Myofascial pain syndrome (MPS), also known as chronic myofascial pain (CMP), is a

syndrome A syndrome is a set of medical signs and symptoms which are correlated with each other and often associated with a particular disease or disorder. The word derives from the Greek language, Greek σύνδρομον, meaning "concurrence". When a sy ...

characterized by

chronic pain Chronic pain is classified as pain that lasts longer than three to six months. In medicine, the distinction between acute and chronic pain is sometimes determined by the amount of time since onset. Two commonly used markers are pain that continue ...

in multiple

myofascial trigger point Myofascial trigger points (MTrPs), also known as trigger points, are described as hyperirritable spots in the skeletal muscle. They are associated with palpable nodules in taut bands of muscle fibers. They are a topic of ongoing controversy, ...

s ("knots") and fascial (connective tissue) constrictions. It can appear in any body part. Symptoms of a myofascial trigger points include: focal point tenderness, reproduction of pain upon trigger point palpation, hardening of the muscle upon trigger point palpation, pseudo-weakness of the involved muscle,

referred pain Referred pain, also called reflective pain, is pain perceived at a location other than the site of the painful stimulus. An example is the case of angina pectoris brought on by a myocardial infarction (heart attack), where pain is often felt in ...

, and limited range of motion following approximately 5 seconds of sustained trigger point pressure. The cause is believed to be muscle tension or spasms within the affected musculature. Diagnosis is based on the symptoms and possible sleep studies. Treatment may include pain medication, physical therapy, mouth guards, and occasionally benzodiazepine. It is a relatively common cause of temporomandibular pain.

Signs and symptoms

Primary symptoms include: * Localized muscle pain * Trigger points that activate the pain (MTrPs) Generally speaking, the muscular pain is steady, aching, and deep. Depending on the case and location the intensity can range from mild discomfort to excruciating and "lightning-like". Knots may be visible or felt beneath the skin. The pain does not resolve on its own, even after typical first-aid

self-care Self-care has been defined as the process of establishing behaviors to ensure holistic well-being of oneself, to promote health, and to actively management of illness when it occurs. Individuals engage in some form of self-care daily with food ...

such as ice, heat, and rest. Electromyography (EMG) has been used to identify abnormal motor neuron activity in the affected region. A physical exam usually reveals palpable trigger points in affected muscles and taut bands corresponding to the contracted muscles. The trigger points are exquisitely tender spots on the taut bands.

Causes

The causes of MPS are not fully documented or understood. At least one study rules out trigger points: "The theory of myofascial pain syndrome (MPS) caused by trigger points (TrPs) ... has been refuted. This is not to deny the existence of the clinical phenomena themselves, for which scientifically sound and logically plausible explanations based on known neurophysiological phenomena can be advanced." Some

systemic disease A systemic disease is one that affects a number of organs and tissues, or affects the body as a whole. Examples * Mastocytosis, including mast cell activation syndrome and eosinophilic esophagitis * Chronic fatigue syndrome * Systemic vas ...

s, such as

connective tissue disease A connective tissue disease (collagenosis) is any disease that has the connective tissues of the body as a target of pathology. Connective tissue is any type of biological tissue with an extensive extracellular matrix that supports, binds togeth ...

, can cause MPS. Poor posture and emotional disturbance might also instigate or contribute to MPS.

Diagnosis

Diagnosis is generally based on the symptoms and possible sleep studies.

Comparison with Fibromyalgia

Myofascial pain syndrom (MPS) is commonly confused with fibromyalgia (FM) as their presentation is similar. However, fibromyalgia is typically associated with fatigue, depression and cognitive dysfunction. The anatomic distribution and characteristic of the pain also differ. While the fibromyalgia pain is generalized, bilateral and typically involving muscles above and below the waist, the MPS pain affects a particular region of the body such as the mandible or the shoulders. The MTrPs found in MPS present overt palpable nodular structures within the muscle, while aside from tenderness, the trigger points in FM are indistinguishable from surrounding tissue. However, there are some challenges distinguishing these symdromes: * Difficulty differentiating FM trigger points from myofascial trigger points * Poor reliability in detecting taut bands * MPS may become generalized over time thus mimicking FM

Treatment

Massage therapy using trigger-point release techniques may be effective in short-term pain relief. Physical therapy involving gentle

stretching Stretching is a form of physical exercise in which a specific muscle or tendon (or muscle group) is deliberately flexed or stretched in order to improve the muscle's felt elasticity and achieve comfortable muscle tone. The result is a feeling ...

and exercise maybe useful for recovering full range of motion and motor coordination. Once the trigger points are gone, muscle strengthening exercise can begin, supporting long-term health of the local muscle system. Myofascial release, which involves gentle fascia manipulation and massage, may improve or remediate the condition. A systematic review concluded that

dry needling Dry needling, also known as trigger point dry needling and intramuscular stimulation, is a treatment technique used by various healthcare practitioners, including physical therapists, physicians, and chiropractors, among others. Acupuncturists us ...

for the treatment of myofascial pain syndrome in the lower back appeared to be a useful adjunct to standard therapies, but that clear recommendations could not be made because the published studies were small and of low quality. Posture evaluation and

ergonomics Human factors and ergonomics (commonly referred to as human factors) is the application of psychological and physiological principles to the engineering and design of products, processes, and systems. Four primary goals of human factors learnin ...

may provide relief in the early stages of treatment. Gentle, sustained stretching exercises within a comfortable range of motion have been shown to lessen symptoms. Regular, non-intense activity is also encouraged.

References

Sources

External links

{{DEFAULTSORT:Myofascial Pain Syndrome Soft tissue disorders Ailments of unknown cause Disorders of fascia Pain Chronic pain syndromes Rheumatology Urologic pelvic pain syndrome