You know you’re a geek when you unwind at the end of the day while listening to a lecture on the role of microglia in central sensitization and depression… Here’s a little outline of the lecture.

How does chronic pain work?

Some chronic pain, especially chronic pain syndromes, seems to stem from central sensitization. Central sensitization happens when the nervous system gets wound up and has trouble calming down, this can happen short-term or turn into a syndrome. Some ways that the system can go awry include:

  • Being overly sensitive and making pain signals stronger.
  • Reading normal signals, like temperature or pressure, as pain.
  • Firing up a bunch of nerve pathways that wouldn’t normally fire.
  • Not turning off the pain signal when no longer needed.

Sometimes people feel pain even when no obvious reason exists. In some cases an obvious reason exists, but people feel a higher level of pain than one would normally expect from it. And in some instances, pain persists after healing. Of course, all of these can occur together.

What is the link between mental health and chronic pain?

Chronic pain also happens to strongly coincide with depression, anxiety, and/or PTSD. People who have chronic pain and/or one of these mental health disorders are more likely to have the other. Statistics also show that people who have both struggle more with managing and improving their conditions. Science has yet to describe exactly how the interplay works.

What are microglia?

Microglia are one of several types of brain cells. These cells take care of the immune response in the brain. They scan for potential problems and then jump into action when they perceive a threat. They can actually change themselves depending on what action is needed– scanning, repairing, removing waste, and regenerating. Just like other parts of the immune system, repetitive trauma or perceived threats can sensitize these cells so that they over work. Unfortunately, when these cells are active for too long (neuroinflammation), they can weaken the brain.

Research indicates that microglia over work in chronic pain syndromes, depression, anxiety, and PTSD (and some other neurodegenerative conditions). 

So what can one do to calm this process?

As much as anyone with chronic pain or depression hates to hear it, exercise seems to help. Proper diet and the right balance of nutrients can also have a positive effect. Mind/body approaches- like yoga, meditation, and deep breathing have led to reduced neuroinflammation. Acupuncture has a few studies behind it. Of course, certain pharmaceuticals seem to help as well. Hopefully, massage will join this list, but no one has studied it yet. Overall the current thinking seems to point to an integrative approach to care.


Research articles Chronic Pain & Depression Chronic Pain & PTSD Chronic Pain & Mental Health Conditions Microglia & Depression


Sciatica and piriformis syndrome both create pain in the low back, buttocks, and back of the leg. Often they bring numbness, tingling, or even weakness with them. Sometimes they make simple things such as walking, sitting, or driving a car painful and difficult prospects. 

Sciatica and piriformis syndrome in brief

Sciatica refers to pain arising from pressure on the sciatic nerve. This nerve travels from the lower spine, through the buttock, and down the leg to the foot. Disc problems in the lower back, spinal stenosis, and bone spurs are common culprits of pressure on the nerve. Typically, sciatica sends pain signals from the low back down the back of the leg and only occurs on one side of the body.

Piriformis syndrome comprises a set of muscular issues that cause sciatica-like symptoms. It gets its name from the piriformis muscle, which lies underneath the gluteus maximus, and crosses the back of the buttocks. This muscle can get tight, it can press on the sciatic nerve, and it can stress the joint. Sometimes people can have both a bone and a muscle pressing on the nerve.

How massage can help

Generally speaking, massage can help ease pain. In our experience with sciatica and piriformis syndrome, massage helps the tight muscle part of the equation the most. It has much less influence on pain from a bone or disc problem.

If a tight piriformis muscle is the main culprit, massage can make a significant difference in alleviating the pain. Softening the tension can relieve tender spots in the buttocks and referred pain to the leg, back, and groin. It can also ease pressure on the nerve itself and allow the joint to align properly.

If the pain stems from a bone or disc problem, massage may not help as much. At most, in our experience, it allows for temporary relief. Of course, this type of sciatic pain can lead to muscle tension around the nerve pathway that can increase pain. In this case, massage can help alleviate the additional pain and sense of tension. So, massage might still benefit people who have sciatica, just not as fully as it can help those who have piriformis syndrome.

When sciatica arises during pregnancy, the same rules apply. The more the pain stems from muscular tension, the better massage helps. In some cases, however, the pain never fully resolves until the end of the pregnancy.

