Myofascial Pain Syndromes: Prevention [Clinical Review Discussion]

During the 1930s and 40s, 3 researchers, working independently in Germany, Australia, and the United States, established myofascial trigger points (MTrPs) as commonly occurring pain generators (1). 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 of 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 (2). 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 (3) and repeated by numerous other authors (4-7) in the scientific literature (Gerwin Article, Edwards Article).

In order to understand risk factors, it may be helpful to understand the evolving hypothesis relating to the etiology of MTrPs. The second edition of The Trigger Point Manual (2) proposed a new model that postulated the neuromuscular junction as key to the formation of MTrPs. According to this hypothesis, excessive release of acetylcholine at the motor endplate causes spontaneous electrical activity which ultimately results in the development of MTrPs. Subsequent work proposed a motor, sensory and autonomic component and expanded the endplate hypothesis (8). According to this hypothesis a variety of factors can result in increased release of acetylcholine and should be considered as risk factors.