Myofascial Pain

Myofascial Pain Syndrome

By Michael Xu BHSc Level IV, McMaster University

Introduction

Myofascial (say: My-oo-fay-shaul) pain syndrome is a form of chronic pain that affects trigger points and fascia around the body. Fascia is connective tissue that surrounds muscles, binding them tightly together and also allowing them to move with less friction. Trigger points can best be described as specific centres in muscles that respond with hypersensitivity to sensations. In myofascial pain syndrome, pressure on the fascia or trigger points causes pain in another area of the body; this is called referred pain.

Trigger points can be active or latent. An active trigger point is always sore or in pain and as a result, limits the function of surrounding muscles. A latent trigger point only causes pain or tenderness when it is touched or the muscles around it become tired or injured.

Myofascial pain syndrome can resemble fibromyalgia in that both have to do with tender points in the muscles. Fibromyalgia usually has more widespread pain and symptoms that extend beyond the muscles and to the rest of the body. Myofascial pain syndrome typically affects people between the ages of 30 and 60 years. It affects females more than males.

Signs and Symptoms

Signs and symptoms of myofascial pain syndrome include:

  • tender knots in the muscle
  • deep aches or pains in the muscle
  • muscle weakness, tingling or stiffness
  • problems sleeping due to pain
  • constant deep muscle pain

Symptoms may develop over time or appear suddenly, and can often start in one area but progress to other muscles.

Causes

The causes behind myofascial pain syndrome are uncertain. Possible causes may include poor posture, muscle overuse, imbalance in muscles, or stress. It has been found that exercise or work involving heavy use of muscles with poor technique can exaggerate and increase strain on the muscles. This increased strain in turn can increase the chances of developing myofascial pain syndrome.

Diagnostic tests

More often than not, the family physician will be the first person to consult about myofascial pain syndrome. A detailed history of the pain and performance of a physical examination is the most important step. Much of the diagnosis will be focused on the affected muscles, looking at the strength and range of motion of the area. If the family physician has training with trigger points and identifying them, he or she may rub the suspected trigger points to examine how the muscles respond and if the pain, if any, happens in a predictable pattern. Blood tests may be order to rule out other possible causes of the muscle pain. Other testing is often not useful in the diagnosis.

Treatment approaches

Medicines

There are three main classes of drugs that are being used to myofascial pain:

  1. Tricyclic antidepressants: such as amitriptyline, nortriptyline, and desipramine can help to reduce pain syndromes and insomnia.
  2. Anticonvulsants: such as gabapentin, pregabalin, topirimate, and carbamazepine have been shown to be effective in treating myofascial and neuropathic pain.
  3. Muscle relaxants have been shown to be effective, but must be used carefully due to their sedative and addictive properties. Common muscle relaxants prescribed include cyclobenzaprine, baclofen, and carisoprodol--all of which have a short-term benefit.

Over-the-counter drugs such as Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), like ibuprofen, indomethacin, and diclofenac have been found to be useful in reducing pain.

Trigger Point Therapy

Trigger point therapy is often recommended to treat myofascial pain, as it involves the manipulation and use of various techniques to apply pressure on the trigger points. Treatment involves identifying affected trigger points, relaxing them, and then stretching the muscles around the area through various techniques such as muscle energy techniques or proprioceptive neuromuscular facilitation. Therapy in this fashion is reliant upon the skill of the therapist; if points are not sufficiently pressured they may not be fully relaxed. Too much pressure, on the other hand, may result in bruising around the area or muscle irritation. Evidence from various reviews shows that trigger point therapy is mildly effective in the short-run but usefulness in the long-run is to be established.

Trigger Point Injection

Trigger point injections are another form of treatment sometimes prescribed. Various solutions can be used, ranging from botulinum toxin to saline to dry needling in order to try and provide relief. Trigger point injections are typically prescribed when other methods fail, and are becoming more recognized as a valid form of treatment for myofascial pain syndrome.

Other

There are other forms of treatment that may be prescribed to help reduce pain and increase coping with other symptoms associated with the pain. These may include:

  • meditation or similar activities
  • relaxation exercises
  • cognitive behavioural therapy

For more information:

References:

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Borg-Stein J. Simons DG. Focused review: myofascial pain. Arch Phys Med Rehabil. 2002;83(3 Suppl 1):S40-7, S48-9.

Gerwin RD. Classification, epidemiology, and natural history of myofascial pain syndrome. Current Science Inc. 2001(5):412-20.

Chandola HC, Chakraborty A. Fibromyalgia and Myofascial Pain Syndrome: A dilemma. Indian J Anaesth. 2009;53(5):575-81.

Bohr TW. Fibromyalgia syndrome and myofascial pain syndrome. Do they exist? Neurol Clin. 1995;13(2):365-84.

Escobar PL Ballesteros J. Myofascial pain syndrome. Orthop Rev. 1987;16(10):708-13.