Myofascial Pain

AbstractMyofascial pain syndromes arise from acute and chronic musculoskeletal pain and often have a referred neuropathic component. It affects more than three quarters of the world's population and is one of the most important and overlooked causes of disability. The origins of pain are thought to reside anywhere between the motor end plate and the fibrous outer covering of the muscle, with involvement of microvasculature and neurotransmitters at the cellular level. Diagnosis is made by clinical examination for the presence of myofascial trigger points, though some ancillary tests may provide supportive evidence. The mainstay of treatment is regular physical therapy with the goal of restoration of normal muscle laxity and range of motion. Adjunct therapies including pharmacologic and nonpharmacologic interventions provide varying degrees of benefit in refractory cases, and onabotulinum toxin A injection has the most evidence of efficacy for these patients. Here, we discuss the epidemiology, pathophysiology, and diagnostic and therapeutic options for the evaluation and treatment of myofascial pain syndrome.

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Pathophysiological substantiation of the complex approach to rehabilitation of patients with myofascial pain syndrome of the neck region

Physical and rehabilitation medicine, medical rehabilitation ◽

10.36425/rehab20422 ◽

2020 ◽

Vol 2 (1) ◽

pp. 66-70

Author(s):

O. V. Shimarova ◽

V. V. Malakhovskiy ◽

V. G. Zilov

Keyword(s):

Myofascial Pain ◽

Neck Region ◽

Pain Syndrome ◽

Myofascial Pain Syndrome ◽

Trigger Points ◽

Muscle Stiffness ◽

Myofascial Pain Syndromes ◽

Pain Syndromes ◽

Complex Approach

Myofascial pain syndromes are a widespread pathology, which is a condition that is characterized by local muscle stiffness and the formation of trigger points in them. The pathophysiology of myofascial pain syndromes is not fully understood. Studies indicate the role of dysfunction of the end plate of the muscle, impaired proprioreception and sensomotor control, central sensitization. The review presents a modern view of approaches to the treatment of myofasial pain syndrome of the neck region, based on an understanding of its pathophysiology.

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Myofascial Pain Syndrome: A Concise Update on Clinical, Diagnostic and Integrative and Alternative Therapeutic Perspectives

International Neuropsychiatric Disease Journal ◽

10.9734/indj/2019/v13i130100 ◽

2019 ◽

pp. 1-14 ◽

Cited By ~ 1

Author(s):

Naseem A. Qureshi ◽

Hamoud A. Alsubaie ◽

Gazzaffi I. M. Ali

Keyword(s):

Myofascial Pain ◽

Trigger Point ◽

Pain Syndrome ◽

Myofascial Pain Syndrome ◽

Trigger Points ◽

Muscle Twitch ◽

Myofascial Trigger Points ◽

Pain Syndromes ◽

Clinical Diagnostic ◽

Regional Pain Syndromes

Background: Myofascial pain syndrome is a common multifactorial condition that presents with key manifestations and comorbid with many systemic diseases and regional pain syndromes. Objective: This study aims to concisely review clinical, diagnostic and integrative therapeutic aspects of myofascial pain syndrome. Methods: E-searches (2000-2019) using keywords and Boolean operators were made and using exclusion and inclusion criteria, 50 full articles that focused on myofascial pain syndrome were retained for this review. Results: Myofascial pain syndrome is a multidimensional musculoskeletal disorder with ill-understood etiopathogenesis and pathophysiology and characterized by tender taut muscle with myofascial trigger points, muscle twitch response, specific pattern of referred pain and autonomic symptoms. A variety of pharmacological and nonpharmacological therapies with variable efficacy are used in myofascial pain syndrome, the latter modalities such as education, stretching and exercises, moist hot and cold packs, dry needling and myofascial massage or myofascial trigger point massage are used as first line options. Conclusion: Myofascial pain syndrome and trigger points initiated by repeated strains and injuries co-occur with diverse physical diseases and regional pain syndromes, which need comprehensive diagnostic evaluation using multiple methods. Several interventions are used in patients with myofascial pain syndrome who effectively respond to myofascial massage. This study calls for exploring etiopathogenesis and basic pathophysiological mechanisms underlying myofascial pain syndrome in future.

