Myofascial Pain Syndromes

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Myofascial Pain Syndromes

Myofascial pain syndrome is a very commonly occurring disorder which is characterized by the presence of a tender nodule in a taut band of muscle known as a trigger point. Pain is felt on compression of the trigger point as well as in a characteristic referred pain pattern. Prevalence of myofascial pain is high with as with as many as 30% of patients seen with pain complaints suffering from myofascial pain (1).

(1) Skootsky SA, Jaeger B, Oye RK. Prevalence of myofascial pain in general internal medicine practice. West J Med 1989; 151(2):157-160.

Clinical Reviews

Myofascial Pain Syndromes: Prevention

During the 1930’s and 40’s three researchers, working independently in Germany, Australia, and the United States, established myofascial trigger points (MTrPs) as commonly occurring pain generators. Of these Janet Travell, M.D. emerged as the best known proponent of treating and reducing MTrPs in order to eliminate muscular pain in many patients. David Simons M.D. collaborated with Travell for well over 20 years and has now assumed the role chief proponent and investigator of myofascial pain syndrome. Although MTrPs have been identified and studied for nearly 70 years and many physicians and researchers acknowledge their role in pain, universal acceptance is still lacking. For the most part the scientific literature relating to risk factors and prevention has been limited to expert opinion, tradition and consensus. The source for most of the risk factors and prevention strategies mentioned below are from the Travell & Simons seminal text, The Trigger Point Manual and repeated by numerous other authors in the scientific literature.

Myofascial Pain Syndromes: Diagnosis

A thorough case history and clinical examination are required to accurately diagnose myofascial pain syndrome (MPS). Since MPS mimics many other conditions, early recognition can reduce the need for more invasive and expensive diagnostic procedures. Myofascial pain syndrome is characterized by deep aching pain, stiffness in the involved area and referred pain often appearing as radiation of pain. In later stages muscle weakness often develops as well as fatigue and sleep disturbances.

Myofascial Pain Syndromes: Therapy

A 2000 survey of pain management providers showed 88.5% considered myofascial pain syndrome (MPS) a valid diagnosis and 81% considered it distinct from fibromyalgia. Although various interventions in MPS have been described in the scientific literature as effective, many are based on a limited number of experimental studies with clinical evidence and expert opinion representing much of the evidence.

Medical Subject Heading (MeSH) Information

MeSH Term: Myofascial Pain Syndromes

Scope Note: Muscular pain in numerous body regions that can be reproduced by pressure on TRIGGER POINTS, localized hardenings in skeletal muscle tissue. Pain is referred to a location distant from the trigger points. A prime example is the TEMPOROMANDIBULAR JOINT DYSFUNCTION SYNDROME.

MeSH Synonyms:

Myofascial Pain Syndromes
Myofascial Pain Syndrome
Pain Syndrome, Myofascial
Pain Syndromes, Myofascial
Syndrome, Myofascial Pain
Syndromes, Myofascial Pain
Myofascial Trigger Point Pain
Trigger Point Pain, Myofascial

Applicable MeSH Subheadings:

blood
chemically induced
classification
complications
diagnosis
diet therapy
drug therapy
economics
epidemiology
etiology
genetics
history
immunology
metabolism
pathology
physiopathology
prevention and control
psychology
radiography
radionuclide imaging
radiotherapy
rehabilitation
surgery
therapy
ultrasonography
urine
veterinary

One-Click Literature Search

Myofascial Pain Syndromes AND Prevention

Myofascial Pain Syndromes AND Diagnosis

Myofascial Pain Syndromes AND Therapy

Informative Links

MayoClinic.com Myofascial Pain Syndrome Information

Mayo Clinic Health Solutions' award-winning consumer Web site offers health information and self-improvement tools. MayoClinic.com's medical experts and editorial professionals bring you access to the knowledge and experience of Mayo Clinic for all your consumer health information needs, from cancer, diabetes and heart disease to nutrition, exercise and pregnancy.

MedlinePlus: Muscle Disorders

MedlinePlus will direct you to information to help answer health questions. MedlinePlus brings together authoritative information from NLM, the National Institutes of Health (NIH), and other government agencies and health-related organizations.

Current Clinical Trials Relating to Myofascial Pain Syndromes

ClinicalTrials.gov: Provides patients, family members, and members of the public easy and free access to information on clinical studies for a wide range of diseases and conditions.

