Written by B. Lambden, MD | 05 August 2009

Introduction

The Pain Terminator is a high quality soft tissue tool that can help control or eliminate pain and make a difference in the quality of your life.  It is our hope that you will use this on a regular basis for both treatment and prevention of pain (or simply because it feels good).  You can go ahead and start using the Pain Terminator right away.  However, we believe you will get more enjoyment and benefit if you spend some time reading through this manual.  Please make sure you read the warning and contraindications section.

What's Included

1 Massage Handle                                          1 Portable Massage Handle


1 Effleurage Roller                                            1 Petrissage Roller

6 Shiatsu Rollers                                             1 Copper Acupresser

1 Acupresser Positioner                                    1 Foam Stopper

Physical Modalities For Treatment of Pain
The main goal in most treatments for soft tissue pain involves breaking the pain cycle.  Physical modalities such as heat, cold, copper, magnetism, and massage therapy have been used for centuries with good results.  Never before have all of these different treatment modalities been available in one device!

COPPER MAGNETIC ACUPRESSER

Cold - The use of cold therapy dates back to the beginning of medicine.  Medical studies have shown beneficial effects in reducing inflammation and for pain relief.  It is universally used by therapists and has been promoted as being extremely effective in treating local muscle tender points or trigger points.

Heat - Historically, therapeutic heat predates the use of cold therapy.  Applied over soft tissue, it increases blood flow which provides nutrients and removes toxins.  It also aids in pain relief and reducing muscle spasm.

Copper - The use of copper for the treatment of aches and pains dates back to the ancient Greeks and Romans.  Numerous scientific studies have shown copper to be a powerful anti-inflammatory.  It is absorbed through the skin, and has been shown to reduce pain and promote healing.

Magnetism - The use of magnetism for health related problems dates back hundreds of years.  Numerous scientific studies have demonstrated improvements in soft tissue healing, tendinitis and pain with magnetic treatment.

Massage Therapy - Massage has been practiced throughout human history.  The main effects include improved circulation and removal of tissue by-products, reduction of swelling, and improvement of  soft tissue adhesions.  It also induces relaxation and feels good!!

Introduction to The Pain Terminator

In Western countries, we often seek the services of a physician or therapist for the treatment of soft tissue pain.  In contrast, Eastern cultures teach from an early age the use of acupressure, exercise and other techniques for self management of pain.  Daily self massage is an excellent habit to develop for both prevention and treatment of pain.  In fact, chronic muscle pain responds better to daily treatment than intermittent  treatment.  Also, by investing the time and interest in self massage, one becomes more in tune with his or her own body and better able to focus the treatment on what works best.  When one starts practicing self massage, several problems become readily apparent:
1.    Many areas on the body are difficult to reach, particularly over your back.
2.    Prolonged pressure using your fingers quickly tires them out or takes away from the relaxation you are seeking.
The Pain Terminator was developed in an effort to minimize the above problems.  It was designed over a 2-year period with input from a wide variety of health practitioners and engineers including physicians specializing in Physical Medicine and Rehabilitation, Rheumatology, Anesthesia, Neurology, Pain Medicine, and Chiropractic, as well as Physical, Occupational and Massage Therapists.  The result is a massage tool which is light weight, portable, and extremely versatile.  It is a useful adjunct to all types of massage therapy and also allows for the use of heat, cold, and magnetism (which have demonstrated positive healing effects in soft tissue pain).

Parts Of The Pain Terminator

Massage Handle
This patented ergonomically designed plastic massage handle is the backbone of the Pain Terminator.  It was specifically designed to allow for easy placement of the copper Acupresser and massage rollers into areas which are difficult to reach such as the mid and lower back.  Simply slide the copper magnetic Acupresser or rollers onto the handle and start massaging!

Portable Massage Handle            
For portability, the Pain Terminator comes with a small 3" handle. Once the copper Acupresser is secured to the portable handle, it can be used for easily accessible areas such as your neck, forearms, legs, etc. or for massaging somebody else.

