How about no narcotics at all? You noticed that when you do too much and get cold you have muscle spasms. Our Post-Polio surveys found that in the nearly three-quarters of polio survivors who reported back and neck pain, the cause is almost always muscle spasms. Polio survivors report that the most common triggers for pain were physical overactivity and exercise, followed by cold exposure, emotional stress, anxiety and type A behavior. The simplest way to prevent the spasms in the first place is not to overdo, to stay warm and to relax. However, once you develop severe muscle spasms, it can be hard to get rid of them because muscles develop a "cycle" of spasm: Muscles become more contracted and painful because they already are contracted and painful. The only way to stop the spasm is to break the cycle.

The first thing to do is to rest the muscle and apply heat. If that doesn't work, find a physical therapist with lots of experience treating both PPS and chronic muscle spasm pain. The therapist can use industrial-strength hot packs, ultrasound (the deep heating of muscles using sound waves), followed by a deep and often painful muscle massage--called "fibrositis" massage or "myofacial release"--that physically separates the muscle fibers to temporarily relieve spasm.

But heat and massage are not enough to break the spasm cycle. Too many physical therapists use only the "shake and bake" method: gentle massage after your muscles have been baked by a hot pack. Sure, massage and heat make you feel better for a few hours, but you have to get rid of the spasm triggers or the pain will return. A home stretching program is vital to keep your spasms turned off. Your PT needs to help you find a small number of stretches, specific to the muscles in spasm, that you will do in the morning, before bed and throughout the day, to turn muscles off before they tighten up. It's also vital that you use assistive devices to prevent muscle overuse (a lumbar cushion, a brace, crutches and wheelchair) and that you learn "painless posture"--sitting and standing in positions that keep muscles relaxed (see "Oh Your Achin' Back" at www.newmobility.com/review_article.cfm?id=601&action=browse ).

Unfortunately, some polio survivors don't want to slow down, take time for stretches or use devices that make them look "more disabled." So they search for a quick fix. You can always find a doctor who will promise pain relief. But polio survivors need to be very cautious. Stay clear of doctors who want to inject local anesthetic into muscles ("trigger points" injections) or around the spinal cord ("epidural block"). Run from docs who want to inject Botox into painful muscles. Botox actually "paralyzes" muscle for about six months. One thing polio survivors don't need is to have more muscles paralyzed, even temporarily. And, now that long-acting narcotics are available--like Oxycontin and the Duragesic pain patch--some doctors hand them out like candy instead of identifying and treating the actual cause of pain. Narcotics only mask pain. If muscle spasms cause pain, then it's muscle spasms that must be treated.