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Myofascial Pain

Pain, which has many different etiologies, is something that affects everyone at some point in their lives, and myofascial pain can be one cause. Pain has survival advantages and serves as a warning to protect one from bodily harm and damage. However, pain should be short-lived, so when it lasts longer than three months it becomes known as chronic pain. Myofascial pain can be an acute or chronic pain issue and is one of several things to be considered when being evaluated by your physician. It is, however, important to realize that several medical conditions may be confused with myofascial pain. Additionally, other medical conditions can have overlapping presentations which further complicate evaluation, diagnosis and treatment.

To understand myofascial pain, one can think about the derivation of the word. “Myo” denotes a relationship to muscle while “fascial” refers to the covering of muscle. So it is easier to think of myofascial pain as pain originating from the muscles and the covering of the muscles themselves. One common area in which this occurs is in the trapezius muscle (Figure A).

Figure A.
Common area that myofascial pain is found in the trapezius musculature.

trapezius musculature

Myofascial pain syndrome is chronic in nature and oftentimes has trigger points. Trigger points are sensitive, tightened areas known as taut bands that occur in muscle and refer pain when pressure is applied to them. The area that pain radiates to is referred to as a target zone. This can cause pain which may be experience as tingling, burning and even weakness.

Some of the things that can cause trigger points include poor posture, injury, overuse, and trauma (i.e. accidents, sports, work). Some of the symptoms that may be experienced by sufferers of myofascial pain include joint stiffness near affected muscles, sleep disturbances, deep aching pain in the muscles, and areas of tension with knots. There are also other common regional pain disorders such as tension headaches, low back and neck strain disorders of unknown cause, repetitive strain syndromes, occupational overuse, and temperomandibular joint syndromes that may have myofascial pain as a component.

Fibromyalgia is well known and often confused with myofascial pain. In fact, some researchers believe that myofascial pain may lead to fibromyalgia, which has specific diagnostic criteria. Furthermore, myofascial pain and fibromyalgia may be confused with rheumatic and systemic illnesses such as lupus, rheumatoid arthritis and osteoarthritis.

A discussion of these conditions is beyond the scope of this discussion, but will be considered during evaluation by a physician. Physician evaluations will also include consideration of other illnesses such as lyme disease and hypothyroidism which can be associated with myofascial pain. Lastly, some musculoskeletal conditions to include in the differential include muscle tendon inflammation, muscle bursa inflammation and even nerve injuries which can mimic myofascial pain. It is important to note that careful history and physical exam can usually differentiate these, and limit the overuse of blood tests so that patients can receive appropriate treatment.

Some of the treatments are similar to those used with Fibromyalgia, including physical therapy, trigger point injections, and medications. The type of treatment initiated depends on patient preference and the treating physician, and will include an evaluation of drug interactions. Physical therapy may include different types of stretching and massage release, or incorporate postural training along with spray and stretch techniques.

Trigger point injections may include the use of medication or simple dry needling of the affected area. Medications that are often used can be taken by mouth and include anti-inflammatory medications such as ibuprofen, or other medications that often have other uses such as antidepressant medications, muscle relaxants and anti-seizure medications. Also important in any treatment regimen for myofascial pain is the incorporation of a healthy lifestyle with an appropriate balance of exercise and healthy nutrition while striving to maintain appropriate sleep hygiene.


References

  1. Wolfe F, Simons D, Fricton J, Bennett R, Goldenberg D, Gerwin R, et al. The fibromyalgia and myofascial pain syndromes: a preliminary study of tender points and trigger points in persons with fibromyalgia, myofascial pain syndrome and no disease. Journal of Rheumatology 1992 Jun;19(6):944-51
  2. Hwang E, Barkhuizen A. Update on rheumatologic mimics of fibromyalgia. Current Pain and Headache Reports. 2006 Oct;10(5):327-32.
  3. Hong C. Treatment of myofascial pain syndrome. Current Pain and Headache Reports. 2006 Oct;10(5):345-9.
  4. Borg-Stein J. Treatment of fibromyalgia, myofascial pain, and related disorders. Physical Medicine and Rehabilitation Clinics of North America. 2006 May;17(2):491-510, vii