Pain Management: Myofascial Pain Syndrome (Muscle Pain)

• Introduction to myofascial pain
• What causes myofascial pain?
• What are the symptoms of myofascial pain?
• How is myofascial pain diagnosed?
• How is myofascial pain treated?

Introduction

Myofascial pain syndrome (MPS) is a fancy way to describe muscle pain. It refers to pain and inflammation in the body's soft tissues.

Myofascial pain is a chronic condition that affects the fascia (connective tissue that covers the muscles). Myofascial pain syndrome may involve either a single muscle or a muscle group. In some cases, the area where a person experiences the pain may not be where the myofascial pain generator is located. Experts believe that the actual site of the injury or the strain prompts the development of a trigger point that, in turn, causes pain in other areas. This situation is known as referred pain.

What causes myofascial pain?

Myofascial pain may develop from a muscle injury or from excessive strain on a particular muscle or muscle group, ligament or tendon. Other causes include:

• Injury to intervertebral disc
• General fatigue
• Repetitive motions
• Medical conditions (including heart attack, stomach irritation)
• Lack of activity (such as a broken arm in a sling)

What are the symptoms of myofascial pain?

Myofascial pain symptoms usually involve muscle pain with specific "trigger" or "tender" points. The pain can be made worse with activity or stress. In addition to the local or regional pain associated with myofascial pain syndrome, people with the disorder also can suffer from depression, fatigue and behavioral disturbances.

How is myofascial pain diagnosed?

Trigger points can be identified by pain that results when pressure is applied to an area of a person's body. In the diagnosis of myofascial pain syndrome, four types of trigger points can be distinguished:

• An active trigger point is an area of extreme tenderness that usually lies within the skeletal muscle and which is associated with a local or regional pain.
• A latent trigger point is a dormant (inactive) area that has the potential to act like a trigger point.
• A secondary trigger point is a highly irritable spot in a muscle that can become active due to a trigger point and muscular overload in another muscle.
• A satellite myofascial point is a highly irritable spot in a muscle that becomes inactive because the muscle is in the region of another trigger pain.

How is myofascial pain treated?

• Physical therapy
• "Stretch and spray" technique: This treatment involves spraying the muscle and trigger point with a coolant and then slowly stretching the muscle.
• Massage therapy
• Trigger point injection

In some chronic cases of myofascial pain, combinations of physical therapy, trigger point injections, and massage are needed. In select cases, medication is used to treat other conditions that often occur with myofascial pain, such as insomnia and depression.

Reviewed by the doctors at The Cleveland Clinic Neuroscience Center.

Edited by Ephraim K Brenman, DO, on March 1, 2007.

Portions of this page © The Cleveland Clinic 2000-2005

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