Myofascial Pain Syndrome

What is myofascial pain syndrome?

Myofascial pain syndrome (MPS) refers to pain and presumed inflammation in the body's soft tissues or muscles. Myofascial pain is a chronic, painful condition that affects the fascia (connective tissue that covers the muscles). Myofascial pain syndrome might involve either a single muscle or a muscle group. In some cases, the area where a person experiences the pain might not be where the myofascial pain generator is located. Experts believe that the actual site of the injury or the strain prompts the development of a trigger point that, in turn, causes pain in other areas. This situation is known as referred pain.

What causes myofascial pain?

Myofascial pain might develop from a muscle injury or from excessive strain on a particular muscle or muscle group, ligament, or tendon. Other causes include:

• Injury to intervertebral discs
• General fatigue
• Repetitive motions
• Medical conditions (including heart attack, stomach irritation)
• Lack of activity (such as a broken arm in a sling)

What are the symptoms of myofascial pain?

Myofascial pain symptoms usually involve muscle pain with specific trigger or tender points. The pain can be made worse with activity or stress. In addition to the local or regional pain associated with myofascial pain syndrome, people with the disorder also can suffer from depression, fatigue, and behavioral disturbances.

How is myofascial pain diagnosed?

The recognition of this syndrome requires a precise understanding of the body's trigger points. Trigger points can be identified by pain that results when pressure is applied to an area of the patient's body. In the diagnosis of myofascial pain syndrome, four types of trigger points can be distinguished:

• An active trigger point is an area of extreme tenderness that usually lies within the skeletal muscle and which is associated with a local or regional pain.
• A latent trigger point is a dormant (inactive) area that has the potential to act like a trigger point.
• A secondary trigger point is a highly irritable spot in a muscle that can become active due to a trigger point and muscular overload in another muscle.
• A satellite myofascial point is a highly irritable spot in a muscle that becomes inactive because the muscle is in the region of another trigger pain.

How is myofascial pain treated?

Physical therapy methods are considered the best treatments for myofascial pain syndrome. Other treatments include a stretch and spray technique, in which the muscle with the trigger point is sprayed along its length with a coolant, then slowly stretched. Massage therapy is another treatment, as is trigger point injection. In the latter form of therapy, anesthesia is injected directly into the trigger point of the patient.

In some chronic cases of myofascial pain, combinations of physical therapy, trigger point injections, and massage are needed. In select cases, medicine is used to treat any co-morbid (existing simultaneously) conditions, such as insomnia and depression. A case can be made for using the older tricyclic antidepressants and some of the newer antidepressants.