needling (Including Medication Injection) in Patients with Chronic Chest Wall Pain Following Surgery    

Eight patients (7 women and 1 man; mean age = 56; 47 to 74) suffered severe chest wall pain (serratus anterior muscle pain syndrome) for 1 to 3 years, with pain levels ranging from 7 to 10.  The chest wall pain had started after surgery for lung cancer (n=2), cardiac surgery (n=2) and total mastectomy (n=4).

Once the trigger points in the serratus anterior muscle were identified, all 8 patients were offered 1 – 3 injections over 3 months.

Ultrasound-guided injection of medicine into the infiltration sites was performed to deactivate the trigger points.  Medication comprised lidocaine, bupivacaine and triamcinolone.

Ultrasound-guided trigger point injection treatment resulted in reduced pain levels (down to 3 or 4) in all 8 patients shortly after the first injection as well as 55% less pain (on average) after 3 months.   

(3) A 29 Year Old Female with Myofascial Pain Syndrome

A 29 year old female patient (let’s call her ‘Annie’) suffered myofascial pain syndrome in her left orofacial region for 3 months (pain rating up to 9).  Annie’s pain was dull, diffuse and ongoing.  Her pain affected her left ear and pre-auricular region, extended to her left temporal area and was accompanied by a headache.  Annie’s pain increased while chewing food and she was unable to open her mouth widely.  Her quality of sleep was also affected.

Following palpation, myofascial trigger points over her masticatory and suboccipital muscles were identified as well as referred pain to her left ear and a taut muscle band.  

Annie was offered 3 deep dry needling sessions over a week to deactivate the myofascial trigger points in the orofacial muscles.  

During Annie’s 1st appointment, the exact locations of her myofascial trigger points were identified via palpation of the affected muscles.  Thereafter, dry needling of her sternocleidomastoid and masseter using a 25 mm stainless steel needle was done.  The needle was positioned perpendicular to the trigger points before performing the ‘lift and thrust’ maneuver to evoke the local twitch response.  

During her 2nd appointment, Annie stated that half of her pain was gone and that her headache was now significantly reduced!  She was also able to open her mouth wider.  Dry needling of her lateral pterygoid (via a 40 mm needle), temporalis (via a 13 mm needle) and deep masseter muscles was performed resulting in a local twitch response in the masseter.

On her 3rd visit (on the 7th day), Annie finally had NIL pain!  There was no pain following palpation of the sternocleidomastoid, masseter, digastric and suboccipital muscles and her myofascial trigger points were no longer tender.  Her headache had disappeared shortly after her 2nd session and she was now able to open her mouth widely. 

Complete resolution of Annie’s myofascial pain syndrome via needling demonstrates the benefits of dry needling in patients with non-dental orofacial pain (Asha et al, 2015).

(4) A 40 Year Old Male with Myofascial Pain Syndrome

A 40 year old man suffered posterior thigh pain despite massage therapy, chiropractic adjustments and physical therapy.  Myofascial pain syndrome in the quadratus femoris was diagnosed following palpation.  Dry needling (based on a grading system) was offered.

The patient enjoyed immediate benefits following dry needling treatment.  Furthermore, he was completely pain free at the 4-month follow-up consultation (Anandkumar, 2017).

(5) An Iranian Clinical Trial Involving Dry Needling of Myofascial Trigger Points for Heel Pain  

A single-blinded clinical trial involving 20 patients with chronic heel pain due to plantar fasciitis revealed that a weekly session of dry needling of myofascial trigger points for 4 consecutive weeks can reduce the severity of heel pain (Eftekharsadat et al, 2016).

(6) A 53 Year Old Male with Painful Plantar Fasciitis

A 53 year old Iranian man suffered bilateral plantar heel pain that involved sharp, stabbing pain and accumulation of fluid beneath the metatarsal heads.  Pain levels were 8 in the right foot and 6 in the left foot and he was unable to stand for more than 20 minutes at a time.  

Dry needling of myofascial trigger points was offered twice a week for 2 weeks.

The man enjoyed a 60-70% decrease in pain levels (ie his pain levels dropped from 8 to 3 in his right foot and from 6 to 2 in his left foot), and he was able to return to his normal daily activities.   


What do trigger points look like?

Ultrasound images of trigger points from 3 studies are shown below:

(1) An Indian ultrasound study found that trigger points appear as echogenic structures under the surface of the trapezius muscle (and not inside the muscle mass).  These echogenic structures do not appear in or around unaffected, healthy skeletal muscle.