Copper Acupresser
The patented  copper Accupresser is made out of copper, and has two 10,800 gaus neodymium magnets implanted near the surface.  These are the most powerful magnets commercially available.  Both copper and magnetism have been shown to have beneficial effects on pain and inflammation.  The Acupresser is designed such that it has a thermal reservoir at the base.  Once it is exposed to heat or cold, the base will retain it, and slowly transfer the heat or cold to the tip which is in contact with the skin.  It will provide up to 5 minutes of therapeutic heat or cold.  The Acupresser slides onto either the portable or larger massage handle, then once in position is secured into place by rotating the copper head clockwise.

Therapeutic Rolling Massagers

The Pain Terminator also comes with 6 Shiatsu rollers, 2 Petrissage rollers and 1 Effleurage roller.  These rollers are useful for applying more diffuse pressure, or providing deep tissue and Swedish types of massage.  Simply slide the appropriate rollers onto the shaft and secure on either end with the foam stopper.  Effleurage means “touching lightly” in French.  The Effleurage Roller is made of a soft yet durable EVA foam and is useful for massaging  over sensitive areas such as the head, bony prominences, or tender soft tissue.  Petrissage is French for “kneading”.  These rollers are made of wood and are used for deeper, more forceful pressure.  They are typically used over large muscles or the soles of the feet.  The Shiatsu Rollers are similar to the Petrissage Rollers, but are more disc-shaped, thereby providing more pressure to the soft tissue.  The rollers can be placed on the shaft in any order you like.  Experiment with the positions of the 3 different types of rollers and determine what works best for you.  The figures below show a few of the possibilities for different parts of the body.

Recommendations for roller positions

Fig. 1- Useful for massaging the soles of your feet.

Fig. 2- Useful for massaging the large muscles over the back of the neck.(cervical paraspinals)

Fig. 3- Useful for massaging over the top of the shoulder, mid and lower back.  

Using The Pain Terminator

In this section we will show you how to put it all together and create a customized routine which will offer the most benefits to each individual in the shortest amount of time.  The following recommendations are only guidelines; we encourage you to experiment with your routine and tailor it to meet your needs.  If you find that a particular technique helps a lot, increase the use of it and eliminate the ones you don’t feel are helpful.  Be creative!!  Everyone’s routine will be different and will evolve as you gain more experience.  Before using the Pain Terminator, it will be helpful to spend a few minutes to determine your temperature preference and learn the basic positions for holding the Terminator.

Determine Temperature Preference
The copper Acupresser can be used either cold, room temperature or hot.  If you prefer cold, then fill a small cup with a mixture of ice and water and dunk the copper head for 3-5 seconds.  If you prefer heat, fill the cup with water that is around 100 degrees F (approximately the temperature of a warm cup of coffee or hot shower water) and again dunk for 3-5 seconds.  Caution: Do not heat the copper Acupresser above 100 degrees F. —It can easily cause burns!  Read all of the warnings at the beginning of this manual.  The copper will retain the temperature for 3-5 minutes before requiring repeat dunking.  Typically, warming an area tends to cause relaxation and decrease muscle spasm.  Cold tends to anesthetize and has frequently been used for breaking the pain cycle for chronic tender points or trigger points.  Also, you may want to pre-heat or pre-cool the involved area with a hot pack or cold pack.  The preferences regarding temperature vary from person to person, so  experiment with different combinations and see what works best for you.

How To Hold The Pain Terminator
Using the 3" portable massage handle is simple.  Slide the copper Acupresser onto the handle, tighten it by rotating the copper head clockwise as in figure 4 and your ready to go!
Using the larger massage handle is also simple, but requires a few minutes to learn the various positions to gain access to different areas over your neck and back.  Similar to the portable handle, the copper Acupresser is secured to the larger massage handle by tightening
the copper piece.  The location of the Acupresser or rollers on the handle can be varied, depending on which area you are massaging.  Refer to diagrams 5 through 11 for examples of how to hold the Pain Terminator and where to place the Acupresser or rollers.  For gentle massage, use the Effleurage roller; for deeper/harder massage use the Petrissage or Shiatsu rollers; for acupressure and deep tissue massage, use the copper Acupresser.  If you have long hair, put it up and out of the way for easier access to tender areas around the back of the neck.  The Acupresser can be placed directly on the skin or over clothing.  (It glides easier when used over clothing, making deep tissue massage easier to perform).

