Myofascial Pain Syndrome

Janet D. Pearl, MD, MSc

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Myofascial Pain Syndrome

What is it?

Myofascial pain syndrome is a chronic pain condition that tends to result from repetitive movements of a particular muscle.  It is a deep, muscle ache or muscle pain that doesn’t go away with rest and can actually feel worse as time goes on.  The hallmark sign of this condition is trigger points.  These are tough nodules of tissue located deep within the muscle.  You may notice them as small lumps, and you may also notice that they elicit strange responses.

Although trigger points hurt when they are pressed on, they do not behave as other tissue that receives pressure.  Many patients report feeling pain far away from the trigger point when the nodule is manipulated or activated.  This is known as referred pain, and it is a primary differentiation point between myofascial pain and chronic myalgia.  Trigger points and referred pain are signs that lead to diagnosis of this rare condition, and the presence of this network of pain receptors often points to a more complicated problem than simple myalgia.

What kind of pain results?

Myofascial pain syndrome usually results in deep, aching muscle pain.  It is the same feeling you would get from straining a muscle, but it tends to be amplified in the case of this condition.  The pain is either more intense or just doesn’t go away.  Another important point to consider about the pain is that it is often referred.  Myofascial pain means that the connective nerves in the muscle fibers are eliciting pain signals.  This is why you have pain in a different area when a trigger point is activated.  For this reason, those who have this type of pain can experience pain in the muscle, of course, but they can also feel it as far away as adjacent joints or nearby muscles.

Who gets it?

Anyone can get myofascial pain syndrome, particularly if you perform a job that requires repetitive motions.  For instance, a plumber may experience myofascial pain in their biceps from constantly working the wrench while repairing plumbing.  Similarly, if you sit hunched over at your desk and improperly use your keyboard, you can develop pain in a number of muscles that are activated through that improper form.

In addition, injury to a muscle from a prior problem can develop myofascial pain.  For instance, muscle tears may heal in time, but they can also develop trigger points and cause chronic muscle pain.  Another overlooked cause of this condition is stress and anxiety.  Certain muscles are activated during chronic stress, and this can cause the overuse injury that leads to so many instances of myofascial pain syndrome.

Treatment

Since this is not a common condition, you will probably get referred to a pain management doctor once you see your primary care physician.  The pain doctor will do a complete assessment, and will examine you for the presence of trigger points or determine if fibromyalgia is present.  The most common way to start treatment for myofascial pain syndrome is by engaging in physical therapy.  This can stretch out the problem muscle and allow for proper ergonomics that may be leading to the formation of trigger points.  Medications are also a large part of early therapy, and prescription non-steroidal anti-inflammatories are usually enough to control the muscle pain.

For most persistent myofascial pain, other treatments are available.  For instance, a Myers cocktail infusion that provides a bolus of nutrients that may be lacking in the body is often used to combat chronic pain.  The most definitive treatment for this painful muscle condition, however, is trigger point injections.  In this procedure, pain relieving medications and anti-inflammatories are injected directly into the trigger point nodule.  Most patients feel relief from their muscle and referred pain after this treatment, and it is used when more conservative measures fail to control pain.

trigger point injections
medication
myofascial physical therapy

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