What Is Myofascial Pain Syndrome?
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In myofascial pain syndrome, there are focal tender points in muscles called trigger points. A trigger point is usually within a taut band of muscle that can be felt by the examiner. They can ultimately be identified by the examiner applying pressure with one to three fingers and the thumb. Patients usually exhibit a jump sign when a trigger point is pressed. The patient with a positive jump sign may wince, cry out, and withdraw from the pressure being applied by an examiner. The pain may be referred, or felt at a distance away from the area being compressed.
Trigger points can occur in muscles, ligaments, fascia, and periosteum (the membrane surrounding a bone). Pain in trigger points can be made worse with activity or stress. Currently, four types of trigger points can be distinguished:
- An active trigger point is an area of extreme tenderness usually within a taut muscle or muscle group
- A latent trigger point is an inactive area with the potential to act like a trigger point
- A secondary trigger point is a highly irritable area in a muscle or muscle group that can be activated due to a trigger point or overload in another muscle or muscle group
- A satellite trigger point is a highly irritable spot in a muscle or muscle group that becomes active because the muscle is in the region of another trigger point
Causes Of Myofascial Pain SyndromeNo one single factor can be identified as causing myofascial pain syndrome. The syndrome may develop from a muscle injury or excessive strain on a certain muscle or muscle group, ligament, or tendon.
In addition, the following factors may be contributors:
- Trauma to the discs between the backbones, or vertebrae
- Inflammatory conditions
- Lack of blood flow to heart muscle
- Deconditioning from lack of exercise
- General fatigue
- Nutritional deficiencies
- Hormonal changes
- Intense cooling of parts of the body
- Use of tobacco
- Repetitive motions
- Overuse of a muscle
- Alcohol or drug abuse
- Long-term emotional stress
Treatments For Myofascial Pain SyndromeMyofascial pain syndrome is best treated with a team of various medical professionals and various forms of therapies. The treatment team may consist of a primary care physician, a specialist in Physical Medicine and Rehabilitation, nurses, physical and occupational therapists, massage therapists, and psychologists. The therapies may be carried out through drug and non-drug means. Current practice is combining non-drug therapies with short-term drug therapies for longer lasting and maximal benefits.
Various drugs can be used in the treatment of myofascial pain syndrome. Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin (Bayer), ibuprofen (Advil), and naproxen sodium (Aleve) can be used short term to reduce acute pain and inflammation. Acetaminophen (Tylenol) and oral narcotics such as oxycodone and hydrocodone may also be used in the short term for pain relief. Tricyclic antidepressants such as trazodone (Desyrel) and amitriptyline (Elavil) can be used at bedtime to improve sleep as well as relieve pain. Muscle relaxants such as cyclobenzaprine (Flexeril) and carisoprodol (Soma) can be used to relax muscle spasm and improve sleep, as they can have a sedating effect.
Antidepressants such as fluoxetine (Prozac), sertraline (Zoloft), and duloxetine (Cymbalta) can be helpful with the chronic pain of myofascial pain syndrome. Anti-seizure medications such as gabapentin (Neurontin) and pregabalin (Lyrica) can also be helpful with the chronic pain of the syndrome. Capsaicin cream, a topical pain reliever derived from chili peppers, may also be helpful with the chronic pain of myofascial pain syndrome.
Injections can also be utilized in the treatment of myofascial pain syndrome. Trigger point injections and botulinum toxin (Botox) injections are two areas of recent interest. Trigger point injections involve direct injection of a local anesthetic into the trigger point. This method is very effective when there are only a few precisely located trigger points. Botox can also be directly injected into trigger points. This method has produced inconsistent results.
Various non-drug therapies can be utilized in the treatment of myofascial pain syndrome. Physical therapy is one of the best treatments for the syndrome. The stretch and spray method has also been used with some success for treatment of the syndrome. It involves spraying the muscle or muscle group containing the trigger point with a coolant, such as flourimethane, and then slowly stretching the muscle.
Massage therapy is another non-drug treatment used in the treatment of the syndrome. Massage therapists exert ischemic compression, which is the application of progressively stronger pressure on a trigger point for the purpose of eliminating its tenderness.
ConclusionMyofascial pain syndrome is a chronic pain disorder that affects muscle and the fascia covering the muscle. Key to the diagnosis and treatment of the syndrome is the identification of trigger points, which are areas of extreme tenderness in bands of taut muscle. No one knows the exact cause of the disorder. The treatment of myofascial pain syndrome is best done by a multidisciplinary team utilizing various drug and non-drug therapies. The combination of physical therapy, trigger point injections, and massage are routinely used with some success in the treatment of myofascial pain syndrome.
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