Myofascial pain syndrome
Encyclopedia
Myofascial pain syndrome (MPS), also known as chronic myofascial pain (CMP), is a syndrome
characterized by chronic pain
caused by multiple trigger point
s and fascia
l constrictions. Among the symptoms are referred pain
, limited range of motion, and sleep disturbance.
share some common symptoms, such as hyperirritability, but the two conditions are distinct. However, a patient may suffer from MPS and fibromyalgia at the same time. In fibromyalgia, chronic pain and hyperirritability are pervasive. By contrast, while MPS pain may affect many parts of the body, it is still limited to trigger points and hot spots of referred pain.
s, such as connective tissue disease
, can cause MPS.
Poor posture and emotional disturbance might also instigate or contribute to MPS.
and exercise is 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.
Three different types of drugs are used to treat myofascial pain: anti-depressants (primarily SNRI
s), calcium channel blocker
s such as pregabalin
(Lyrica), and muscle relaxant
s such as Baclofen
.
Myofascial release
, which involves gentle fascia manipulation and massage, may improve or remediate the condition.
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.
Posture evaluation and ergonomics
may provide significant relief in the early stages of treatment. Movement therapies such as Alexander Technique
and Feldenkrais Method
may also be helpful.
Syndrome
In medicine and psychology, a syndrome is the association of several clinically recognizable features, signs , symptoms , phenomena or characteristics that often occur together, so that the presence of one or more features alerts the physician to the possible presence of the others...
characterized by chronic pain
Chronic pain
Chronic pain has several different meanings in medicine. Traditionally, the distinction between acute and chronic pain has relied upon an arbitrary interval of time from onset; the two most commonly used markers being 3 months and 6 months since the initiation of pain, though some theorists and...
caused by multiple trigger point
Trigger point
Trigger points, also known as trigger sites or muscle knots, are described as hyperirritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers. Trigger point practitioners believe that palpable nodules are small contraction knots and a common cause of...
s and fascia
Fascia
A fascia is a layer of fibrous tissue that permeates the human body. A fascia is a connective tissue that surrounds muscles, groups of muscles, blood vessels, and nerves, binding those structures together in much the same manner as plastic wrap can be used to hold the contents of sandwiches...
l constrictions. Among the symptoms are referred pain
Referred pain
Referred pain is pain perceived at a location other than the site of the painful stimulus. An example is the case of ischemia brought on by a myocardial infarction , where pain is often felt in the neck, shoulders, and back rather than in the chest, the site of the injury...
, limited range of motion, and sleep disturbance.
Symptoms
Myofascial pain can occur in distinct, isolated areas of the body, and because any muscle or fascia may be affected, this may cause a variety of localized symptoms. More 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.MPS and fibromyalgia
MPS and fibromyalgiaFibromyalgia
Fibromyalgia is a medical disorder characterized by chronic widespread pain and allodynia, a heightened and painful response to pressure. It is an example of a diagnosis of exclusion...
share some common symptoms, such as hyperirritability, but the two conditions are distinct. However, a patient may suffer from MPS and fibromyalgia at the same time. In fibromyalgia, chronic pain and hyperirritability are pervasive. By contrast, while MPS pain may affect many parts of the body, it is still limited to trigger points and hot spots of referred pain.
Causes
The precise causes of MPS are not fully documented or understood. Some systemic diseaseSystemic disease
Life-threatening disease redirects here.A systemic disease is one that affects a number of organs and tissues, or affects the body as a whole. Although most medical conditions will eventually involve multiple organs in advanced stage Life-threatening disease redirects here.A systemic disease is one...
s, such as connective tissue disease
Connective tissue disease
A connective tissue disease is any disease that has the connective tissues of the body as a target of pathology. Connective tissue is any type of biological tissue with an extensive extracellular matrix that supports, binds together, and protects organs...
, can cause MPS.
Poor posture and emotional disturbance might also instigate or contribute to MPS.
