Myofascial Pain: a pain for doctors and patients

Myofascial pain is thought to be secondary to the tightening of fascia which reduces the fascia’s sliding ability and acts as a source of tension. This may be caused my acute micro-trauma or repeated injury (1).

These areas of tightened fascia are known as trigger points, defined as “spots of exquisite tenderness and hyperirritability in muscles or their fascia, localized in taut, palpable bands, which mediate a local twitch response of muscle fibers under a specific type of palpation – called snapping – and, if sufficiently hyperirritable, give rise to pain, tenderness and autonomic phenomena as well as dysfunction in areas usually remote from their site, called targets.” Myofascial pain syndrome is very common, and often underdiagnosed.

Diagnosis depends on history and physical exam. Confirmation involves surface and needle EMG, US imaging, pain threshold measurement, and thermographic examination (showing a hot spot over the trigger point). Myofascial trigger points are especially common in patients with fibromyalgia, possibly due to an increase in the number of micro-traumatic events on muscle structures. Trigger points causing myofascial pain are also common in the muscles of the head and neck for those suffering from migraines and tension-type headaches.

Several treatments are available with variable evidence of efficacy. Trigger point injections, however, have been shown to be one of the most effective treatment modalities. These involve injecting local anesthetic into the trigger point of the muscle. “Dry-needling,” in which just the needle is inserted into the trigger point without anesthetic, is also effective (2).

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Photo by Kindel Media:

  1. Laimi K, Mäkilä A, Bärlund E, Katajapuu N, Oksanen A, Seikkula V, Karppinen J, Saltychev M. Effectiveness of myofascial release in treatment of chronic musculoskeletal pain: a systematic review. Clin Rehabil. 2018 Apr;32(4):440-450. doi: 10.1177/0269215517732820. Epub 2017 Sep 28. PMID: 28956477.
  2. Giamberardino MA, Affaitati G, Fabrizio A, Costantini R. Myofascial pain syndromes and their evaluation. Best Pract Res Clin Rheumatol. 2011 Apr;25(2):185-98. doi: 10.1016/j.berh.2011.01.002. PMID: 22094195.

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