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Evaluation of the Analgesic Effect of Combination Therapy on Chronic Plantar Pain Through the Myofascial Trigger Points Approach

Journal of the American Podiatric Medical Association ◽

10.7547/16-038 ◽

2018 ◽

Vol 108 (1) ◽

pp. 27-32 ◽

Cited By ~ 2

Author(s):

Rocío Melero-Suárez ◽

José Antonio Sánchez-Santos ◽

Gabriel Domínguez-Maldonado

Keyword(s):

Combination Therapy ◽

Analgesic Effect ◽

Myofascial Pain ◽

Pressure Pain Threshold ◽

Pain Syndrome ◽

Myofascial Pain Syndrome ◽

Trigger Points ◽

Adductor Muscle ◽

Rank Test ◽

Myofascial Trigger Points

Background: Closely related pathologic disorders sometimes manifest with the same symptoms, making for a complex differential diagnosis. This is the situation in plantar fasciitis (PF) and myofascial pain syndrome (MPS) with myofascial trigger points (MTPs) in the sole of the foot. This research assessed the analgesic effect on plantar pain of combination therapy with interferential current stimulation therapy (ICST), treating MTPs in the great toe adductor muscle and the short flexor muscles of the toes in patients whose diagnosis was compatible with PF or MPS. Methods: This study included 22 feet of 17 patients with a diagnosis compatible with PF or MPS with MTP. Participants received combination therapy with ICST for 15 sessions, and the decrease in pain was measured with an algometer and the visual analog scale. Both measurements were taken before and after every fifth session. The pressure pain threshold (PPT) results obtained with the Student t test and the pain intensity perception (PIP) results obtained with the Wilcoxon signed rank test were analyzed by comparing the measurements taken before the treatment and after the fifth, tenth, and 15th sessions. Results: The decrease in PIP was significant after the fifth, tenth, and 15th sessions (P < .001). The increase in PPT was also significant after the fifth (P = .010), tenth (P = .023), and 15th (P = .001) sessions (P < .05). Conclusions: The suggested combination therapy of ultrasound with ICST is clinically significant for reducing plantar pain after 15 treatment sessions, with a 6.5-point reduction in mean PIP and a 4.6-point increase in PPT.

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Results of the post-registration clinical study “PARUS” on efficiency and safety assessment of Mydocalm-Richter for local injection therapy of a myofascial trigger zone

Terapevticheskii arkhiv ◽

10.26442/terarkh201890681-88 ◽

2018 ◽

Vol 90 (6) ◽

pp. 81-88

Author(s):

F I Devlikamova

Keyword(s):

Muscle Relaxant ◽

Blood Circulation ◽

Myofascial Pain ◽

Ultrasound Examination ◽

Pain Syndrome ◽

Myofascial Pain Syndrome ◽

Trigger Points ◽

Orthostatic Test ◽

Myofascial Trigger Points ◽

Sedative Effects

Aim. The “PARUS” program included investigation of the analgesic, muscle relaxant and sedative effects of Mydocalm-Richter which acts as central muscle relaxant in patients with myofascial pain syndrome, taking into account its registered indication for use - the hypertonus and cross-striated muscle spasm. Materials and methods. Fifty patients with myofascial trigger points, the mean age of 41.67±11.86 years, have been enrolled in the study. All patients had undergone clinical examination that allowed the diagnosis of myofascial pain syndrome. The intensity of pain syndrome was evaluated using the pain visual analogue scales and McGill pain questionnaire. Visualization of area in spasm and evaluation of blood circulation was carried out using the ultrasound scan of target muscle. In order to objectively evaluate any conceivable hypotensive and sedative effects of Mydocalm-Richter we used the orthostatic test, Schulte’s test for attention span and perfor-mance distribution and Munsterberg’s test for attention discrimination and concentration. Results. The analgesic and muscle relaxant effects of Mydocalm-Richter become apparent by day 3 post-injection, and the muscle relaxation effect is reaching its maximum on day 10 post-injection. Cardiovascular function following administration of Mydocalm-Richter was evaluated using the orthostatic test which revealed good orthostatic tolerance. Single injection of tolperisone hydrochloride possessing a central muscle relaxant activity has no sedative effect and does not influence patient response time. The ultrasound examination data demonstrated the improvement and in some cases restoration of blood circulation in the myofascial trigger points. Conclusion. Clinical study “PARUS” conducted in patients with myofascial pain has demonstrated a positive muscle relaxant and analgesic effect of Mydocalm-Richter that resulted in restoration of peripheral circulation in the myofascial trigger pointsconfirmed by ultrasound examination. An important benefit of this drug product is the absence of sedative effect and arterial hypotension.

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The relative effectiveness of a home programme of ischaemic compression, sustained stretch and a combination of both for the treatment of myofascial trigger points in the upper trapezius musculature

10.51415/10321/2738 ◽

2003 ◽

Author(s):

◽

Marlon Thoresson

Keyword(s):

Myofascial Pain ◽

Relative Effectiveness ◽

Pain Syndrome ◽

Myofascial Pain Syndrome ◽

Trigger Points ◽

Clinical Findings ◽

Myofascial Trigger Points ◽

Upper Trapezius

The purpose of this study was to determine the relative effectiveness of a home programme of ischaemie compression, sustained stretch and a combination of the two, in terms of subjective and objective clinical findings for the treatment of Myofascial Pain Syndrome.

