Myofascial Pain Syndrome

What is it and what are my treatment options?

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What is it?

MYOFASCIAL PAIN SYNDROME is thought to be a form of muscle or soft tissue pain. It may result from a single significant trauma such as a motor vehicle accident. It may also result from repetitive minor trauma. Patients develop “tight”, “sore” or irritated muscles. There is a tendency for the development of poorly functioning areas of muscle called trigger or tender points. These areas may be felt as “knots” of tissue under the skin. An experienced clinician can determine whether painful regions are indicative of myofascial pain syndrome. When trigger points are present and active, they can lead to localized discomfort as well as pain in nearby muscles.

SYMPTOMS

Symptoms are usually confined to the muscle itself or muscle located near a painful joint. The pain can be aggravated by motion and relieved with rest. Range of motion may be impaired. Trigger points are thought to result in or result from prolonged muscle spasm. These areas are stiff and painful to the touch. Stress, limited sleep, and deconditioning make symptoms significantly worse..

MYOFASCIAL PAIN VERSUS FIBROMYALGIA

Although often used interchangeably by patients and physicians, these are different conditions. Fibromyalgia is considered part systemic disease and part syndrome. It has more clearly defined criteria for diagnosis, including pain present for more than three months, sleep disturbance, and a minimum number of specific tender points. It is more generalized with pain above and below the waist and on both sides of the body. Fibromyalgia may also be associated with irritable bowel syndrome, chronic fatigue syndrome, depression and mitral valve prolapse. There may also be a family association. Myofascial pain syndrome is typically more localized and less likely to be associated with systemic conditions. There are no laboratory, radiographic or other diagnostic tests for myofascial pain syndrome or fibromyalgia. The diagnosis is made when other conditions are not present or “ruled out”.

TREATMENT OPTIONS

Successful long-term treatment involves proper exercise. An individualized program of stretching and cardiovascular exercise is the mainstay of treatment. The key ingredients to preventing recurrence are strengthening the involved muscles and restoring physical activity. Non-impact activities such as brisk walking, swimming and bicycling are often helpful in preventing deconditioning. Anti-inflammatory medications also called NSAIDS such as ibuprofen and naproxen can be helpful. Muscle relaxants and low dose anti-depressants have a role in relieving spasm and helping to restore sleep patterns. Intramuscular or trigger point injections can be very helpful when trigger points are present. Specific physical therapy techniques such as neuromuscular massage and myofascial release can provide significant relief as can moist heat and TENS (a form of electrical stimulation). In stubborn, persistent cases additional resources are used to teach patients techniques to promote relaxation and enable functioning despite discomfort. These include stress management, biofeedback and psychotherapy. Tobacco use and caffeinated beverages need to be discontinued. Caffeine and nicotine are stimulants. They have been found to irritate muscles and perpetuate muscular or myofascial pain.

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