Background

Myofascial pain (MP) is a common painful disorder responsible for many pain clinic visits. MP can affect any skeletal muscles in the body. Skeletal muscle accounts for approximately 50% of body weight, and approximately 400 muscles make up the body. MP is responsible for many cases of chronic musculoskeletal pain.

MP is extremely common, and almost everyone develops a Trigger Point at some time. In the US, 14.4% of the general population suffers from chronic musculoskeletal pain. Approximately 21-93% of patients with regional pain complaints have MP. Studies have demonstrated that 25-54% of asymptomatic individuals have latent Trigger Points.

Patients usually report regionalized aching and poorly localized pain in the muscles and joints. They also may report sensory disturbances such as numbness in a characteristic of distribution. The type of pain felt is characteristic of the muscle involved. Onset may be acute after a specific event or trauma (e.g., moving quickly in an awkward position) or chronic from poor posture or overuse Patients may note disturbed sleep. Those with cervical and periscapular myofascial pain may have been through the "great pillow search" to try to find a comfortable sleeping position. They may or may not be aware of muscle weakness in the affected muscles. They may have a tendency to drop things.

Causes

Several factors contribute to MP. Abnormal stresses on the muscles from sudden stress on shortened muscles, leg-length discrepancies, or skeletal asymmetry are thought to be common causes of MP. Poor posture also may serve to cause MP. Assumption of a static position for a prolonged period of time also has been implicated in MP. Anemia and low levels of calcium, potassium, iron, and vitamins C, B-1, B-6, and B-12 are believed to play a role. Chronic infections and sleep deprivation have been cited as causative factors, as have radiculopathy, visceral diseases, and depression. Hypothyroidism, hyperuricemia, and hypoglycemia also have been implicated in MP.

Treatment Options

Physical Therapy
Physical therapy focuses on correction of muscle shortening by targeted stretching, strengthening of affected muscles, and correction of aggravating postural and biomechanical factors. Modalities can be useful to decrease pain to allow participation in an active exercise program.

Corrections of leg-length discrepancies with a heel lift or use of dynamic insoles also may be helpful. Various other techniques and procedures, including the following, have been demonstrated to be effective in some patients:

		Massage and exercise
		Stretching
		Electrical muscle stimulation (EMS) using interferential current (IFC) or functional electric stimulation (FES)/electrical nerve stimulation (ENS) or high frequency transcutaneous electrical nerve stimulation (TENS)
		Ultrasound
		EMG biofeedback

Trigger Point injections
sometimes are performed with bupivacaine, lidocaine, saline, or sterile water. Occasionally, dry needling is performed without injection of any substance. Steroids may be used in areas possibly associated with inflammation, as in frozen shoulder. Botulinum toxin (BOTOX®) shows promise as a substance that can provide long-lasting relief.

Medications

These are very broad and general approaches to the treatment of Myofascial Pain. The physiatrists at My Pain Clinic will develop an individual treatment plan for you.

Prevention

Deterrence and prevention focus on removing perpetuating factors. Using appropriate body mechanics, properly fitting furniture and workstations, and avoidance of prolonged static positioning all are important. Daily full ROM of all muscles is extremely helpful.