Massage for sciatica or piriformis syndrome will focus on the posterior hip of the affected side, that is the butt. The therapist may also work the low back and leg depending on specific symptoms and time. The therapist may employ a range of techniques including focused direct pressure massage, light gliding massage, and stretching. Sometimes, the client wears sports attire and does movements along with the massage therapist. Most typically, clients use massage as part of an integrative care approach that also involves their medical team and physical therapist.



For those struggling with Fibromyalgia, the added demands and stresses of the holiday season can lead to one that is anything but happy as pain and fatigue levels often flare. How can one navigate the season while minimizing any additional discomfort?

by Susan Fishell

In the seven years that I have lived with Fibromyalgia, I have learned that wisely choosing my activities, enlisting help, taking shortcuts, using magnesium products and scheduling a mandatory rest period can make a significant difference in managing my pain levels. It is my hope that these tips will be of benefit to anyone living with chronic pain who is struggling to make it through the season.

Pick your favorites

The first and most important tip I have learned is to choose my activities carefully. A wise friend recently suggested that I choose the activities that are most life-giving to me. What activities energize you, bring you joy, feed your spirit? Whenever possible, choose those over the ones that you dread doing, that suck you dry or stress you out. Save your limited energy for that favorite activity that brings the holiday to life for you. For me it is sitting in a sanctuary filled with white lights listening to the reading of the Christmas story or a family outing in our old pick-up to find the “perfect” tree. Perhaps for you it is cooking a favorite family recipe or watching much loved holiday movie. Whatever it is, always expend your energy on those about which you are passionate and eliminate those that fill you with stress.

Accept a hand

Secondly, enlist help and take shortcuts. Don’t be afraid to admit that you can’t tackle all the holiday projects that you used to do. Because I loved writing individual notes in all my Christmas cards, it took me several seasons of arm and shoulder flare-ups before I reluctantly admitted to myself that I could no longer manage this activity without help. Now my husband types on the PC for me the letter that I write and also assists in the addressing of the envelopes. Baking and cooking with all of the stirring, chopping, measuring and cleaning up, can easily flare arms, shoulders and back muscles. After learning this fact the hard way,  I have sought over the last few years the assistance of my teen neighbors, my son’s girlfriend and my daughter-in-law to assist in baking my Christmas sweets. They go home with bags of freshly baked goodies, and I have a supply to share at family gatherings or to give as gifts to friends – a win-win for us all. For me, nothing can cause pain to arise quicker than a shopping trip especially if it requires carrying items in my arms or pushing a cart.  Skip it all by shopping on-line or taking advantage of some of the new services that retailers are offering where they shop for you and then deliver your purchases to your waiting vehicle. Forego wrapping presents by using gift bags or better yet give a gift card or money gift which eliminates either altogether. Instead of decorating your entire house, focus on the room where you spend the most time. If you put your mind to it, I am sure there are many more shortcuts that you can devise to conserve your energy and prevent painful muscle fatigue.

Self care

Next, magnesium! Over the past several years, I have discovered the amazing properties of this essential mineral which relaxes muscles and can alleviate pain. Many Fibromyalgia patients are deficient in it so have your doctor check your levels if you have never done so. Whenever I begin to experience the muscle soreness that feels like you have just completed a 10k race, I pull out my Epsom Salts and go soak in a bath filled with them. Not only is it soothing and relaxing, but these soaks plus the application of a magnesium lotion or oil eliminate my soreness within 24-48 hours. Ancient Minerals and Life-Flo are two providers of these products. If you have sensitive skin, apply these products sparingly at first as they may sting when initially applied and can have a drying impact if used for a prolonged period of time.  If you have your doctor’s approval, a magnesium supplement may also benefit you. I use a magnesium citrate supplement called Natural Calm as it is more easily absorbed by the body than the magnesium oxide pills that you often find in the vitamin aisle. I mix the Natural Calm with water to make a fizzy flavored liquid that I drink about two hours before bed. As a bonus the magnesium may help your sleep too. Too much magnesium, however, can act as a laxative so it is important to discuss with your doctor the appropriate dosage for you to take.


Lastly, accept that you may need more rest time as you juggle the holiday’s demands and stresses. Allot a minimum of 30 to 60 minutes per day for relaxing your muscles in a place free of distractions and interruptions. If you are not a napper, listen to the music of the season, watch a Christmas movie (Did anyone say Hallmark channel?) or listen to a holiday story on-line or on CD. Make this time a top priority as it is hard to enjoy the holidays if you are in constant pain.

