What is Myofascial Pain?
The Symptoms and Causes
Myofascial pain syndrome is a chronic local or regional musculoskeletal pain disorder that may involve either a single muscle or a muscle group. The pain may be of a burning, stabbing, aching or nagging quality. Importantly, where the patient experiences the pain may not be where the myofascial pain generator is located. This is known as referred pain. The pathophysiology of myofascial pain remains somewhat of a mystery due to limited clinical research; however, based on case reports and medical observation, investigators think it may develop from a muscle lesion or excessive strain on a particular muscle or muscle group, ligament or tendon. It is thought that the lesion or the strain prompts the development of a “trigger point” that, in turn, causes pain.
In addition to the local or regional pain, people with myofascial pain syndrome also can suffer from depression, fatigue and behavioral disturbances, as with all chronic pain conditions.
How to Diagnose and Treat Myofascial Pain Syndrome
Recognition of this syndrome is difficult and requires the physician to have a precise understanding of the body’s anatomy. Trigger points can be identified by pain produced upon digital palpation (applying pressure with one to three fingers and the thumb). In diagnosing myofascial pain syndrome, four types of trigger points can be distinguished:
active trigger point — an area of exquisite tenderness that is usually located in a skeletal muscle and is associated with local or regional pain
latent trigger point — a dormant area that can potentially behave like an active trigger point
secondary trigger point — a hyperirritable spot in a muscle that becomes active as a result of a trigger point and muscular overload in another muscle
satellite myofascial point — a hyperirritable spot in a muscle that becomes active because the muscle is located within the region of another trigger point.
The best treatments for myofascial pain syndrome are active and passive physical therapy methods. There is also the “stretch and spray”
technique, in which the muscle with the trigger point is sprayed along its length with a coolant such as fluorimethane, and then stretched slowly.
Trigger point injection, whereby local anesthesia is injected directly into the trigger point, also is used. At times, corticosteroids and botulinum toxin can be injected. Massage therapy also can be of significant benefit in some patients. Often a combination of physical therapy, trigger point injections and massage are needed in refractory chronic cases.
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