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.
References: 

Frontera WR, et al. Myofascial pain syndrome. In: Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 3rd ed. Philadelphia, Pa.: Saunders Elsevier; 2015. http://www.clinicalkey.com. Accessed Nov. 14, 2017

Han SC, Harrison P. Myofascial pain syndrome and trigger-point management. Regional Anesthesia. 1997;22(1):89–101.

10. Sola A, Bonica J. Myofascial pain syndromes. In: Loeser J, et al., editors. Bonica’s Management of Pain. 3rd edition. Philadelphia, Pa, USA: Lippincott Williams & Wilkins; 2001.

Hong C. Myofascial Pain Therapy. Regional Musculoskeletal Pain. 2004;12(3):37–43. 

Author: 
Nikhraj S. Brar