Myofascial pain syndrome

Myofascial pain syndrome

Myofascial pain syndrome is a long-term pain condition. It involves some muscles and the thin cover of tissue that holds muscles in place, called fascia. Pressure on these areas, called trigger points, causes pain.

Sometimes, the pain is felt in other parts of the body. This is called referred pain. The pain often is felt as shoulder pain, back pain, tension headaches and face pain.

This syndrome can happen after a muscle has been tensed over and over. Repeated motions used in jobs or hobbies can be the cause. So can stress-related muscle tension, poor posture and weak muscles. In some cases, the cause of myofascial pain is unknown.

Almost everyone has felt muscle tension pain. But the pain of myofascial pain syndrome doesn't go away. Treatment options include exercise, massage, physical therapy and shots in the trigger points. Pain medicines and finding ways to relax also can help.

Symptoms

Symptoms of myofascial pain syndrome may include:

• Deep, aching pain in a muscle.
• Pain that doesn't go away or gets worse.
• A tender knot in a muscle.
• Trouble sleeping due to pain.
• A general feeling of being not well, called malaise.
• Tiredness.

Most people have muscle pain at times. But if your muscle pain doesn't go away with rest, massage and other self-care measures, make an appointment with your healthcare professional.

Causes

The exact cause of myofascial pain syndrome is not known. Areas of tight muscle fibers, called trigger points, form in muscles. Too much use of the muscles, most often with poor form, injury to the muscle and mental stress likely help cause trigger points.

Risk factors

In myofascial pain syndrome, something such as muscle tightness sets off trigger points in the muscles. Factors that may increase the risk of muscle trigger points include:

• Muscle injury. A muscle injury or ongoing muscle stress may lead to the forming of trigger points. For instance, a spot in or near a strained muscle may become a trigger point. Repeat motions and poor posture also can increase the risk.
• Stress and anxiety. People who often feel stressed and anxious may be more likely to get trigger points in their muscles. One theory is that these people may be more likely to clench their muscles. Clenching is a form of repeated strain that leaves muscles open to trigger points.

Complications

Complications linked to myofascial pain syndrome include:

• Sleep problems. Symptoms of myofascial pain syndrome may make it hard to sleep. It might be hard to find a good sleep position. And if you move while sleeping, you might hit a trigger point and awaken.

• Fibromyalgia. Some research suggests that myofascial pain syndrome may lead to fibromyalgia in some people. Fibromyalgia is a long-term condition of widespread pain.

  It's believed that the brains of people with fibromyalgia respond more to pain signals over time. Some experts believe myofascial pain syndrome might help start this process.

• Diagnosis

  During a physical exam, your healthcare professional may put gentle finger pressure on the affected muscle, feeling for painful areas. Certain ways of pressing on the trigger point can cause certain responses. For instance, you might have a muscle twitch.

  Muscle pain has many possible causes. Your healthcare professional uses other tests and procedures to rule out other causes of muscle pain.

  Treatment:

  Treatment for myofascial pain syndrome typically includes medicines, shots into the trigger points and physical therapy. Exercise is a big part of any treatment plan.

  Discuss treatment options and what you prefer with your healthcare professional. You may need to try more than one approach to find pain relief.

  Medications

  Medicines used for myofascial pain syndrome include:

• Pain relievers. Pain relievers you can get without a prescription, such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), may help. Some come in the form of creams or patches that you put on the skin. Or your healthcare professional may prescribe stronger pain relievers.
• Antidepressants. Many types of antidepressants can help relieve pain. For some people with myofascial pain syndrome, amitriptyline seems to reduce pain and improve sleep.
• Muscle relaxers. Clonazepam (Klonopin) and other medicines called benzodiazepines help treat the anxiety and poor sleep that sometimes come with myofascial pain syndrome. These medicines can cause sleepiness and can be habit-forming.
• Stretching. A physical therapist may lead you through gentle stretches to help ease the pain in your sore muscle. If you feel trigger point pain when stretching, the therapist may put a numbing spray on your skin.
• Massage. A physical therapist may massage your affected muscle to help relieve your pain. The therapist may use long hand strokes along your muscle or place pressure on areas of your muscle to release tension.

          Procedures:

• Shots, also called injections, into trigger points. A shot of a numbing medicine or a steroid into a trigger point can help relieve pain. OnabotulinumtoxinA (Botox) also might be used.
• Dry needling. In some people, just putting the needle into the trigger point helps break up the muscle tension. This is called dry needling. Acupuncture also appears to help some people who have myofascial pain syndrome.
• dry and wet cupping
• Extracorporeal shock wave therapy. Sound waves are directed at the area of pain. Some studies have shown it to ease pain in myofascial pain syndrome.