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Myofascial Pain Syndrome, Trigger points, and Treatment Options


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Trigger points in taut bands of muscle

Myofascial pain syndrome can be considered, at least partially, a side effect of our modern lifestyles. It is caused by numerous factors: trauma, tension, inflammation, overuse, overload, poor posture, stress, repetitive strain, poor sleep, emotional stress, or other medical conditions, such as nerve entrapment, thyroid dysfunction, vitamin insufficiencies, metabolic dysfunctions. Myofascial pain is pain localized in the muscles and surrounding tissues. The constellation of symptoms includes achiness, fatigue, poor sleep, chronic muscle tightness, and limited range of motion. Sometimes, myofascial pain can produce numbness and sensory disturbances. If myofascial pain occurs in the neck, it can cause ringing in the ears, loss of balance, or chronic headaches.

Trigger points:

Trigger points are commonly associated with myofascial pain. In a study of 200 asymptomatic young adults, 54% of females and 44 % of males had latent trigger points. Latent trigger points are not painful unless they are pressed. In adult populations with complaints of pain, 86-93% of people had active trigger points. Active trigger points cause pain with or without applied pressure. Trigger points are hypersensitive, painful “knots” in taut muscle bands. When pressed, the trigger point often causes localized or referred pain. The trigger point may cause numbness, tingling, increased sweating, muscle spasms, or radiating pain to other areas. Infact, the trigger point can mimic nerve related (neuropathic) pain.

Ergonomics and Posture:

Because this is often a chronic condition, treatment requires multiple repeated therapies. Because of our sedentary lifestyles and numerous hours seated at a desk, the small muscles of the neck and upper back are under considerable strain. Being cognizant of one’s posture as well as ergonomic considerations may be helpful in decreasing the intensity and frequency of painful episodes. Intermittent stretching and regular relaxation techniques can help quell the pain, improve range of motion, and promote more restful sleep.

Therapeutic options:

Passive therapeutic options include physical therapy which includes, application of deep heating modalities such as ultrasound, electrical stimulation, and ice or hot packs. Other physical therapy techniques include range of motion, stretching, and, after the pain has subsided, strengthening exercises. Massage therapy helps to manually break up the muscle “knots” and relax the muscle fibers. Massage therapy also causes release of local endorphins into the bloodstream to create a relaxed mood. Chiropractic care and acupuncture may be also be used for treatment.

Trigger point injections:

trigger point injection

Another important therapeutic treatment option includes trigger point injections. Trigger point injections employ small needles and local anesthetic ( lidocaine) to mechanically break up the muscle “knots”. The procedure takes less than 5 minutes. Side effects may include mild soreness during the first 24 hours, followed by a sense of openness and looseness in the muscle group. Possible side effects of any injection include a risk for bleeding or infection. Lidocaine is an anesthetic which can stop cardiac arrhythmias, but can also cause them if injected intravenously. Because the injection site is the muscle and the syringe is pulled back to make sure we are not in a blood vessel the risk is extremely low. Lidocaine is metabolized in the liver. Lidocaine leaves the body within 4-6 hours. Aside from lidocaine, traumeel, a blend of several herbal medications, can be injected into the trigger points.

Contraindications to trigger point injections:

People who should not get trigger point injections include pregnant or nursing women. Anyone on blood thinners (325mg of aspirin, coumadin, plavix or someone who has a problem with clotting). Anyone with a rash or skin infection, or anyone who has an allergy to lidocaine.

Dry needling:

For those with an allergy to lidocaine or those who prefer not to inject any medications, trigger point injections can be done with out lidocaine. This is referred to as “dry needling.” Dry needling can also cause release of trigger points and the sensation of openness, but may be accompanied with more soreness than when lidocaine is injected.

Medications:

Sometimes medications can be prescribed, such as anti-inflammatories or muscle relaxants. These are not without their side effects and risks. Anti-inflammatories can erode gastric lining, impair renal function, and alter clotting mechanisms. Muscle relaxants can cause sedation, grogginess, and decreased ability to focus. Other medications may also be used. Alternatively, an anti-inflammatory diet can be incorporated to help decrease inflammation in the body.

References:

1. Travell JG, Simons DG, Simons LS: Myofascial Pain and Dysfunction: The Trigger Point Manual. Volume 1. Edited by Johnson ES. Lippincot Williams & Wilkins, Philadelphia, 1999. pp12-177.

Photo Credits:

1.1. Travell JG, Simons DG, Simons LS: Myofascial Pain and Dysfunction: The Trigger Point Manual. Volume 1. Edited by Johnson ES. Lippincot Williams & Wilkins, Philadelphia, 1999. pp 120,159.

5 Comments »


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[…] Myofascial Pain Syndrome, Trigger points, and Treatment Options SUMMARY: Myofascial pain syndrome can be considered, at least partially, a side effect of our modern lifestyles. It is caused by numerous factors: trauma, tension, inflammation, overuse, overload, poor posture, stress, repetitive strain, … […]

  neelam wrote @ May 26th, 2008 at 6:27 pm

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Hi thanks for including this post in your website. I checked out your website and found it to be very informative. What is your specialty?

Best,
Neelam

  Marcelo wrote @ July 6th, 2009 at 11:10 am

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It’s a big problem, I feeling lot of disconforts because it, I’ll try anestesics.

  Lexi wrote @ March 18th, 2010 at 1:31 am

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Thanks for this post!! This post, and your stated philosophy make me wish I could see you as my Dr.

I don’t know if you write back to people, but just in case, in your opinion, which I understand is not medical advice what is the relationship between thoracic outlet syndrome and myofascial pain syndrome? Is it possible to have a misdiagnosis of TOS rather than MPS, or are they just different words for the same thing? If actually different, how might I convince my Dr to give me a differential diagnosis? Also have you heard if a dx of MPS affects insurance differently? Or if MPS has a lower likelihood of requiring surgery than TOS?

I’m asking because foam roller seems to help me quite a lot where other things have not. And I’m looking into finding a trigger point massage person. Anyway I understand I might not get an answer. But answers that seemed hopeful would make it less scary to get a 2nd opinion.

  Beverly wrote @ March 26th, 2010 at 8:04 pm

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Thank you so much for this information. I am in severe pain. It is inhibiting my ability to live “normally”. I have FM, but lately have been having severe pain in several muscles, with a raised band of muscle that won’t go away and is inhibiting movement because of the severe pain. I am on Muscle relaxers, but they don’t seem to be helping except to stop the jaw clenching and grinding. I also have tmj replacements in my face, one is dislocated and is slowly rubbing a hole through to my cranium. How is that for a good story? Anyway, I have just figured out I have CMS and I will talk to my doctor about it. I am not confident that he will understand or treat it properly. I am a pet groomer and have been for 20 years. I am sure the heavy work load and weight I lift only aggravate this condition, but as I have to work to eat, I don’t see any relief in sight. Thanks again for writing this post. It is a relief to find a name for this painful condition, and hope there is help is sight!! I also have a constant raised place in my neck, which over the years has caused headaches, especially when under stress..it will swell and cause such pain I can’t get comfortable at night.. I think this might be where the problem is starting..and then spreads down my side to the muscles which are constantly contracted and painful.. Thanks again Bev

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