Myofascial pain syndrome

Myofascial pain syndrome
Classification and external resources
Specialty
ICD-10	M79.1 – Myalgia (excl. myositis)
ICD-9-CM	729.1 – Myalgia and myositis, unspecified
MedlinePlus	DS01042
Patient UK	Myofascial pain syndrome

Myofascial pain syndrome (MPS), also known as chronic myofascial pain (CMP), is a syndrome characterized by chronic pain in multiple myofascial trigger points ("knots") and fascial constrictions. Characteristic features of a myofascial trigger points include: focal point tenderness, reproduction of pain upon trigger point palpation, hardening of the muscle upon trigger point palpation, pseudo-weakness of the involved muscle, referred pain, and limited range of motion following approximately 5 seconds of sustained trigger point pressure.

Symptoms

Myofascial pain can occur in distinct, isolated areas of the body, and because any muscle or fascia may be affected, this may cause a variety of localized symptoms. More generally speaking, the muscular pain is steady, aching, and deep. Depending on the case and location the intensity can range from mild discomfort to excruciating and "lightning-like". Knots may be visible or felt beneath the skin. The pain does not resolve on its own, even after typical first-aid self-care such as ice, heat, and rest.

MPS and fibromyalgia

MPS and fibromyalgia share some common symptoms, such as hyperirritability, but the two conditions are distinct. However, a patient may suffer from MPS and fibromyalgia at the same time. In fibromyalgia, chronic pain and hyperirritability are pervasive. By contrast, while MPS pain may affect many parts of the body, it is still limited to trigger points and hot spots of referred pain.

Causes

The causes of MPS are not fully documented or understood. At least one cause is ruled out: "The theory of myofascial pain syndrome (MPS) caused by trigger points (TrPs) ... has been refuted. This is not to deny the existence of the clinical phenomena themselves, for which scientifically sound and logically plausible explanations based on known neurophysiological phenomena can be advanced." Some systemic diseases, such as connective tissue disease, can cause MPS. Poor posture and emotional disturbance might also instigate or contribute to MPS.

Treatment

Massage therapy using trigger-point release techniques may be effective in short-term pain relief. Physical therapy involving gentle stretching and exercise is useful for recovering full range of motion and motor coordination. Once the trigger points are gone, muscle strengthening exercise can begin, supporting long-term health of the local muscle system.

Three types of drugs are used to treat myofascial pain: anti-depressants (primarily SNRIs), anticonvulsants such as pregabalin (Lyrica), and muscle relaxants such as Baclofen.

Myofascial release, which involves gentle fascia manipulation and massage, may improve or remediate the condition.

A systematic review concluded that dry needling for the treatment of myofascial pain syndrome in the lower back appeared to be a useful adjunct to standard therapies, but that clear recommendations could not be made because the published studies were small and of low quality.

Trigger point injections using local anaesthetic such as Lidocaine is a controversial treatment with many anaesthetists not willing to perform them due to their belief of the technique being unable to provide relief or due to little knowledge of myofascial pain syndrome and how to perform TPIs. The treatment has been found effective in regard to patients finding longer term relief after a few sessions or regular TPIs providing relief from pain substantial to reduce the use of severe pain medications like Oxycodone or Tramadol.

Posture evaluation and ergonomics may provide significant relief in the early stages of treatment. Movement therapies such as Alexander Technique and Feldenkrais Method may also be helpful.