Myofascial pain syndrome

{{Infobox medical condition (new)

| name = Myofascial pain syndrome

| synonyms = Chronic myofascial pain, myofascial pain and dysfunction syndrome (MPDS or MFPDS)

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| field = Rheumatology

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Myofascial pain syndrome (MPS), also known as chronic myofascial pain (CMP), is a syndrome characterized by chronic pain in multiple myofascial trigger points ("knots") and fascial (connective tissue) constrictions. It can appear in any body part. Symptoms of a myofascial trigger point include: focal point tenderness, reproduction of pain upon trigger point palpation, hardening of the muscle upon trigger point palpation, pseudo-weakness of the involved muscle, referred pain, and limited range of motion following approximately 5 seconds of sustained trigger point pressure.{{cite journal | vauthors = Bennett R | title = Myofascial pain syndromes and their evaluation | journal = Best Practice & Research. Clinical Rheumatology | volume = 21 | issue = 3 | pages = 427–445 | date = June 2007 | pmid = 17602992 | doi = 10.1016/j.berh.2007.02.014 }}

The cause is believed to be muscle tension or spasms within the affected musculature.{{cite web |title=Myofascial Pain Syndrome - Dental Disorders |url=https://www.merckmanuals.com/professional/dental-disorders/temporomandibular-disorders/myofascial-pain-syndrome |website=Merck Manuals Professional Edition |access-date=27 May 2019}} Diagnosis is based on the symptoms and possible sleep studies.

Treatment may include pain medication, physical therapy, mouth guards, and occasionally benzodiazepine. It is a relatively common cause of temporomandibular pain.

Signs and symptoms

Primary symptoms include:{{cite web | title = Myofascial Pain Syndrome | work = Made for this Moment | publisher = American Society of Anesthesiologists | url = https://www.asahq.org/madeforthismoment/pain-management/types-of-pain/myofascial-pain-syndrome/}}

Localized muscle pain
Trigger points that activate the pain (MTrPs)

Generally speaking, the muscular pain is steady, aching, and deep. Depending on the case and location the intensity can range from mild discomfort to excruciating and "lightning-like". Knots may be visible or felt beneath the skin. The pain does not resolve on its own, even after typical first-aid self-care such as ice, heat, and rest.{{cite web|url=http://www.mayoclinic.com/health/myofascial-pain-syndrome/DS01042/DSECTION=symptoms|title= Myofascial pain syndrome: Symptoms|author= Mayo Clinic Staff|date= 3 Dec 2009|access-date=8 May 2011}} Electromyography (EMG) has been used to identify abnormal motor neuron activity in the affected region.

A physical exam usually reveals palpable trigger points in affected muscles and taut bands corresponding to the contracted muscles. The trigger points are exquisitely tender spots on the taut bands.{{cite book | vauthors = Tantanatip A, Chang KV | chapter = Myofascial Pain Syndrome. | date = July 2022 | title = StatPearls [Internet] | location = Treasure Island (FL) | publisher = StatPearls Publishing | pmid = 29763057 | url = https://www.ncbi.nlm.nih.gov/books/NBK499882/ }}

Causes

The causes of MPS are not fully documented or understood. At least one study rules out trigger points: "The theory of myofascial pain syndrome (MPS) caused by trigger points (TrPs) ... has been refuted. This is not to deny the existence of the clinical phenomena themselves, for which scientifically sound and logically plausible explanations based on known neurophysiological phenomena can be advanced."{{cite journal | vauthors = Quintner JL, Bove GM, Cohen ML | title = A critical evaluation of the trigger point phenomenon | journal = Rheumatology | volume = 54 | issue = 3 | pages = 392–399 | date = March 2015 | pmid = 25477053 | doi = 10.1093/rheumatology/keu471 | publisher = Rheumatology (Oxford). 2015 Mar;54(3):392-9. doi: 10.1093/rheumatology/keu471. Epub 2014 Dec 3. | doi-access = free }} Some systemic diseases, such as connective tissue disease, can cause MPS.{{cite journal |doi=10.1300/J094v12n03_04 |title=Differential Diagnosis of Trigger Points |year=2005 | vauthors = Gerwin R |journal=Journal of Musculoskeletal Pain |volume=12 |issue=3 |pages=23–8|s2cid=71224028 }}{{Dead link|date=July 2015}} Poor posture and emotional disturbance might also instigate or contribute to MPS.{{cite journal | vauthors = Fricton JR, Kroening R, Haley D, Siegert R | title = Myofascial pain syndrome of the head and neck: a review of clinical characteristics of 164 patients | journal = Oral Surgery, Oral Medicine, and Oral Pathology | volume = 60 | issue = 6 | pages = 615–623 | date = December 1985 | pmid = 3865133 | doi = 10.1016/0030-4220(85)90364-0 }}

Diagnosis

Diagnosis is generally based on the symptoms and possible sleep studies.