7- Step Method for Using the Pain Terminator
If you have time, it is best to perform all of the following steps for optimum benefit.  It is perfectly fine, however, to eliminate any or all of these steps.  (It’s better to use the Terminator for just 1-2 minutes rather than not do anything because you feel you don’t have the time to complete all of these steps).  Stretching is a very important part of the treatment process, so always try to finish your session with step 6 - Post-treatment stretching.  If you only have a few minutes and would like to use the Terminator quickly, skip to step 5 and perform the trigger point search and destroy technique then follow it with step 6 - post treatment stretching.

Step 1- Pre-treatment
Get comfortable; preferably find a warm, quiet environment.
Concentrate on what your doing - forget your worries and distractions.
Practice relaxed breathing - abdominal breathing is associated with relaxation whereas chest breathing is associated with stress.  Sit up tall, slowly take in a deep breath with your abdomen, while saying to yourself “breathe in relaxation”.  Pause, then exhale fully while saying, “breathe out tension”, repeat this 5 times.

Step 2- Tissue Preparation
Use the Effleurage, Pettrisage, and Shiatsu rollers to gently massage along the entire length of the muscle for 1-5 minutes as in the figure to the left.  This will increase the circulation and decrease pain and hypersensitivity.  Use light pressure, and roll back and forth over the length of the muscle.


Step 3- Deep Tissue Techniques
If you have a particular problem area, use the copper Acupresser, preferably warm, and over clothing (to improve gliding).  Use gentle but firm pressure and massage along the length of the muscle, progressing very slowly (about 1" every 5 - 10 seconds).  The Pain Terminator is held as in the figure to the left, but the rollers are removed and replaced with the Acupresser as shown in the figure to the right.

Step 4-  Pressure Point Technique
This technique is based upon the ancient practice of Shiatsu or Acupressure. The only difference is that you will be using the copper Acupresser to apply pressure instead of your fingers.  For more comprehensive information on this technique, refer to the references section.  Refer to the figures below to identify where the acupressure points are in the area you want to treat.  Use the copper Acupresser and acupress most of the points in the diagram near the location of your pain, in any order, until you feel relief.  (For example, if it is neck pain you want to treat, look at the figures below and press the points on the front, side, and back of the neck).  Duration of pressure should be 5-7 seconds.  The amount of pressure applied should be enough such that it is slightly uncomfortable but not painful (mid-way between pleasure and pain).  This part of the treatment can be repeated several times per day.

Below, it can be seen that there are dozens of acupressure points for each area.  In order to simplify treatment, a number of practitioners have classified the pressure points according to physical complaints and prioritized them, thereby decreasing the number of points.  These are called potent points.  The most common physical complaints in patients with soft tissue pain include neck pain, low back pain, shoulder pain and headaches.  Potent points for these problems are outlined in the figures below.  The technique for potent points is similar to that outlined above for pressure points.  Since there are less points, you can acupress each point a little longer (1-3 minutes each).  As before, the amount of pressure should be half way between pleasure and pain.  For more detailed information on potent points, refer to the references section of this manual.

Fig. 13- Classic Acupressure Points

Fig. 14- Acupressure Potent Points for Headaches -Acupress these points for 1-3 minutes each for headaches.  These are also helpful for neck and shoulder pain.

Fig 15- Acupressure Potent Points for Neck and Shoulder Pain - Acupress these points for1-3 minutes for neck or shoulder pain.

Fig. 16 - Acupressure Potent Points for Low Back Pain - Acupress each of these points for1-3 minutes for lower back pain. One additional point that should also be Acupressed is located one inch below the naval.

Step 5- Trigger Point “Search & Destroy “
Gently massage over the involved muscles with the copper Acupresser, looking for any remaining  tender points or trigger points.  If you find one, use the Acupresser either warm or cold (whichever you find is most beneficial) and apply enough pressure over the tender/trigger point until it is almost painful and hold it for 1-3 minutes, slowly increasing pressure for the first 2/3 then slowly decreasing pressure during the remaining 1/3 of the time.  Repeat this procedure until you’ve treated all of the remaining tender/trigger points.  Repeat this 3-4 times during the rest of the day.