Here is an example of an echogenic structure (i.e. trigger point):

Credit for above ultrasound image of a trigger point: Parthasarathy et al, 2017.


(2) An American paper called Dry Needling for Myofascial Trigger Point Pain included 2 ultrasound images (A and B, below).  In A, a trigger point appears as a focal hypoechoic nodule in the upper trapezius.  In B, four (4) hypoechoic myofascia trigger points are visible.

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Credit for above ultrasound images: Unverzagt et al, 2015.


(3) A Romanian ultrasound- and thermal-based study identified trigger points via:

  • Clinical examination;
  • Ultrasound imaging; and
  • Thermal analysis.  

Thermal analysis via infrared thermography revealed that trigger points have higher temperatures than the areas immediately surrounding them.  It is possible that reduced blood flows lead to decreased temperatures around trigger points.

Thus, trigger points have unique thermal patterns.  Specifically, a cooler region surrounds a hotter area, the latter representing the trigger points themselves.  NB The thermal images are available in the paper by Cojocaru et al, 2015.

The trigger points could no longer be detected during follow-up clinical and ultrasound examination done 5 days after the successful injection procedure.

A trigger point, described as (quoting from paper) ‘an ellipsoidal hypoechogenic area in the muscle’, is seen here:



Credit for above ultrasound image of a trigger point: Cojocaru et al, 2015.


(4) Many ultrasound images of trigger points are available in literature (Wong, 2017; Mayoral et al, 2013; other papers).

Benefits of Ultrasound Imaging of Trigger Points

Ultrasound-guided needling of trigger points can enhance the accuracy of needle placement in deeper musculature and intraarticular regions hence reducing the risk of pneumothorax, needling damage to organs and tissue (eg kidneys, lungs, salivary glands, adipose) as well as other complications (Botwin et al, 2008).    

Is dry needling of trigger points similar to acupuncture?

Researchers have suggested that the entire fascia network may be the physical substrate of all acupuncture-related meridians (the latter having been part of Traditional Chinese Medicine for 1,000’s of years).  Peter Dorsher noted an 89% overlap in myofascial meridians and the acupuncture principal meridian (Behnam et al, 2015).  Dorsher also found that 92% of all 255 trigger points correlated with acupuncture points.  The local twitch response can be compared to acupuncture’s ‘de qi’ sensation (Bai et al, 2011; Dorsher, 2006; Dorsher, 2009).

These observations suggest a positive correlation between the anatomy-based dry needling of trigger points and acupuncture.  


The science behind dry needling (aka non-injection) vs injection needling of trigger points is incomplete.  Many medical professionals are still sceptical about this procedure.  Quoting from a paper offering a critical view (see Abstract):

‘…the theory of MPS [myofascial pain syndrome] caused by TrPs [trigger points] has been refuted…’ (Quintner et al, 2015).

Ongoing research that includes imaging (e.g. real-time ultrasonography) to specifically locate and identify the trigger points during dry needling (puncture) will enhance the underlying science and credibility for this technique.

Real-time ultrasound imaging can also enhance the accuracy of trigger point needling, particularly when targeting hyperactive trigger points located within the deeper fascia and musculature layers, intraarticular regions and other areas that cannot be palpated.  This reduces the risk of pneumothorax and other complications that may otherwise result from ‘blind methods’ (Mayoral et al, 2013).  

Dry needling of myofascial trigger points may offer effective and long-lasting pain relief, reduced focal inflammation, regeneration, increased mobility and enhanced autonomic function for patients suffering from musculoskeletal pain and/or myofascial pain syndromes.

Note: For patients who have a fear of needles (i.e. needle phobia), hypnotherapy may be beneficial.  For further information, please refer to my blog post called ‘Chronic Pain and Hypnotherapy’.

Sabina Walker

Blogger, Pain Matters (in WordPress)

PS A follow-up blog post on The myoActivation System of Pain Care (developed by Dr Greg Siren, BC, Canada) will be added shortly.  Stay tuned…


Case Studies

(1) Ultrasound-Guided Trigger Point Needling for Myofascial Pain  

Bubnov and Wang. Clinical Comparative Study for Ultrasound-Guided Trigger-Point Needling for Myofascial Pain. Medical Acupuncture (17 Dec 2013); 25(6): 437-443.