= Comparison with fibromyalgia =

Myofascial pain syndrome (MPS) is commonly confused with fibromyalgia (FM) as their presentation is similar. However, fibromyalgia is typically associated with fatigue, depression and cognitive dysfunction. The anatomic distribution and characteristic of the pain also differ. While the fibromyalgia pain is generalized, bilateral and typically involving muscles above and below the waist, the MPS pain affects a particular region of the body such as the mandible or the shoulders. The MTrPs found in MPS present overt palpable nodular structures within the muscle, while aside from tenderness, the trigger points in FM are indistinguishable from surrounding tissue.

{{cite journal | vauthors = Bourgaize S, Newton G, Kumbhare D, Srbely J | title = A comparison of the clinical manifestation and pathophysiology of myofascial pain syndrome and fibromyalgia: implications for differential diagnosis and management | journal = The Journal of the Canadian Chiropractic Association | volume = 62 | issue = 1 | pages = 26–41 | date = April 2018 | pmid = 30270926 | pmc = 6160895 | doi = | url = https://www.chiropractic.ca/wp-content/uploads/2018/05/107243-2_Chiro_62_1d_Bourgaize.pdf }}

However, there are some challenges distinguishing these syndromes:

Difficulty differentiating FM trigger points from myofascial trigger points
Poor reliability in detecting taut bands
MPS may become generalized over time thus mimicking FM

Treatment

Massage therapy using trigger-point release techniques may be effective in short-term pain relief.{{cite journal | vauthors = de las Peñas CF, Campo MS, Carnero JF, Page JC |title=Manual therapies in myofascial trigger point treatment: a systematic review|journal=Journal of Bodywork and Movement Therapies|date=Jan 2005|volume=9|issue=1|pages=27–34|doi=10.1016/j.jbmt.2003.11.001}} Physical therapy involving gentle stretching and exercise may be useful for recovering full range of motion and motor coordination. Once the trigger points are gone, muscle strengthening exercise can begin, supporting long-term health of the local muscle system.{{sfn|Starlanyl|Copeland|2001|page=221}}

Myofascial release, which involves gentle fascia manipulation and massage, may improve or remediate the condition.{{cite journal | vauthors = Harris RE, Clauw DJ | title = The use of complementary medical therapies in the management of myofascial pain disorders | journal = Current Pain and Headache Reports | volume = 6 | issue = 5 | pages = 370–374 | date = October 2002 | pmid = 12357980 | doi = 10.1007/s11916-002-0078-6 | s2cid = 41632904 }}

A systematic review concluded that dry needling for the treatment of myofascial pain syndrome in the lower back appeared to be a useful adjunct to standard therapies, but that clear recommendations could not be made because the published studies were small and of low quality.{{cite journal | vauthors = Furlan AD, van Tulder MW, Cherkin DC, Tsukayama H, Lao L, Koes BW, Berman BM | title = Acupuncture and dry-needling for low back pain | journal = The Cochrane Database of Systematic Reviews | issue = 1 | pages = CD001351 | date = January 2005 | pmid = 15674876 | doi = 10.1002/14651858.CD001351.pub2 | veditors = Furlan AD }}

Posture evaluation and ergonomics may provide relief in the early stages of treatment.{{sfn|Starlanyl|Copeland|2001|page=230}} Gentle, sustained stretching exercises within a comfortable range of motion have been shown to lessen symptoms. Regular, non-intense activity is also encouraged.{{cite journal | vauthors = Borg-Stein J, Simons DG | title = Focused review: myofascial pain | journal = Archives of Physical Medicine and Rehabilitation | volume = 83 | issue = 3 Suppl 1 | pages = S40–S47 | date = March 2002 | pmid = 11973695 | doi = 10.1053/apmr.2002.32155 }}

References

Sources

{{cite book | vauthors = Starlanyl DJ, Copeland ME |title=Fibromyalgia & Chronic Myofascial Pain: A Survival Manual |edition=2nd |year=2001 |publisher=New Harbinger Publications |location=Oakland, CA |isbn=978-1-57224-238-8}}