Referred Pain From Trigger Point (simple explanation)

OK, for folks that suffer from pain in your hands which does not seem to make sense, maybe this explanation can help (with diagram). I suffer from myofascial pain syndrome which results from bits of hardened connective tissue called trigger points. You can often feel them by palpation (this will likely hurt!). For me, this is connected to a larger condition with trigger points all over my body, but trigger points can also result from local injuries and old trauma. But few people seem to understand how they work. Doctors often do not understand either or may understand at a cerebral level but fail to explain them to a patient. (Sports medicine folks sometimes do the best job with both recognizing the problem and making it make sense to the patient.)
[Disclaimer: I am not a doctor; I am not your doctor.]

A trigger point in the upper arm can refer pain to the lower arm and hand. [Eric Vought]

So, I have a trigger point in my upper arm (one of many), shown roughly in my diagram. The trigger point is in the connective tissue. There is a major junction of a nerve, an artery, and a vein between it and the muscle. Open the Gray's Anatomy diagram below for more (and better) detail. This is a pulse point and a good pressure point for controlling bleeding. You might be able to feel the pulse change a bit as you move your arm up and down. As the muscle tightens, it moves the artery and changes the pressure of your finger on the blood vessels.

Gray's Anatomy, Brachial Artery (Public Domain)

This can be why your hand hurts, why you rub your hand or put liniment on your hand and the pain is not affected. This can be why taking NSAIDs doesn´t make your hand feel better. Your hand is not where the problem is.
Recall that the trigger point is a hardened bit of connective tissue. When the muscle tightens, the nerve and blood vessels between it and the muscle get trapped and pinched. This can reduce blood flow back from the hand and it can cause the nerve (which travels down to the hand) to register pain. It also tends to make you move your arm differently (even if you do not realize it), put tension on tendons, etc, and this affects the way you use your lower arm and hand, the way you grip, etc., causing pain or loss of function. The symptoms in your hand may not seem to make sense. But dealing with the trigger point in your arm may relieve the pain in your hand (or at least help).

The exact same process can happen in any of dozens of places in your body, causing a variety of unusual symptoms or (seemingly) inexplicable pain.

If you have trigger points like this, Travell and Simons´ "The Trigger Point Manual" may help your doctors understand how this works and will explain at a level that I could never do, especially in a blog. That book provides detailed diagrams of where trigger points occur, the satellite symptoms they may cause, and why. When I walk into an office and see a copy of this book, it makes me feel more comfortable that a practitioner will understand my condition. For yourself, Starlanyl and Copeland's "Fibromyalgia and Chronic Myofascial Pain Syndrome: A Survival Manual" is targeted at the individual sufferer who is trying to understand and cope with a bewildering condition. That book, given to me by a friend and fellow sufferer now gone, is what allowed me to get a handle on why my life was suddenly falling apart.
Learning to recognize where the pain is and why it happens helps to find relief. In the past, I would try to rub something into the hand or take an antiinflammatory. Now I know that often will not work. I find, personally, that concentrated capsaicin (from say, Capzasin-HP) on the trigger point will make my hand feel better. Capsaicin (from hot peppers) is absorbed through the skin and numbs the underlying nerve. It causes local pain (it burns a bit!) and skin irritation if I use it too much. But if I can use my hands more, it is a net win. If you have pain like this, learning more about it may help you find ways to live just a bit better. (Just wash your hands very well before you rub your face...) Massage and physical manipulation can also help or even correct trigger points. Just be careful and learn what you are doing (or find a good professional!) because doing the wrong thing can cause further harm. There are several old quack treatments for trigger points which did no good and left patients in agony, including "work hardening", surgery, and (some, older) trigger point injections.

Addicted to Bad Statistics - a Growing Epidemic

OK, references keep popping up to this CDC study on the dangers of patients receiving prescriptions for opiate pain-relievers becoming chronic opiate users. Specifically, they make reference to a finding that patients receiving a 1-day prescription for opiates only have a 2.6% chance of still being on opiates 1 year later while those given an initial 30-day prescription have a 45% chance of being on opiates 1 year later... So, I look up the study to see the data and conclusions for myself. Apparently not enough people sit through classes on research traps and simple mistakes.

This is the most telling point which should jump out at anyone interested in citing the research to make recommendations on opioid prescriptions or policy:

The findings in this report are subject to at least five limitations... Second, the extent to which chronic opioid use was intentional ... is not known. ... Third, information on pain intensity or duration were not available, and the etiology of pain, which might influence the duration of opioid use, was not considered in the analysis. [ https://www.cdc.gov/mmwr/volumes/66/wr/mm6610a1.htm (emphasis mine)]

They also note that longer-term prescriptions were much less common than short-term prescriptions. So... the obvious conclusion would be that doctors tend to write prescriptions for longer-terms for patients expected to need the pain relief for a longer period of time and... not surprisingly, they do. The study also notes that those receiving longer-term prescriptions tend to (among other things) be older and have a previous pain diagnosis. (duh!)

In other words, doctors are already likely exercising judgement by providing short term prescriptions to most people and only giving 30-day prescriptions to a much smaller number of people with longer-term conditions. But the researchers did not have data available to exclude this possibility ---and to their credit, say so. The warning in the study, however, is completely ignored by everyone citing it even though the data is useless for the purposes they are trying to make of it.

Garbage in; Garbage out

The capital-P Problem is that the purpose they are generally trying to make of it is this: recommending that doctors stop providing 30-day prescriptions to people with chronic conditions because of the higher danger of long-term use! This is usually linked to a claim that 80% of heroin users get their start with prescription opioids (another bad statistic I'll save for another day) and that reducing opioid prescriptions will therefore reduce future heroin use.

Question: what will long-term pain sufferers likely turn to when they cannot get legal prescriptions from their doctor to treat their valid medical conditions? In all likelihood, they will turn to black market sources, with no quality control, which has a higher chance of leading to addiction and overdose as well as feeding our larger issues with drug smuggling.

Is there a very large recent increase in drug overdoses? Yes. Is this a problem? Yes. Does stupid misuse of incomplete data help point to a solution? No.

And the solutions we persistently fail to consider...

You cannot willy nilly stop prescribing opiates to people with long-term pain unless and until you can offer other solutions. To do so is inhuman. Unfortunately, for many people who suffer long-term pain (including myself until recently), other solutions are few and non-existent. Opiates are more effective for short-term pain and lousy for long-term pain--- this is well-known. Using opiates to control long-term pain simply sucks less than being in pain for months on end with no other alternative.

Ironically, better alternatives for long-term pain are either difficult to get FDA-approval in the US or are flat illegal. Marijuana, for instance, shows long-term efficacy for chronic pain for some classes of patients and is much less dangerous than opium-based medications, but it is currently defined in law as having no valid medical use. Nor am I making a pro-marijuana case here, but rather the case that it is disingenuous to say people should stop using opiates while we are actively foreclosing alternatives.