If you find all of the above a pipe dream because it takes all of your energy just to roll out of bed in the morning knowing that every movement brings pain, I get it. I have been there and I pray I never go back!  Instead, take a baby step. Make soaking in an Epsom salt bath your first priority. Push yourself to do something easy and enjoyable like a drive to look at Christmas lights and decorations. Don’t let Fibromyalgia win by robbing you of the joy of Christmas! You can get better. I am living proof of that. There is hope! After all, isn’t that what the Christmas story is all about?  A tiny baby is born bringing with him hope for us all including the hope of healing and relief from pain. Hold onto that hope now as you begin the baby steps that can lead to a relatively normal life that while not entirely pain-free is significantly better than the place you find yourself now. Take that first step!


While our main focus is on clinical and therapeutic massage we are not afraid of a little “woo.” At least, not woo that has some medical research behind it. Search “reiki” in PubMed (a trusted online database of medical research papers) and you will find a small number of studies that form a beginning of some positive research for reiki and other therapeutic touch  as a part of biofield therapy. The gist of the data so far indicates that reiki may have a positive influence on stress and pain relief.

Origins of Reiki

Reiki originated in Japan and it is essentially a laying on of hands. The history goes as follows, Dr. Mikao Usui went to the mountain, had a vision, and came back connected to the life force energy of the universe. He was able to heal people by touching them and tapping into this energy. He passed down this ability to other practitioners through an attunement process, which is how we still do it today.

In the original form of Reiki, the practitioner would place hands on the recipient wherever the energy felt out of balance. In the modern western version, the practitioner uses hand placements on the chakras which correspond to the rest of the body to facilitate healing. One science-based theory of how reiki works focuses on the possibility of one person’s electromagnetic field influencing the other’s. However, nothing has been proven through methodological study.

Traditionally, people have sought out reiki to heal and balance mind, body, and spirit. It  follows an integrated eastern philosophy of wellness in which any of these components alone or together may disturb overall well-being and lead to health problems. Each chakra corresponds not only to a physical part of the body, but to an emotional state, and a spiritual concept as well. Here is a quick and dirty list of the major chakras.


1st/Root Chakra– At the base of the spine. Physically relates to the lower body and immune system– sciatica, low back pain, depression. Mental and emotional correlations include safety and security, basic physical needs, family, standing up for oneself.

2nd/Sacral Chakra– At the sacrum. Physically relates to the viscera, sexual organs, and hip area– urinary problems, problems related to the sexual organs, low back or hip pain. Mental and emotional correlations include blame and guilt, creativity, control, money issues, and ethics.

3rd/Solar Plexus Chakra– Above navel. Physically relates to the stomach, abdomen, and abdominal organs– ulcers, diabetes, GERD, liver problems, and adrenal fatigue. Mental and emotional correlations include trust, self-esteem, self-care, decision making, and honor.

4th/Heart Chakra– In the center of the chest near the heart. Physically relates to the heart, lungs, shoulders/arms, and chest– heart problems, asthma, allergies, upper back and shoulder pain. Mental and emotional correlations include love, resentment, grief, anger, forgiveness, loneliness, and self-centeredness.

5th/Throat Chakra– At the throat. Physically relates to the throat, neck, mouth, and glands– sore throat, TMD, scoliosis, and thyroid problems. Mental and emotional correlations include personal choice and expression, hopes and dreams, addiction, criticism, faith, and decision making.

6th/Third Eye Chakra– In the center of the forehead. Physically relates to the brain, nervous system, eyes, ears, nose, and glands– neurological or brain problems, learning difficulties, seizures, and hearing and vision problems. Mental and emotional correlations include intellectual ability, truth, wisdom, and emotional intelligence.

7th/Crown Chakra– At the crown of the head. Physically relates to the muscles, bones, and skin– chronic exhaustion, depression, and sensitivity to light and sound. Mental and emotional correlations include big picture thinking, spirituality, selflessness, values, courage, and trusting in life.


It can get complex and very in depth for those who appreciate the metaphysical. There can be levels, symbols, colors, crystals, sound, and smoke. There can be connecting of the worldly and ethereal. There can be inviting of enlightened beings.

People experience reiki in a variety of different ways. Some feel heat or vibration. Some see colors or visions. Some simply feel relaxed.  Some have emotional outpourings. Many specifically seek it out for this reason- it can bring up emotional or spiritual issues for processing. And for some, there is a profound connection that feels divine. The wisdom of reiki says that whatever the person experiences is exactly what they need for healing.

Another piece of the wisdom of reiki is that it “calls” to those who should try it…

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