What Is Myofascial Pain Syndrome?

Overview

Myofascial pain syndrome is a type of chronic pain condition that affects the musculoskeletal system. Most people will experience some form of muscle pain at some point in their lives, though it typically resolves on its own after a few weeks. However, for some people, the pain persists. 

For MPS patients, these sensitive spots are referred to as trigger points. They are the areas that usually form in the ropey, taut bands of the muscles called the fascia. Whenever pressure is applied to these trigger points, it leads to pain (referred pain) in a different area of the body. 

Some of the common symptoms of MPS include:

•   Deep pain experienced in localized muscle areas

•   Muscle pain that continues to get worse or doesn’t improve over time

•   Pain that worsens whenever the affected muscle is strained or stretched

•   Presence of painful knots in the muscles when pressed, which produce intense referred or localized pain

•   Sleep or mood disturbances

•   Weak, inflexible, or stiff muscles or ones with a reduced range of motion

Myofascial pain syndrome or fibromyalgia 

Most of the people experiencing fatigue and pain in their skeletal muscles either have MPS or fibromyalgia. Fibromyalgia is a disorder that causes widespread muscular pain. It can be felt throughout the entire body, though people suffering from MPS experience localized pain in regional groups of muscles such as the neck, lower back, or the jaw.

MPS is often characterized by several localized trigger points in the said ropey bands of the muscles. Trigger points are usually tender and can produce localized pain. However, their key defining characteristic is that they usually trigger referred pain. Fibromyalgia is usually associated with multiple, and often more widespread tender points. These are different from trigger points as they don’t produce referred pain. 

Myofascial Pain causes and risk factors

Much of the trigger points often form due to muscle injury/trauma muscle overuse, or emotional stress. These points usually develop from sustained repetitive actions, including working on a computer for an entire day or lifting heavy objects at work. There’s no single factor that’s responsible for the development of myofascial trigger points. Usually, a combination of contributing factors will be at play. These include:

•   Nutritional deficiencies

•   Poor posture

•   Lack of sleep

•   Sitting for extended periods in awkward positions

•   General fatigue

•   Serious lack of movement or exercise

•   Injuries to the intervertebral disks or the musculoskeletal system

•   Emotional problems (anxiety, depression)

•   Obesity

•   Hormonal changes (e.g. menopause)

•   Smoking

•   Intense cooling of muscles (e.g. when sleeping in front of an air conditioning unit)

•   Other inflammatory or pain conditions 

Diagnosis

Your physician will perform physical examinations to identify any myofascial trigger points. They will also look for tender nodules in the taut bands of your muscles and press them to check for pain responses. When they press a trigger point, they will feel for a twitch in the muscle (“jump sign”). 

There are no other physical tests that could be used to diagnose MPS. Your doctor will rely on you to describe how and where you’re experiencing the pain. Be sure to tell your doctor about all of your current symptoms and past surgeries or injuries. 

Your doctor may find several different kinds of myofascial trigger points including:

•   Latent trigger points: These include nodules that don’t cause pain when touched. They can stay dormant for many years only to become active when there’s stress or stigma. 

•   Active trigger points: These are nodules within a band of muscle that are often the source of muscular pain. They are characteristically tender, produce a twitch when touched, and cause referred pain. 

•   Secondary trigger points: These include the painful points in a muscle that becomes active when another muscle is stressed. 

•   Satellite myofascial points: These are painful spots that become active since they are located close to another trigger point. 

Trigger points chart of myofascial pain syndrome 

Medications 

Several medications can help to ease MPS symptoms, including:

•   NSAIDs (non-steroidal anti-inflammatory drugs): Over the counter medications like ibuprofen (Advil) and acetaminophen (Tylenol) can help to relieve the pain and swelling. 

•   Muscle relaxants: Tizanidine (Zanaflex) and Benzodiazepines can help to reduce muscle spasms. 

