Myofascial Pain
WHAT IS MYOFASCIAL PAIN SYNDROME?
Myofascial pain syndrome is thought to be a form of muscle pain. It may result from a single trauma to a muscle or from repetitive minor trauma over time. There is no laboratory, radiographic or other diagnostic tests to prove the diagnosis for myofascial pain syndrome, so it is considered a “subjective” diagnosis. Many patients with myofascial pain develop “trigger or tender points”, which may be felt as "knots" of tissue under the skin. At the Virginia Spine Institute, an experienced physician will help to determine whether painful regions are indicative of myofascial pain syndrome. When trigger points are present and active, they can lead to discomfort in nearby muscles.
CAUSES OF MYOFASCIAL PAIN:
This topic is hotly debated amongst experts. Leading theories state that the painful trigger points develop in susceptible muscle tissues that are overworked for long periods of time. These muscles develop focal regions, or knots of increased contraction [Figure 1]. These focal areas are not able to get their proper blood flow because the contracted fibers are closing down nearby capillaries that supply individual fibers with essential nutrients and oxygen. Furthermore, because the blood flow is insufficient, the muscle fibers are unable to get rid of toxic waste products (e.g. lactic acid) that build up during normal resting metabolic states. What ensues is a chronic cycle of pain in the affected tissues that is difficult to break out.
Figure 1: A trigger point or “knot-like” band of muscle that may be palpated beneath the skin and cause pain.
IS THERE A DIFFERENCE BETWEEN MYOFASCIAL PAIN SYNDROME AND FIBROMYALGIA?
Simply put - yes. Although often used interchangeably by patients and physicians, they are different. Fibromyalgia is considered part systemic disease and part syndrome. Fibromyalgia has more clearly defined criteria for diagnosis, including generalized pain for more than 3 months, sleep disturbance, and a minimum number of specific tender points. Fibromyalgia may also be associated with irritable bowel syndrome, chronic fatigue syndrome, mitral valve prolapse as well as a possible family association.
Myofascial pain syndrome and fibromyalgia are similar in that there is no laboratory or radiographic tests to prove that a patient has either one, and the diagnosis is made when other diseases have been ruled out.
SYMPTOMS OF MYOFASCIAL PAIN SYNDROME:
Symptoms usually involve pain in the muscle itself or in the muscle near a painful joint. Over time, this pain may spread to involve other muscles and tissues. This is typically described as “referred pain” because when pressure is applied to the painful trigger point, pain radiates to other parts of the body (usually, but not always, nearby to the trigger point) [Figure 2]. Stress, poor sleep and deconditioning have a significant effect on worsening the symptoms.
Figure 2: A typical referral pattern from two separated trigger points in the upper trapezius muscle indicates that pain may be felt along the shoulder blade or over the outside of the shoulder.
TREATMENT OPTIONS:
An individualized program of regular stretching and cardiovascular exercise is the most important treatment for myofascial pain. To prevent deconditioning, patients with myofascial pain should be involved in activities such as brisk walking, swimming, or bicycling. Also, avoiding extreme conditions, such as doing activities in cold weather, can prevent an active trigger point from getting worse or exacerbating a dormant trigger point.
Chronic pain stress management counseling may also be valuable in teaching a patient how to deal with the social impact of long-term pain, as well as techniques on how to function despite the discomfort.
Medications are rarely needed. However, during intense flare-ups a short course of anti-inflammatories or muscle relaxers may be helpful. Dry needling, and/or trigger point injections can be performed in an office setting to decrease muscle spasm [Figure 3]. If an individual suffers from sleep disturbance, medications such as cyclobenzaprine, doxepin, trazodone, amitriptyline, or short term zolpidem may be used to promote a more normal sleep / wake cycle.
Tobacco use and caffeinated beverages should be discontinued. Caffeine and nicotine are stimulants, and have been found to irritate the muscles, thereby perpetuating myofascial pain.
Figure 3: Dry needling or trigger point injections using local anesthetic may provide relief from myofascial pain. The injections are performed within the muscle at the location of the trigger point.
Is surgery an option for myofascial pain syndrome?
There is no indication for surgery in patients with a primary diagnosis of myofascial pain syndrome.
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