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Myofascial Pain Syndrome – Causes and Treatment

Myofascial pain syndrome is a chronic pain condition affecting the muscles, characterized by sensitive pressure points known as trigger points that cause local and referred pain.

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Things worth knowing about "Myofascial Pain Syndrome"

Myofascial pain syndrome is a chronic pain condition affecting the muscles, characterized by sensitive pressure points known as trigger points that cause local and referred pain.

What Is Myofascial Pain Syndrome?

Myofascial pain syndrome (MPS) is a common chronic pain condition originating in the skeletal muscles and the surrounding connective tissue known as the fascia. The hallmark of the condition is the presence of locally hypersensitive spots within muscle tissue called myofascial trigger points. These are tight, palpable nodules within a taut band of muscle fiber that, when compressed or irritated, produce characteristic pain patterns -- often radiating to distant areas of the body in a phenomenon known as referred pain.

Myofascial pain syndrome can affect people of all ages and is one of the most common causes of musculoskeletal pain. While any muscle can be involved, the neck, shoulders, upper and lower back, and hips are the most frequently affected regions.

Causes

The exact causes of myofascial pain syndrome are not yet fully understood. Recognized contributing factors include:

Acute muscle overload or repetitive microtrauma from monotonous or repetitive movements
Poor posture and ergonomic strain, particularly in occupational settings
Psychological stress and emotional tension, which can lead to involuntary muscle guarding
Physical inactivity and muscle weakness
Trauma such as sprains, strains, or accidents
Underlying conditions including sleep disorders, thyroid dysfunction, or nutritional deficiencies (especially vitamin D and vitamin B12)
Cold exposure or drafts as triggering factors in already sensitized muscles

Symptoms

The primary symptom of myofascial pain syndrome is persistent, dull, or aching muscle pain that can be difficult to localize precisely. Common symptoms include:

Local tenderness at trigger points within the muscle
Referred pain radiating to distant areas -- for example, headaches caused by trigger points in the neck muscles
Restricted range of motion and stiffness in the affected muscle groups
Muscle weakness without visible muscle wasting
Sleep disturbances due to pain, particularly at night
Associated symptoms such as tingling, numbness, or dizziness depending on the location of trigger points

Diagnosis

Myofascial pain syndrome is primarily a clinical diagnosis, as there are no specific laboratory markers or imaging findings that confirm the condition. Diagnosis is based on:

Medical history: A thorough interview regarding the onset, character, and pattern of pain
Physical examination: Systematic palpation of muscles to identify trigger points and reproduce the characteristic pain pattern
Exclusion of other conditions: Imaging (MRI, ultrasound) and laboratory tests to rule out other disorders such as fibromyalgia, rheumatic diseases, or herniated discs

An important distinction must be made from fibromyalgia, which presents with more diffuse, generalized pain without discrete trigger points.

Treatment

Treatment of myofascial pain syndrome is multimodal and should be individually tailored. The following approaches have demonstrated clinical benefit:

Physical Therapy

Manual trigger point therapy: Sustained pressure applied to trigger points to release muscle tension
Physiotherapy and stretching: Targeted strengthening and flexibility exercises to restore normal muscle function
Heat therapy: Application of local warmth to promote muscle relaxation
TENS (Transcutaneous Electrical Nerve Stimulation): Electrical stimulation to reduce pain signals

Interventional Therapy

Dry needling: Insertion of an acupuncture needle directly into the trigger point to release the taut muscle band
Trigger point injections: Injection of local anesthetics (e.g., procaine, lidocaine) into the trigger point

Pharmacological Therapy

Analgesics (NSAIDs such as ibuprofen or diclofenac) for short-term pain relief
Muscle relaxants in cases of severe muscle spasm
Antidepressants (e.g., amitriptyline) for chronic pain management

Complementary and Psychological Approaches

Stress management and relaxation techniques (e.g., progressive muscle relaxation, yoga)
Cognitive behavioral therapy for patients with chronic pain
Acupuncture as a complementary treatment option

In the long term, a combination of active exercise therapy, stress reduction, and ergonomic improvements is the most effective strategy. Early treatment is essential to prevent the condition from becoming chronic.

References

Simons D. G., Travell J. G., Simons L. S. - Myofascial Pain and Dysfunction: The Trigger Point Manual (1999), Williams and Wilkins, Baltimore.
Fernandez-de-las-Penas C., Dommerholt J. - International Consensus on Diagnostic Criteria and Clinical Considerations of Myofascial Trigger Points. Pain Medicine, 2018; 19(1): 142-150.
National Institute of Neurological Disorders and Stroke (NINDS) - Chronic Pain Information, National Institutes of Health (NIH), 2023. Available at: www.ninds.nih.gov

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