•   Analgesics: Pain relievers like tramadol, diclofenac patch or lidocaine, COX-2 inhibitors, and tropisetron (Not available in the U.S.) can also work effectively. 

•   Anticonvulsants: Pregabalin (Lyrica) and Gabapentin (Neurontin) can help to reduce muscle spasms and relieve pain.

•   Botox injections: Botulinum type A is a very potent neurotoxin that helps prevent muscular contractions, and might also help in relieving pain. 

•   Tricyclic antidepressants: These are used to treat fibromyalgia, chronic pain, and nerve pain, all of which are conditions that resemble MPS. 

Treatments

Myofascial pain syndrome needs a long treatment plan. Therapies that relieve muscle pain and other medications are used by most people. 

Dry Needling

This is one of the fastest ways to inactivate the active myofascial trigger points. Your physician will insert a needle in the trigger point, move it around the area and then poke it in and out. This can be quite painful though it’s still one of the best ways to inactivate a trigger point effectively and reduce the pain. Some clinicians will prefer using acupuncture needles which are typically much smaller and less painful compared to hypodermic needles. There are a few major differences between acupuncture and dry needling.

Trigger point injections 

These are quite similar to dry needling but it involves injecting a solution into the tissues. Doctors usually inject saline or local anesthetic like lidocaine. While the effects are comparable to dry needling, the procedure may result in much less discomfort. You can also opt for injecting the trigger points with steroids. 

Ultrasound therapy

Here, ultrasound machines are used to diffuse sound waves into the surrounding tissue via a special sound-conducting gel pre-applied onto the skin. These sound waves can heat up and even relax muscles, remove scar tissue, and improve blood flow. The pain easing effects could be minimal; however, the treatment is effective at increasing mobility and reducing stiffness, especially if done before stretching. This treatment is effectively used for relieving pain associated with rheumatoid arthritis, and it might be worth discussing with your doctor about it. 

Massage Therapy

There are a few types of massage treatments that could help relax the myofascial trigger points. They include:

•   Active rhythmic release

•   Passive rhythmic release

•   Trigger point pressure release

•   Shiatsu (acupressure)

Massage therapy increases blood flow and helps to warm up the muscles. This, in turn, eases pain and helps to reduce stiffness. The massage therapist might use their thumbs to pressure the trigger points which will help release the muscle tension but might aggravate the pain. 

Spray and Stretch

MPS symptoms can sometimes be helped with stretching. Some physical therapists will use cold, numbing spray around the muscle area before the stretching exercises. There might also be gentle stretches and exercises that you could do at home to reduce the pain. 

Home Remedies

There are a few steps you can take at the comfort of your home to lower the pain and improve your symptoms. They include

•   Improving your posture and using a better chair at work

•   Adjusting the height of your computer such that it’s level with your natural eye line

•   Wearing a back brace whenever you’re doing the heavy lifting

•   Practicing yoga Pilates, and other stretching exercises

•   Getting your muscles moving every day and ideally developing an exercise program

•   Using personal massager or similar devices

•   Using an ice pack following any form of muscle injury

•   Reducing your stress levels and seeing a mental health expert if necessary

•   Taking a hot bath

•   Practicing mindfulness for pain management

•   Using moist heat for treating muscle inflammation. Consider learning how to make a heating pad on your own

•   Using a traction device where necessary

Complications 

Myofascial pain syndrome can affect the quality of your life. you might be unable to participate in physical activities that you enjoy doing. This could eventually lead to isolation and depression. MPS also impact mobility. The best approach is to seek treatment as soon as the symptoms first develop, talk with friends and family about it and find a support group. 

Outlook 

MPS can be quite a challenging condition to live with. The key is proper pain management through the treatment options that work for you. No single treatment options will work for everyone, so don’t be discouraged if the one you chose doesn’t work. However, with some healthy lifestyle choices along with effective treatment, you can manage MPS successfully.