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:
Fibromyalgia
Temporomandibular Joint Disorder
Self-Management
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Gerwin RD. Classification, epidemiology, and natural history of myofascial pain syndrome.
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Chandola HC, Chakraborty A. Fibromyalgia and Myofascial Pain Syndrome: A dilemma.
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