Myofascial pain syndrome

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 points 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.[2]

Myofascial pain syndrome
Other namesChronic myofascial pain, myofascial pain and dysfunction syndrome (MPDS or MFPDS)
SpecialtyRheumatology
Differential diagnosisGiant cell arteritis, arthritis[1]

The cause is believed to be muscle tension or spasms within the muscles of mastication.[1] Diagnosis is based on the symptoms and possible sleep studies.[1]

Treatment may include pain medication, physical therapy, mouth guards, and occasionally benzodiazepine.[1] It is a relatively common cause of temporomandibular pain.[1]

Signs and symptoms

Myofascial pain is pain in muscles or fascia (a type of connective tissue that surrounds muscles). It can occur in distinct, isolated areas of the body. Because any muscle or fascia in the body may be affected, this may cause a variety of localized symptoms.

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.[3] Myofascial pain syndromes are characterized by localized pain in an area of repetitive use or trauma with resultant trigger points that cause non-dermatomal pain radiation upon palpation.  Autonomic dysfunction and spontaneous EMG activity can be seen in the affected region.

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."[4] Some systemic diseases, such as connective tissue disease, can cause MPS.[5] Poor posture and emotional disturbance might also instigate or contribute to MPS.[6]

Diagnosis

Diagnosis is generally based on the symptoms and possible sleep studies.[1]

Treatment

Massage therapy using trigger-point release techniques may be effective in short-term pain relief.[7] Physical therapy involving gentle stretching and exercise maybe 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.[8]

Myofascial release, which involves gentle fascia manipulation and massage, may improve or remediate the condition.[9]

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.[10] (See also: Fu's subcutaneous needle)

Posture evaluation and ergonomics may provide relief in the early stages of treatment.[11] Gentle, sustained stretching exercises within a comfortable range of motion have been shown to lessen symptoms. Regular, non-intense activity is also encouraged.[12]

References
  1. "Myofascial Pain Syndrome - Dental Disorders". Merck Manuals Professional Edition. Retrieved 27 May 2019.
  2. Bennett, Robert (2007). "Myofascial pain syndromes and their evaluation". Best Practice & Research Clinical Rheumatology. 21 (3): 427–45. doi:10.1016/j.berh.2007.02.014. PMID 17602992.
  3. Mayo Clinic Staff (3 Dec 2009). "Myofascial pain syndrome: Symptoms". Retrieved 8 May 2011.
  4. Quintner JL, Bove GM, Cohen ML (2015). "A critical evaluation of the trigger point phenomenon". Rheumatology (Oxford). Rheumatology (Oxford). 2015 Mar;54(3):392-9. doi: 10.1093/rheumatology/keu471. Epub 2014 Dec 3. 54 (3): 392–9. doi:10.1093/rheumatology/keu471. PMID 25477053.
  5. Gerwin, Robert (2005). "Differential Diagnosis of Trigger Points". Journal of Musculoskeletal Pain. 12 (3): 23–8. doi:10.1300/J094v12n03_04.
  6. Fricton, James R.; Kroening, Richard; Haley, Dennis; Siegert, Ralf (1985). "Myofascial pain syndrome of the head and neck: A review of clinical characteristics of 164 patients". Oral Surgery, Oral Medicine, Oral Pathology. 60 (6): 615–23. doi:10.1016/0030-4220(85)90364-0. PMID 3865133.
  7. Peñas, César Fernández-de-las; Campo, Mónica Sohrbeck; Fernández Carnero, Josué; Miangolarra Page, Juan Carlos (Jan 2005). "Manual therapies in myofascial trigger point treatment: a systematic review". Journal of Bodywork and Movement Therapies. 9 (1): 27–34. doi:10.1016/j.jbmt.2003.11.001.
  8. Starlanyl & Copeland 2001, p. 221.
  9. Harris, R. E.; Clauw, Daniel J. (2002). "The Use of complementary medical therapies in the management of myofascial pain disorders". Current Pain and Headache Reports. 6 (5): 370–4. doi:10.1007/s11916-002-0078-6. PMID 12357980.
  10. Furlan, Andrea D; Van Tulder, Maurits W; Cherkin, Dan; Tsukayama, Hiroshi; Lao, Lixing; Koes, Bart W; Berman, Brian M (2005). Furlan, Andrea D (ed.). "Acupuncture and dry-needling for low back pain". Cochrane Database of Systematic Reviews (1): CD001351. doi:10.1002/14651858.CD001351.pub2. PMID 15674876.
  11. Starlanyl & Copeland 2001, p. 230.
  12. Borg-Stein, Joanne; Simons, David (March 2002). "Myofascial Pain". Archives of Physical Medicine and Rehabilitation. 83 (1): S40–S47. doi:10.1053/apmr.2002.32155. PMID 11973695.

Sources
  • Starlanyl, Devin J.; Copeland, Mary Ellen (2001). Fibromyalgia & Chronic Myofascial Pain: A Survival Manual (2nd ed.). Oakland, CA: New Harbinger Publications. ISBN 978-1-57224-238-8.
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