Step 6- Post Treatment Stretching
It is important to conclude your Terminator session with post-treatment stretching for a number of reasons:
1.  Stretching reduces adhesions and scar tissue and improves circulation             which results in improved healing.
2.  Stretching decreases post-treatment soreness and reduces the chances           for re-injury.
3.  Stretching decreases muscle tension which leads to improved relaxation           and posture.  This is important in preventing recurrence of trigger/tender        points and helps break the cycle of pain.
Refer to Appendix A for specific stretches and techniques.

Step 7-  Post Treatment Relaxation
Finish your Terminator session with a few brief relaxation techniques.  Again, get comfortable and forget your worries; practice imagery (think of something very relaxing such as a meadow with a stream running through it).

Practice progressive relaxation.  For each muscle that was treated with the Terminator, one at a time, contract the muscle hard for 1-2 seconds- then completely relax it.  If you have time, perform the whole-body progressive relaxation procedure outlined in appendix B.

Relaxed abdominal breathing - take in a deep breath while thinking “breathe in relaxation”, pause, then exhale fully while thinking,   “ breathe out tension”, repeat 5 times.

Appendix A

Stretching for soft tissue pain: As mentioned in step 6, stretching is a very important part of the treatment for soft tissue pain.  As we grow older, we should spend even more time stretching since flexibility decreases with age.   Inflexibility is a frequent cause of chronic soft tissue pain.  Over time, muscular imbalances can develop which leads to poor posture which then leads to the development of trigger/tender points.  In addition, tight muscles are more prone to muscle aches.   A minimum of 5-10 minutes of general stretching should be performed daily; preferably more.  The stretches in this appendix are specific stretches to be used for the muscles that have been treated with the Pain Terminator.  We have chosen 10 stretches for the most commonly involved muscles.  For additional resources on stretching, refer to the references section.

Guidelines for stretching:
1.  Stretch each muscle  that was previously treated with the Pain Terminator.
2.  Isolate the muscle to be stretched, then slowly and gently move into the stretch as far as it will comfortably go. Do not force the stretch beyond  what is comfortable!  Stretching should not be painful.
3.  Hold each stretch for 20-60 seconds, and repeat each stretch at least 3 times.
4.  Stretch slowly and gently; do not use bouncing or ballistic techniques,  as these are less effective and can cause injury.

Appendix B
Progressive relaxation technique:  This is a technique developed by Dr. Jacobson  to help achieve deep relaxation.  Once learned, you can use the technique anywhere and significantly improve your state of relaxation which will reduce the recurrence of trigger points.  It’s very simple to perform- just follow along as we progressively relax each segment of the body, starting at the feet and ending with the head.  Each muscle contraction should be quite forceful and last about 1-2 seconds.
Feet- Wiggle your toes, push them down against the floor hard then up hard, then rotate your ankles, point them down hard then up hard, then relax your entire foot.           
Legs- Contract your thigh muscles in front (quadriceps) then the muscles in back (hamstrings) then relax them.
Trunk- Squeeze your buttocks muscles then your stomach muscles as hard as you can, then relax them.
Breathe- Relaxed abdominal breathing- take in a deep breath while thinking “breathe in relaxation”, pause, then exhale fully while thinking “breathe out tension”.
Back- Pull your shoulders back hard then shrug them. Now relax your whole back.
Arms- Squeeze your biceps muscles hard, then flex your wrists down then up, now make a tight fist then relax your whole arm.
Head- Look all the way down with your neck, then up, then from side to side.  Move your jaw from side to side.  Now let go of the tension in your ears, eyebrows and jaw.  Feel your ears, eyes, lips and tongue relax.
Body- Now let your whole body relax; your arms legs and eyes should feel heavy.  Repeat the relaxed abdominal breathing, let your mind relax, think of a relaxing thought.

References
1) The Relaxation & Stress Reduction Workbook, M.Davis, E. Eshelmen, M. McKay, Harbinger Pub. Inc., 1995

2) Acupressure’s Potent Points, Michael R. Gach, Bantam Books, 1990