Trial of Acupuncture in the Treatment of Fibromyalgia

(Status: Recruiting)

Improvement of the Health-related Quality of Life of Patients With Fibromyalgia Using Multidisciplinary Treatment

(Status: Completed)

Efficacy and Safety of an Oral Growth Hormone Drug in the Treatment of Fibromyalgia

(Status: Completed)

Mindfulness-Based Stress Reduction Program as an Intervention in Patients With Fibromyalgia

(Status: Active, not recruiting)

Study To Assess The Clinical Benefit Of Droxidopa And Droxidopa/Carbidopa In Subjects With Fibromyalgia

(Status: Completed)

Coping Skills Training for Adolescents With Fibromyalgia

(Status: Recruiting)

Effect of Revival Soy on Fibromyalgia Pain

(Status: Completed)

Prevalence of Fibromyalgia in Israel

(Status: Recruiting)

Pain and Stress Management for Fibromyalgia

(Status: Recruiting)

Influenza Vaccination in Fibromyalgia Patients

(Status: Not yet recruiting)

Occipital Transcranial Direct Current Stimulation in Fibromyalgia

(Status: Recruiting)

Clinical Trial Testing the Safety and Efficacy of Fluoxetine in Juvenile Fibromyalgia

(Status: Completed)

Drug and Talk Therapy for Fibromyalgia

(Status: Active, not recruiting)

Yoga for Fibromyalgia

(Status: Active, not recruiting)

A Multicentre Trial to Determine the Efficacy and Safety of AD-337 in the Treatment of Fibromyalgia

(Status: Completed)

Study to Assess the Efficacy and Safety of Dysport® in Upper Back Myofascial Pain Syndrome

(Status: Completed)

Exercise in Women With Fibromyalgia

(Status: Recruiting)

Effect of PERMEAPROTECT on the Quality of Life of Patients With Fibromyalgia

(Status: Not yet recruiting)

Dynamic Contrast Enhanced (DCE)-MRI in Fibromyalgia

(Status: Enrolling by invitation)

Web-based Education to Enhance Fibromyalgia Management

(Status: Completed)

20 Clinical Trials Returned

Ultrasound Therapy: 2010 Research Support

ChiroACCESS Editorial Staff

Typically physical therapy modalities have had very poor evidence to support their use. Despite the historical lack of evidence 63% of chiropractors use ultrasound for therapy. Positive results account for this significant segment of the profession using ultrasound therapy (UT) but without evidence reimbursement has become a challenge. Fortunately more emphasis is now being placed on examining the efficacy of UT and there have been a significant number of research studies published in 2010 that support its use. Two different papers recommend UT for myofascial pain syndromes. It is characterized as both safe and cost-effective for trigger points. In another small (N=26) single blind trigger point study the conclusion was that “Thermal ultrasound over latent trigger points is comfortable and can decrease stiffness of a trigger point”.

ChiroACCESS |

October 11, 2010

Therapeutic Ultrasound: A Review of the Literature

Daniel A. Martinez, MA, DC, Research Scientist

Ultrasound (US) has been a widely used and accepted adjunct modality for the management of many musculoskeletal conditions. It was first introduced as a therapeutic modality in the 1950s, when both animal and human studies demonstrated its ability to safely heat tissue several centimeters below the skin. In the late 1960s and 1970s, reports on the non-thermal therapeutic effects of US, primarily in the area of enhanced tissue healing, further bolstered its popularity (1). Despite the years of clinical use, the lack of studies confirming its benefits has led scientists to question the traditional view of its therapeutic benefits (2).

Several papers reviewing the available literature have been published concerning the biophysical effects, application, and efficacy of therapeutic ultrasound, as well as the safety and calibration of ultrasonic equipment (2-7). The purpose of this paper is to present a general overview of these findings.

ChiroACCESS |

October 1, 2010

Cryotherapy: A Review of the Literature

Daniel A. Martinez, MA, DC, Research Scientist

Cold application (cryotherapy) is the simplest and most commonly used method for treatment of acute musculoskeletal injury. Among chiropractic practitioners it is the most often utilized (94.5%) passive adjunctive therapy. The pathophysiological effects of cold have been well documented. Studies have shown that cold applications can reduce the metabolic rate of a tissue, decrease pain and swelling, and reduce muscle spasm. Most health care practitioners are taught to use ice therapy for treatment of bruises, strains, sprains, or muscle tears and most are familiar with the rest, ice, compression, and elevation (RICE) principle following acute soft tissue injury, yet there is little agreement in the literature on the optimum application technique for such care.

Parker College of Chiropractic Research Institute |

February 4, 2008