Myofascial Pain Syndrome

Definition

Myofascial pain syndrome abbreviated as MPS is also referred to as chronic myofascial pain that has been considered as a common painful disorder among patients affecting a single or multiple skeletal muscles of the body.


This condition is being characterized by the presence of chronic muscle pain felt along the multiple trigger points and with some fascial constrictions, feelings of tenderness and muscle spasm.

myofascial pain syndrome


Source – epainassist.com

MPS is accounted for a lot of clinic visits by patients and some studies have shown that an early diagnosis of MPS is also constantly missed by medical practitioners. The trigger points or TrPs ends up with a referred pain involving specific muscles, limited range of motion activities among affected individuals, and a visible local twitch response to local stimulation given.

Symptoms of Myofascial Pain Syndrome

MPS usually presents with some muscle pain that can become worse when specific trigger points or the tender points in the body are being stimulated.

MPS leads to the following clinical symptoms:

  • Localized muscle pain such as neck pain, upper back pain or lower back pain
  • Spasm and tenderness felt in painful areas
  • Tenderness might be felt in some areas with absence of chronic pain
  • Poor sleep patterns with feelings of fatigue and lack of rest
  • Depression and behavioral disturbances
  • Stiffness noted after some inactivity

Patients with MPS and fibromyalgia share some common manifestations, such as hyperirritability. These two conditions are distinct from each other although a person can have the chance to suffer both MPS and fibromyalgia at the same period of time. Chronic pain and hyperirritability are generally present in fibromyalgia; while in MPS, the pain is very much limited to the trigger points and the hot spots with an existing referred pain.


Causes

The specific causes of MPS are not yet fully understood nor documented until today, though a theory about TrPs or the trigger points can explain myofascial syndrome as a problem. A person’s exposure to some kind of injuries or the overuse of muscles can stimulate the trigger points of tight muscle fibers, thus resulting to strain and chronic pain to the entire muscle. During the history taking and consultation with an attending physician, it is then called as MPS when the type of pain felt is persisting.

Other possible causes of MPS are:

  • Injury involving the intervertebral disk
  • Repetitive motions done
  • Feelings of general fatigue
  • Medical conditions such as cardiovascular attack, irritation of the stomach
  • Limited activity due to a broken arm or leg

Trigger points

The unique features of the myofascial trigger points are:

  • Reproduction of pain upon the palpation of a specific trigger point
  • Pseudo-weakness of the involved muscle
  • Referred pain
  • Focal point tenderness
  • Hardening of the muscle upon the palpation of a specific trigger point
  • Limited range of motion approximately 5 seconds from sustained trigger point pressure

There are four types of Trigger Points/TrPs:

  • Active TrP is that site with extreme tenderness located within a skeletal muscle and is associated with a regional pain or with local pain
  • Latent TrP is an inactive site that has the chance to act as a trigger point
  • Secondary TrP refers to that highly irritable site within a muscle that can be active anytime as a result of a trigger point and the presence of muscular overload involving another muscle
  • Satellite myofascial point is that highly irritable site within a muscle that can be inactive anytime since the location of the muscle is in an area of another trigger pain spot

Diagnosis

The diagnosis to confirm an MPS is usually performed when the physician does a physical examination by application of pressure to areas which are claimed to be painful and with some level of tenderness.

Muscle pain can have many other possible causes; thus physicians usually recommend some other tests and procedures in order to rule out the muscle pain resulting from other causes not related with the rise of MPS.

Diagnostic considerations can include:

  • Articular dysfunction patterns of painful areas that need manual mobilization
  • Observations of nonmyofascial trigger points
  • Presence of cervical radiculopathy

Differential diagnosis can be evaluated through rehabilitation and comparison with fibromyalgia.

Treatment

The optimal treatment applicable for MPS is based on a multifaceted approach by attending physicians to patients affected with MPS. These include the following:

  • Physical therapy techniques with some stretching and exercise programs to minimize the pain; some patients may receive a skin spray to numb the area with the trigger point
  • Massage therapy to gently apply pressure on specific areas with muscle tension
  • Stress reduction techniques
  • Education of the patient about MPS
  • Posture training to relieve MPS of an affected muscle and prevent the overworking of another nearby muscle
  • Applying heat, using a hot pack or through a hot shower to lessen the pain and for muscle tension relief
  • Ultrasound where the waves can promote muscle healing
  • Trigger point injection where an anesthesia is injected direct to the patient’s trigger point to relieve pain
  • Acupuncture or dry needling by inserting needles in and around trigger points for pain relief
  • Improvement of sleep pattern
  • Eating a healthy well-balanced diet to include with it more fruits and vegetables

Medications

Use of Over-the-counter pain medications such as ibuprofen (Advil/Motrin) and naproxen sodium (Aleve)

Medicines at bedtime to improve sleep and can relieve pain:

  • Trazodone (Serzone)
  • Amitriptyline (Elavil)

Meds at bedtime to relax the muscles and aid in sleep:

  • Cyclobenzaprine (Flexeril) Orphenadrine (Norflex)

Antidepressants that can control pain:

  • Sertraline (Zoloft)
  • Fluoxetine (Prozac)
  • Duloxetine (Cymbalta)

References:

  1. Myofascial pain syndrome risk factors, complications, tests, home remedies, treatment at  http://www.mayoclinic.org/diseases-conditions/myofascial-pain-syndrome/basics/definition/con-20033195
  2. Physical Medicine and Rehabilitation for Myofascial Pain Clinical Presentation at http://emedicine.medscape.com/article/313007-clinical
  3. http://www.medicinenet.com/muscle_pain/page2.htm
  4. How is myofascial pain treated ? at https://my.clevelandclinic.org/health/diseases_conditions/hic_Myofascial_Pain_Syndrome
  5. Schneider M, Vernon H, Ko G, Lawson G, Perera J (2009). Chiropractic management of fibromyalgia syndrome: a systematic review of the literature. J Manipulative Physiol Ther. 32:25–40.
  6. Cummings M, Baldry P (2007). Regional myofascial pain: diagnosis and management. Best Practice & Research in Clinical Rheumatology. 21:367–387.
  7. Matsutani LA, Marques AP, Ferreira EA, Assumpção A, et al (2007). Effectiveness of muscle stretching exercises with and without laser therapy at tender points for patients with fibromyalgia. Clin Exp Rheumatol25:410–5.

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