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Effect of bloodletting therapy at local myofascial trigger points and acupuncture at Jiaji (EX-B 2) points on upper back myofascial pain syndrome: a randomized controlled trial

Journal of Traditional Chinese Medicine ◽

10.1016/s0254-6272(16)30004-8 ◽

2016 ◽

Vol 36 (1) ◽

pp. 26-31 ◽

Cited By ~ 4

Author(s):

Jiang Guimei ◽

Jia Chao ◽

Lin Mode

Keyword(s):

Randomized Controlled Trial ◽

Myofascial Pain ◽

Controlled Trial ◽

Pain Syndrome ◽

Myofascial Pain Syndrome ◽

Trigger Points ◽

Myofascial Trigger Points ◽

Randomized Controlled ◽

Bloodletting Therapy

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Myofascial Trigger Points and Myofascial Pain Syndrome: A Critical Review of Recent Literature

Journal of Manual & Manipulative Therapy ◽

10.1179/jmt.2006.14.4.125e ◽

2006 ◽

Vol 14 (4) ◽

pp. 125E-171E ◽

Cited By ~ 1

Author(s):

David G. Simons ◽

Jan Dommerholt

Keyword(s):

Critical Review ◽

Recent Literature ◽

Myofascial Pain ◽

Pain Syndrome ◽

Myofascial Pain Syndrome ◽

Trigger Points ◽

Myofascial Trigger Points

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Probable Mechanisms of Needling Therapies for Myofascial Pain Control

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2012/705327 ◽

2012 ◽

Vol 2012 ◽

pp. 1-11 ◽

Cited By ~ 36

Author(s):

Li-Wei Chou ◽

Mu-Jung Kao ◽

Jaung-Geng Lin

Keyword(s):

Animal Studies ◽

Myofascial Pain ◽

Pain Syndrome ◽

Myofascial Pain Syndrome ◽

Trigger Points ◽

Dry Needling ◽

Myofascial Trigger Points ◽

Appropriate Treatment ◽

Clinical Pain ◽

Hormonal System

Myofascial pain syndrome (MPS) has been defined as a regional pain syndrome characterized by muscle pain caused by myofascial trigger points (MTrPs) clinically. MTrP is defined as the hyperirritable spot in a palpable taut band of skeletal muscle fibers. Appropriate treatment to MTrPs can effectively relieve the clinical pain of MPS. Needling therapies, such as MTrP injection, dry needling, or acupuncture (AcP) can effectively eliminate pain immediately. AcP is probably the first reported technique in treating MPS patients with dry needling based on the Traditional Chinese Medicine (TCM) theory. The possible mechanism of AcP analgesia were studied and published in recent decades. The analgesic effect of AcP is hypothesized to be related to immune, hormonal, and nervous systems. Compared to slow-acting hormonal system, nervous system acts in a faster manner. Given these complexities, AcP analgesia cannot be explained by any single mechanism. There are several principles for selection of acupoints based on the TCM principles: “Ah-Shi” point, proximal or remote acupoints on the meridian, and extra-meridian acupoints. Correlations between acupoints and MTrPs are discussed. Some clinical and animal studies of remote AcP for MTrPs and the possible mechanisms of remote effectiveness are reviewed and discussed.

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Fibromyalgia: A Review of Current Knowledge

Acupuncture in Medicine ◽

10.1136/aim.10.1.13 ◽

1992 ◽

Vol 10 (1) ◽

pp. 13-17 ◽

Cited By ~ 3

Author(s):

Peter Baldry

Keyword(s):

Myofascial Pain ◽

Current Knowledge ◽

Trigger Points ◽

Short Term ◽

Myofascial Pain Syndromes ◽

Myofascial Trigger Points ◽

Muscular Pain ◽

Pain Syndromes ◽

Disturbed Sleep ◽

Specific Disorders

Muscular pain in the presence of a normal ESR has laboured under a variety of names and supposed causes, often being dismissed as psychogenic in origin. It is now clear that there are two specific disorders of body musculature, each with its own defined pattern of symptoms. Fibromyalgia is a disease of unknown aetiology, predominantly affecting women, that gives generalised muscular pain, a disturbed sleep pattern, morning stiffness and fatigue. Tender spots are found at certain charecteristic sites. The Myofascial Pain Syndromes, on the other hand, can usually be related to some form of trauma and are normally localised to particular muscles with readily palpable myofascial trigger points at specific spots according to the pattern of pain referral. Acupuncture may be a rapid and effective treatment for both disorders, often giving long lasting relief in Myofascial Pain Syndromes, but offering only repeated short term responses to Fibromyalgia sufferers.

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