Myofascial Pain

Overview

• Definition
  • Chronic Pain Syndrome
  • Characterized by multiple tender points in muscles 
  • These tender points have also been characterized at “taut bands” known as trigger points
• Pathophysiology
  • Occurs from repetitive contraction of a muscle
  • This repetitive contraction can be a result of sports, work, hobbies, or stress
  • Muscle Injury: Strained muscles can get tight and form trigger points
  • Stress: Theory is under stress individuals can clench their muscles leading to muscle strain
• Diagnosis: 
  • Physical Exam- The examiner must palpate painful muscle regions and feel for taut bands consistent with trigger points

Challenges

• Poorly defined pathophysiology makes definitive treatments challenging
  • Treatments vary from muscle relaxers to anxiolytics to anti-depressants to physical therapy to stretches to trigger point injections to massage to modalities such as heat and ultrasound
• Association with Fibromyalgia
  • It has been suggested that these two syndrome can be co-related and at times myofascial pain syndrome can develop into fibromyalgia. 
  • Fibromyalgia is an inherently difficult disease to define and treat
• Association with mental health disorders
  • Some studies suggest that myofascial pain can be a manifestation of depression and anxiety and can lead to sleep disturbance

Treatment  Recommendations

• Medications
  • Tylenol, NSAIDS (systemically and topical)
  • Muscle Relaxers such as cyclobenzaprine (Flexeril), baclofen, methocarbamol (Robaxin), tizanidine
  • Anxiolytics such as Diazepam
  • Antidepressants such as Amitriptyline
• Modalities
  • Physical Therapy 
  • Stretching
  • Massage
  • Ultrasound
  • Acupuncture
• Interventional Therapy
  • Trigger Point Injections- insertion of needle into a palpable trigger point to relieve muscle tension. Can be accompanied by dry needling and injection of local anesthetic.