Myofascial Pain Syndrome (MPS) is a is a painful musculoskeletal condition, a common cause of musculoskeletal pain. MPS is characterized by the development of Myofascial trigger points (TrPs) that are locally tender when active, and refer pain through specific patterns to other areas of the body. A trigger point or sensitive, painful area in the muscle or the junction of the muscle and fascia (hence, myofascial pain) develops due to any number of causes. Trigger points are usually associated with a taut band, a ropey thickening of the muscle tissue. Typically a trigger point, when pressed upon, will cause the pain to be felt elsewhere. This is what is considered “referred pain”.

These factors can cause trigger points:

•Sudden trauma to musculoskeletal tissues (muscles, ligaments, tendons, bursae)
•Injury to intervertebral discs
•Generalize fatigue (fibromyalgia is a perpetuating factor of MPS, perhaps chronic fatigue syndrome may produce trigger points as well)
•Repetative motions; Excessive exercise; Muscle strain due to over activity
•Systemic conditions (eg, gall bladder inflammation, heart attack, appendicitis, stomach irritation)
•Lack of activity (eg, a broken arm in a sling)
•Nutritional deficiencies
•Hormonal changes (eg, trigger point development during PMS or menopause)
•Nervous tension or stress
•Chilling of areas of the body (eg, sitting under an air conditioning duct; sleeping in front of an air conditioner)

The fascia is a tough connective tissue which spreads throughout the body in a three dimensional web from head to foot without interruption. The fascia surrounds every muscle, bone, nerve, blood vessel and organ of the body, all the way down to the cellular level. Therefore, malfunction of the fascial system due to trauma, posture, or inflammation can create a binding down of the fascia, resulting in abnormal pressure on nerves, muscles, bones or organs.

This can create pain or malfunction throughout the body, sometimes with bizarre side effects and seemingly unrelated symptoms. It is thought that an extremely high percentage of people suffering with pain and/or lack of motion may be having myofascial problems; but most go undiagnosed, as the importance of fascia is just now being recognized.

Many of the standard tests, such as x-rays, myelograms, CAT scans, eletromyography, etc., do not show the fascia. (John Barnes, P.T., 1992)

Occassionally, trigger points produce autonomic nervous system changes such as flushing of the skin, hypersensitivity of areas of the skin, sweating in areas, or even “goose bumps.” The trigger points cause localized pain, although TrPs can involve the whole body.

In three studies, the prevalence of myofascial TrPs among patients complaining of pain anywhere in the body ranged from 30% to 93%; (among patients with chronic craniofacial pain, 55%; and for lumbogluteal pain, 21%.)

The characteristic electrical activity of myofascial TrPs most likely originates at dysfunctional endplates of extrafusal muscle fibers. This dysfunction appears to play a key role in the pathophysiology of TrPs. (Simons 1996)

Subjective shortness of breath can be part of the myofascial pain syndrome of the levator scapulae muscle. In one study, 75 patients who reported neck pain & shortness of breath were examined. Trigger points were located and inactivated with acupuncture needles (dry needling). 68 of the 75 patients in the study reported that their shortness of breath and soreness were abolished immediately after inactivation of the TrPs. The other 7 patients needed a second trial of inactivation. Eliminating the trigger points eliminated the symptoms. (Journal of Muskuloskeletal Pain, 1996)

Like fibromyalgia, Myofascial Pain syndrome is an often misunderstood condition. Even today, some doctors either don’t believe that MPS exists or they don’t understand its symptoms and treatment.

Treatment of MPS can only begin after an accurate diagnosis is accomplished. Methods for managing this painful condition:

• Trigger Point Therapy {Myofascial release therapy, myotherapy, massotherapy (medical massage therapy)}
• Spray and Stretch technique (stretching of the muscles involved with a vapocoolant spray – a coolant is sprayed on the trigger point to lessen the pain and then the muscle is stretched. this is often done by a physical therapist.)
• Trigger Point Injections (local anesthetic,such as lidocaine, injected directly into the trigger points)
• Dry Needling (the use of a needle without injecting anything)
[TrP injections and dry needling mechanically disrupt the tirgger point. The use of lidocaine is no more effective, but it reduces the soreness afer injection. For MPS there is no role for injected steroids]
• Chiropractic or Osteopathic manipulation treatment
• Craniosacral Therapy
• Physical Therapy (hands-on)
• Exercise
• Improvement of nutrition
• Changing sleeping habits
• The use of tricyclic antidepressants in low doses
• Elimination of stress; Biofeedback; Counseling for depression that may result from this painful condition

An active trigger point when treated well or with rest will become latent (quiet, or not causing active symptoms). It can often resurface after trauma after acute overload or fatigue, or even sudden exposure to cold. Conversely, new trigger points may arise elsewhere, or at least become more sinificant as others become latent.

For MPS, you should see a doctor knowledgeable in chronic pain such as a physical medicine doctor (a physiatrist), or a neurologist. The diagnosis is made by the history and physical exam. There is no lab test nor imaging studies to confirm the diagnosis. A history of acute trauma or chronic overuse should be looked for.. On exam, there is typically restricted motion with pain of the affected muscle. Other medical problems need to be ruled out with imaging or other studies. For instance, if a patient presents with back pain, disc and other problems need to be ruled out.

Altered Pain Perception Accompanies MPS: A Danish study indicates that people with chronic myofascial pain perceive and transmit pain differently than people without the syndrome. As many as 72 percent of people with fibromyalgia may have trigger points associated with myofascial pain.
Source: “Qualitatively altered nociception in chronic myofascial pain,” by L. Bendtsen, R. Jensen, and J. Olesen, Pain, 65 (1996), pages 259-264

Fibromyalgia or Myofascial Pain Syndrome or both?

Differential features of Fibromyalgia & Myofascial Pain Syndrome

Feature

FMS MPS
Pain

Diffuse

Local

Fatigue

Common

Uncommon

AM Stiffness

Common

Uncommon

Tender Points

X

Trigger Points

X

Prognosis

Chronic

Resolves with treatment

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