Myofascial Pain Syndrome

Topic Overview

What is myofascial pain syndrome?

Most people have muscle pain from time to time. But myofascial pain is a kind of ongoing or longer-lasting pain that can affect the connective tissue (fascia) of a muscle or group of muscles. With myofascial pain, there are areas called trigger points. Trigger points are usually in fascia or in a tight muscle.

When you put pressure on a trigger point, you not only feel pain at the trigger point but you may also feel it in muscles in another area. For example, pressure on a trigger point in the neck may cause pain in your arm. This is called referred pain.

Myofascial pain often goes away with treatment.

What causes myofascial pain syndrome?

Experts don't know exactly what causes myofacial pain syndrome. It may start after:

  • Strain or injury to the muscles, ligaments, or tendons.
  • Overuse, such as from typing on a computer or writing at a desk.
  • Using a muscle after you haven't used it for a while, such as after a stroke or after having a broken bone.

What are the symptoms?

The main symptom of myofascial pain syndrome is ongoing or longer-lasting muscle pain, in areas such as the low back, neck, shoulders, and chest. You might feel the pain or the pain may get worse when you press on a trigger point. The muscle may be swollen or hard—you may hear it called a "taut band" of muscle or "knot" in the muscle. Symptoms of myofascial pain may include:

  • A muscle that is sensitive or tender when touched.
  • Muscle pain that happens with pressure on a trigger point.
  • Pain that feels like aching, burning, stinging, or stabbing.
  • Reduced range of motion in the affected area.
  • A feeling of weakness in the affected muscle.

People with myofascial pain syndrome may have other health problems, such as tension headaches, depression, sleep problems, and fatigue. These problems are common in people who have chronic pain.

How is myofascial pain syndrome diagnosed?

To diagnose myofascial pain syndrome, your doctor will ask if you have had a recent injury, where the pain is, how long you have had the pain, what makes it better or worse, and if you have any other symptoms.

The doctor will also give you a physical exam. He or she will press on different areas to see if the pressure causes pain. If pressure on a certain area causes your pain to get worse, this means that the doctor has found a trigger point for your pain. Your pain may be in a different spot than the trigger point.

You may have tests to see if some other condition is causing your pain.

How is it treated?

Talk to your doctor about the best way to treat your pain. The main treatment may include any of the following:

  • Spray and stretch. This involves using a cooling spray directly on the skin from the trigger point to the painful area and then gently stretching the muscle. This may be repeated several times.
  • Physical therapy , which may include stretching and strengthening exercises. It may also include counseling about how to change the things that make the pain worse. For example, you may learn how to adjust your workstation, improve your posture, or change your sleep position to avoid muscle tension.
  • Massage.
  • Ultrasound .
  • Trigger point shots (injections). A doctor inserts a needle into the trigger point and injects medicine such as a local anesthetic.

Your doctor may also recommend nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin. These medicines may help with your symptoms.

Sometimes doctors prescribe certain antidepressants or muscle relaxants that help relax muscles and relieve sleep problems related to myofascial pain.

Some people with myofascial pain also find complementary therapies helpful. These include acupuncture, massage, behavioral therapy, and relaxation techniques.

References

Other Works Consulted

  • Bennet RM (2008). Fibromyalgia and chronic fatigue syndrome. In L Goldman, D Ausiello, eds., Cecil Textbook of Medicine, 23rd ed., vol. 2, pp. 2082–2083. Philadelphia: Saunders.
  • Binder M (2006). Neck pain, search date May 2006. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.
  • Kay TM, et al. (2005). Exercises for mechanical neck disorders. Cochrane Database of Systematic Reviews (3). Oxford: Update Software.
  • Langford CA, Gilliland BC (2008). Arthritis associated with systemic disease and other arthritides. In AS Fauci et al., eds., Harrison's Principles of Internal Medicine, vol. 2, pp. 2183–2184. New York: McGraw Hill.
  • Lavelle ED, et al. (2007). Myofascial trigger points. Medical Clinics of North America, 91(2): 229–239.
  • Makrides JC (2002). Myofascial syndrome. In CA Warfield, HJ Fausett, eds., Manual of Pain Management, 2nd ed., pp. 158–164. Philadelphia: Lippincott Williams and Wilkins.

Credits

Author Merrill Hayden
Editor Katy E. Magee, MA
Associate Editor Michele Cronen
Primary Medical Reviewer Adam Husney, MD - Family Medicine
Primary Medical Reviewer Martin Gabica, MD - Family Medicine
Specialist Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Last Updated February 23, 2010

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