(2) Ultrasound-Guided Trigger Point Needling (Including Medication Injection) in Patients with Chronic Chest Wall Pain Following Surgery  

Vargas-Schaffer et al. Ultrasound-Guided Trigger Point Injection for Serratus Anterior Muscle Pain Syndrome: Description of Technique and Case Series. A&A Case Reports (15 Sept 2015): 5(6); 99-102.

(3) A 29 Year Old Female with Myofascial Pain Syndrome

Asha et al. A Novel Case of Orofacial Pain Treated by Dry Needling Technique – A Case Report. Dentistry (2015); 5: 319.

(4) A 40 Year Old Male with Myofascial Pain Syndrome

Anandkumar, S. Effect of Dry Needling on Myofascial Pain Syndrome of the Quadratus Femoris: A Case Report. Physiotherapy Theory and Practice (Feb 2018); 34(2): 157-164.

(5) An Iranian Clinical Trial Involving Dry Needling of Myofascial Trigger Points for Heel Pain  

Eftekharsadat et al. Dry Needling in Patients with Chronic Heel Pain Due to Plantar Fasciitis: A Single-Blinded Randomized Clinical Trial. Medical Journal of the Islamic Republic of Iran (2016); 30: 401.

(6) A 53 Year Old Male with Painful Plantar Fasciitis

Behnam et al. The Use of Dry Needling and Myofascial Meridians in a Case of Plantar Fasciitis. J Chiropr Med. (March 2014); 13(1): 43–48.

Other Academic References

(1) Mayoral et al. Myofascial Trigger Points: New Insights in Ultrasound Imaging. Techniques in Regional Anesthesia and Pain Management (July 2013); 17(3): 150–154.

(2) Mayo Clinic. Acupuncture And Myofascial Trigger Therapy Treat Same Pain Areas. ScienceDaily (14 May 2008).>

(3) Dorsher PT. Trigger Points and Acupuncture Points: Anatomic and Clinical Correlations. Medical Acupuncture (May 2006); 17.

(4) Dorsher PT. Myofascial Referred-Pain Data Provide Physiologic Evidence of Acupuncture Meridians. J Pain (July 2009); 10 (7): 723–31.


(5) Liu et al. Traditional Chinese Medicine Acupuncture and Myofascial Trigger Needling: The Same Stimulation Points? Complementary Therapies in Medicine (2016); 26: 28-32.


(6) Bai et al. Review of Evidence Suggesting That the Fascia Network Could Be the Anatomical Basis for Acupoints and Meridians in the Human Body (2011). Evidence-Based Complementary and Alternative Medicine (2011); Article ID 260510, 6 pages.

(7) Unverzagt et al. Dry Needling for Myofascial Trigger Point Pain: A Clinical Commentary. International Journal of Sports Physical Therapy. 2015;10(3):402-418.

(8) Wong YM. Developments of Nonacupoint Needling in Japan. Medical Acupuncture (2017); 29(6): 349-351.


(9) Botwin et al. Ultrasound-Guided Trigger Point Injections in the Cervicothoracic Musculature: A New and Unreported Technique. Pain Physician (Nov/Dec 2008); 11(6): 885-9.

(10) Parthasarathy S, John Charles S A. Analgesic Efficacy of Ultrasound Identified Trigger Point Injection in Myofascial Pain Syndrome: A Pilot Study in Indian Patients. Indian J Pain (2016); 30: 162-5.;year=2016;volume=30;issue=3;spage=162;epage=165;aulast=Parthasarathy

(11) Wong YM. Developments of Nonacupoint Needling in Japan. Medical Acupuncture (2017) ;29(6): 349-351.

(12) Myofascial Trigger Point

(13) Zhou K, Ma Y & Brogan MS. Dry needling versus acupuncture: the ongoing debate.

(14) Cojocaru MC, Cojocaru IM, Voiculescu VM, Cojan-Carlea NA, Dumitru VL, Berteanu Met al. Trigger points–ultrasound and thermal findings. J Med Life (2015); 8(3): 315-8.

(15) Stecco et al. Fascial components of the myofascial pain syndrome. Curr Pain Headache Rep (2013); 17: 352.

(16) Quintner, Bove and Cohen. A Critical Evaluation of the Trigger Point Phenomenon, Rheumatology (1 March 2015); 54(3): 392–399.


This is the story of my exploration on matters of chronic pain.