myofascial pain syndrome

Introduction

Localized musculoskeletal pain & tenderness in association with trigger points.

Etiology

• may follow trauma or overuse
• may follow state of prolonged contraction of a muscle or muscle group
  • reading or writing at a desk
  • working at a computer
• may be associated with osteoarthritis in the neck or lower back

Clinical manifestations

• pain is deep & aching & may be accompanied by burning
• myofascial trigger points are diagnostic feature
• pain almost always involves the posterior neck, low back, shoulders & chest
• referral of pain originating from occiput or trapezius trigger points (see fibromyalgia) may result in persistent headaches
• trigger points in paravertebral areas, may refer to buttocks
• gluteal trigger points may refer to the posterior aspect of the leg mimicking sciatica
• infraspinatus trigger point may produced pain down the outside of the arm to the hand

Complications

• may evolve into fibromyalgia syndrome
  • risk factors
  • anxiety
  • depression
  • non-restorative sleep
  • fatigue

Management

• trigger point injections
• massage
• ultrasound
• acupuncture may be helpful
• osteopathic manipulation may be helpful
• pharmaceutical agents
  • NSAIDs
  • muscle relaxants
  • tricyclic antidepressant
  • opiates if other agents & treatment modalities not effective
• patient education
  • prevent muscle stresses related to work & recreation
  • good posture & proper resting positions
  • prognosis is good

More general terms

• muscular disease; myopathy
• syndrome

Additional terms

• fibromyalgia syndrome (fibromyositis, fibrositis)
• myofascial pain
• myofascial pain dysfunction (MPD) syndrome
• myofascial trigger point