Myofacial Pain Syndrome and its Rehabilitation

Myofacial Pain Syndrome and its Rehabilitation 

Myofascial pain syndrome is a chronic pain disorder. In this condition, pressure on sensitive points in your muscles (trigger points) causes pain in the muscle and sometimes in seemingly unrelated parts of your body. This is called referred pain.

This syndrome typically occurs after a muscle has been contracted repetitively. This can be caused by repetitive motions used in jobs or hobbies or by stress-related muscle tension.

While nearly everyone has experienced muscle tension pain, the discomfort associated with myofascial pain syndrome persists or worsens. Treatment options include physical therapy and trigger point injections. Pain medications and relaxation techniques also can help.

Symptoms

Signs and symptoms of myofascial pain syndrome may include:

• Deep, aching pain in a muscle
• Pain that persists or worsens
• A tender knot in a muscle
• Difficulty sleeping due to pain

Causes

Sensitive areas of tight muscle fibers can form in your muscles after injuries or overuse. These sensitive areas are called trigger points. A trigger point in a muscle can cause strain and pain throughout the muscle. When this pain persists and worsens, doctors call it myofascial pain syndrome.

Risk factors

Myofascial pain syndrome is caused by a stimulus, such as muscle tightness, that sets off trigger points in your muscles. Factors that may increase your risk of muscle trigger points include:

• Muscle injury. An acute muscle injury or continual muscle stress may lead to the development of trigger points. For example, a spot within or near a strained muscle may become a trigger point. Repetitive motions and poor posture also may increase your risk.
• Stress and anxiety. People who frequently experience stress and anxiety may be more likely to develop trigger points in their muscles. One theory holds that these people may be more likely to clench their muscles, a form of repeated strain that leaves muscles susceptible to trigger points.

Complications

Complications associated with myofascial pain syndrome may include:

Sleep problems. Signs and symptoms of myofascial pain syndrome may make it difficult to sleep at night. You may have trouble finding a comfortable sleep position. And if you move at night, you might hit a trigger point and awaken.

Fibromyalgia. Some research suggests that myofascial pain syndrome may develop into fibromyalgia in some people. Fibromyalgia is a chronic condition that features widespread pain. It's believed that the brains of people with fibromyalgia become more sensitive to pain signals over time. Some doctors believe myofascial pain syndrome may play a role in starting this process.

Diagnosis

During the physical exam, your doctor may apply gentle finger pressure to the painful area, feeling for tense areas. Certain ways of pressing on the trigger point can elicit specific responses. For instance, you may experience a muscle twitch.

Muscle pain has many possible causes. Your doctor may recommend other tests and procedures to rule out other causes of muscle pain.

Treatment

Treatment for myofascial pain syndrome typically includes medications, trigger point injections or physical therapy. No conclusive evidence supports using one therapy over another, but exercise is considered an important component of any treatment program. Discuss your options and treatment preferences with your doctor. You may need to try more than one approach to find pain relief.

• Medications

  Medications used for myofascial pain syndrome include:
  • Pain relievers. Over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) may help some people. Or your doctor may prescribe stronger pain relievers. Some are available in patches that you place on your skin.
  • Antidepressants. Many types of antidepressants can help relieve pain. For some people with myofascial pain syndrome, amitriptyline appears to reduce pain and improve sleep.
  • Sedatives. Clonazepam (Klonopin) helps treat the anxiety and poor sleep that sometimes occur with myofascial pain syndrome. It must be used carefully because it can cause sleepiness and can be habit-forming.

  Therapy

  A physical therapist can devise a plan to help relieve your pain based on your signs and symptoms. Physical therapy to relieve myofascial pain syndrome may involve:
  • Stretching. A physical therapist may lead you through gentle stretching exercises to help ease the pain in your affected muscle. If you feel trigger point pain when stretching, the physical therapist may spray a numbing solution on your skin.
  • Posture training. Improving your posture can help relieve myofascial pain, particularly in your neck. Exercises that strengthen the muscles surrounding your trigger point will help you avoid overworking any one muscle.
  • Massage. A physical therapist may massage your affected muscle to help relieve your pain. The physical therapist may use long hand strokes along your muscle or place pressure on specific areas of your muscle to release tension.
  • Heat. Applying heat, via a hot pack or a hot shower, can help relieve muscle tension and reduce pain.
  • Ultrasound. This type of therapy uses sound waves to increase blood circulation and warmth, which may promote healing in muscles affected by myofascial pain syndrome.

  Needle procedures

  Injecting a numbing agent or a steroid into a trigger point can help relieve pain. In some people, just the act of inserting the needle into the trigger point helps break up the muscle tension. Called dry needling, this technique involves inserting a needle into several places in and around the trigger point. Acupuncture also appears to be helpful for some people who have myofascial pain syndrome.