Myofascial Pain: Mechanisms to Management

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Key points

  • Chronic pain is the main reason for seeking health care, the most common reason for disability and addiction, and the highest driver of health care costs, and it is most often caused by myopain conditions.

  • Myofascial pain (MFP) is the most common cause of persistent regional pain such as back pain, headaches, and facial pain.

  • MFP is readily diagnosed through identifying differential clinical characteristics and soft tissue palpation.

  • Treatments of myopain conditions include:

    • Stretching, postural,

Clinical Characteristics

The clinical characteristics of MFP include hard, palpable, discrete, localized nodules, called trigger points (TrPs), which are located within taut bands of skeletal muscle (Box 1). TrPs are painful on compression and associated with pain in predictable regional patterns within a referral zone. The pain in the zone of reference is usually located over the tender point (TeP) or spreads out in a referral pattern to distant sites (Fig. 1). This tenderness is often referred to as a TrP because

Cause and pathophysiology

The results of this research suggest that an explanatory model can account for the mechanisms in the development of myalgia from its onset to increasing severity found with clinical and chronic cases. It is apparent that both central and peripheral mechanisms are associated with this process but peripheral sensitization may have more prominence in MFP, whereas central sensitization may occur more in FBM.9

Evidence-based management

Treatment of MFP can range from simple cases with transient single-muscle syndromes to complex cases involving multiple pain areas and many interrelating contributing factors, including the presence of FBM. Many systematic reviews and randomized controlled trials (RCTs) have shown success in treatment of MFP using a wide variety of techniques, such as exercise, TrP injections, myotherapy, vapocoolant spray and stretch, transcutaneous electrical nerve stimulation, biofeedback, posture

Summary

MFP is a regional muscle pain disorder characterized by localized muscle tenderness and pain and is the most common cause of persistent regional pain. FBM is a widespread pain disorder characterized by sleep disturbance, fatigue, cognitive symptoms, and often psychological distress. The affected muscles in both disorders may also have increased fatigability, stiffness, subjective weakness, pain in movement, and slightly restricted range of motion that is unrelated to joint restriction. They are

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      Myofascial syndrome is a common condition, considered to participate in many chronic pain syndromes, such as low back pain, fibromyalgia and chronic headache [1].

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      MPS is typically diagnosed via physical exam, and the generally agreed upon diagnostic criteria include the presence of TrPs, pain upon palpation, a referred pain pattern, and a local twitch response [6]. In the United States, more than 100 million adults suffer from chronic pain conditions, and several studies have shown that myopain conditions like MPS and fibromyalgia are the most common culprits [2]. Although the exact prevalence of MPS in the general population is infrequently cited in existing literature, some studies have estimated that MPS comprises 30–85% of cases of musculoskeletal pain [6].

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    Disclosures: None.

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