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Myofascial Pain

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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 of 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

While this topic is hotly debated amongst experts, leading theories state that 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. These focal areas are not able to get proper blood flow. The contracted fibers close down nearby capillaries that supply individual fibers with essential nutrients and oxygen. Because the blood flow is insufficient, muscle fibers are unable to rid toxic waste products (e.g. lactic acid) that build up during normal resting metabolic states. A chronic cycle of pain ensues in the affected tissues which is difficult to break. 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. While they are different, often patients and physicians interchange these terms. Fibromyalgia is considered a widespread chronic systemic disorder with 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 other conditions. 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

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, this pain is felt nearby to the trigger point. Stress, poor sleep and physical deconditioning have a significant effect on worsening symptoms.

Treatment

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. Avoiding extreme conditions, such as doing activities in cold weather, can prevent an active trigger point from worsening or exacerbating a dormant trigger point.

Chronic pain stress management counseling may also be valuable in teaching a patient how to deal with the impact of long-term pain, as well as techniques on how to function despite discomfort. Medications are rarely needed. During intense flare-ups a short course of anti-inflammatory medications or muscle relaxers may be helpful. Dry needling, and/or trigger point injections can be performed in an office setting to decrease muscle spasm. Physical therapy and massage therapy can be helpful to restore muscle tension and strengthen in proper alignment. At home techniques such as stretching with a foam roller, using a trigger point ball or theracane can be helpful as well. If an individual suffers from sleep disturbance, medications may be used to short term to promote a more normal sleep cycle. Tobacco use and caffeinated beverages should be discontinued. Caffeine and nicotine are stimulants and have been found to irritate the muscles. There is no indication for surgery in patients with a primary diagnosis of myofascial pain syndrome.

 

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