Treatment
Massage therapy using trigger-point release techniques may be effective in short-term pain relief. Physical therapy involving gentle stretchingStretching
Stretching is a form of physical exercise in which a specific skeletal muscle is deliberately elongated, often by abduction from the torso, in order to improve the muscle's felt elasticity and reaffirm comfortable muscle tone. The result is a feeling of increased muscle control, flexibility and...
and exercise is useful for recovering full range of motion
Range of motion
Range of motion , is the distance that a movable object may normally travel while properly attached to another object. It is also called range of travel, particularly when talking about mechanical devices and in mechanical engineering fields...
and motor coordination
Motor coordination
thumb|right|Motor coordination is shown in this animated sequence by [[Eadweard Muybridge]] of himself throwing a diskMotor coordination is the combination of body movements created with the kinematic and kinetic parameters that result in intended actions. Such movements usually smoothly and...
. Once the trigger points are gone, muscle strengthening exercise can begin, supporting long-term health of the local muscle system.
Three different types of drugs are used to treat myofascial pain: anti-depressants (primarily SNRI
SNRI
SNRI may refer to:* Serotonin–norepinephrine reuptake inhibitor* Strategic Naval Research Institute...
s), calcium channel blocker
Calcium channel blocker
A calcium channel blocker is a chemical that disrupts the movement of calcium through calcium channels.CCB drugs devised to target neurons are used as antiepileptics. However, the most widespread clinical usage of calcium channel blockers is to decrease blood pressure in patients with...
s such as pregabalin
Pregabalin
Pregabalin is an anticonvulsant drug used for neuropathic pain and as an adjunct therapy for partial seizures with or without secondary generalization in adults. It has also been found effective for generalized anxiety disorder and is approved for this use in the European Union. It was designed...
(Lyrica), and muscle relaxant
Muscle relaxant
A muscle relaxant is a drug which affects skeletal muscle function and decreases the muscle tone. It may be used to alleviate symptoms such as muscle spasms, pain, and hyperreflexia. The term "muscle relaxant" is used to refer to two major therapeutic groups: neuromuscular blockers and spasmolytics...
s such as Baclofen
Baclofen
Baclofen is a derivative of gamma-aminobutyric acid . It is primarily used to treat spasticity and is under investigation for the treatment of alcoholism....
.
Myofascial release
Myofascial Release
The myofascial release approach is a form of soft tissue therapy used to treat somatic dysfunction and resulting pain and restriction of motion. It is a treatment described by Andrew Taylor Still, founder of osteopathy/osteopathic medicine, and his early students, which uses continual palpatory...
, which involves gentle fascia manipulation and massage, may improve or remediate the condition.
A systematic review
Systematic review
A systematic review is a literature review focused on a research question that tries to identify, appraise, select and synthesize all high quality research evidence relevant to that question. Systematic reviews of high-quality randomized controlled trials are crucial to evidence-based medicine...
concluded that dry needling
Dry needling
Dry needling is the use of solid filiform needles for therapy of muscle pain, sometimes also known as intramuscular stimulation. The needles are similar to acupuncture needles. Dry needling contrasts with the use of a hollow hypodermic needle to inject substances such as saline solution, botox or...
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.
Posture evaluation and ergonomics
Ergonomics
Ergonomics is the study of designing equipment and devices that fit the human body, its movements, and its cognitive abilities.The International Ergonomics Association defines ergonomics as follows:...
may provide significant relief in the early stages of treatment. Movement therapies such as Alexander Technique
Alexander Technique
The Alexander Technique teaches the ability to improve physical postural habits, particularly those that have become ingrained and conditioned responses...
and Feldenkrais Method
Feldenkrais method
The Feldenkrais Method is a somatic educational system designed by Moshé Feldenkrais . The Feldenkrais method aims to improve movement repertoire, aiming to expand and refine the use of the self through awareness, in order to reduce pain or limitations in movement, and promote general well-being...
may also be helpful.