Myofascial
Pain Syndrome
Myofascial Pain -- The Symptoms
and Causes
How to Diagnose and Treat Myofascial
Pain Syndrome
Myofascial
Pain -- The Symptoms and Causes
Myofascial pain syndrome is a chronic local or regional musculoskeletal
pain disorder that may involve either a single muscle or a
muscle group. The pain may be of a burning, stabbing, aching
or nagging quality. Importantly, where the patient experiences
the pain may not be where the myofascial pain generator is
located. This is known as referred pain. The pathophysiology
of myofascial pain remains somewhat of a mystery due to limited
clinical research; however, based on case reports and medical
observation, investigators think it may develop from a muscle
lesion or excessive strain on a particular muscle or muscle
group, ligament or tendon. It is thought that the lesion or
the strain prompts the development of a "trigger point"
that, in turn, causes pain.
In
addition to the local or regional pain, people with myofascial
pain syndrome also can suffer from depression, fatigue and
behavioral disturbances, as with all chronic pain conditions.
How to Diagnose
and Treat Myofascial Pain Syndrome
Recognition of this syndrome is difficult and requires
the physician to have a precise understanding of the body's
anatomy. Trigger points can be identified by pain produced
upon digital palpation (applying pressure with one to three
fingers and the thumb). In diagnosing myofascial pain syndrome,
four types of trigger points can be distinguished:
active trigger point --
an area of exquisite tenderness that is usually located in
a skeletal muscle and is associated with local or regional
pain;
latent
trigger point -- a dormant area that can potentially
behave like an active trigger point;
secondary trigger point --
a hyperirritable spot in a muscle that becomes active as a
result of a trigger point and muscular overload in another
muscle;
satellite myofascial point --
a hyperirritable spot in a muscle that becomes active because
the muscle is located within the region of another trigger
point.
The
best treatments for myofascial pain syndrome are active and
passive physical therapy methods. There is also the "stretch
and spray" technique, in which the muscle with the trigger
point is sprayed along its length with a coolant such as fluorimethane,
and then stretched slowly.
Trigger
point injection, whereby local anesthesia is injected directly
into the trigger point, also is used. At times, corticosteroids
and botulinum toxin can be injected. Massage therapy also
can be of significant benefit in some patients. Often a combination
of physical therapy, trigger point injections and massage
are needed in refractory chronic cases.
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