Myofascial Pain Syndrome

Myofascial Pain Syndrome is one of the most common causes of musculoskeletal pain. It consists of a local neuromuscular disorder characterized by sensitive areas strained muscle bands that generate pain in remote areas or neighboring.

Myofascial pain syndrome is a set of signs and symptoms that generate localized pain, in addition to muscle sensitivity and reduced range of motion. It occurs more frequently in the arms, head, neck, legs, buttocks, shoulders, and lower back and can affect any muscle group.

This syndrome causes a lot of pain but does not pose a risk to the patient’s life. Despite this, it compromises their quality of life, especially when it comes to living with other individuals. Pain is usually more significant during periods of stress and during physical activities.

It can occur in both sexes, with greater incidence in people over thirty years of age, especially in athletes. Trigger points are perceived, which are well-defined points where a nodule or muscle contraction is perceived. When this region is stimulated, there is great pain, but not in the exact location as the trigger point (it radiates to another area of ​​the body ).

The symptoms of myofascial pain syndrome are a pain in certain areas of the body, in muscles or joints. It can appear both at rest and during physical activities, but it happens more frequently in the latter case when there is physical effort.


Treatment of Myofascial Pain Syndrome


Treatment consists of identifying the cause and correcting it.

The treatment of myofascial syndrome aims to eliminate or minimize pain generated by the trigger point.

The association of treatments such as myofascial release, trigger point infiltration, acupuncture, stretching exercises, use of medications such as analgesics and muscle relaxants, and treatment of etiology when possible and observation of the patient in their social environment.

A widely used practice is trigger point injection., which aims to eliminate them and, consequently, tense muscle bands, reducing or minimizing pain, increasing range of motion, making it impossible for these nodules to become fibrotic and resistant to treatment, or causing recurrences to be frequent.

The infiltration on the trigger point can be accomplished primarily through two techniques: dry needling or infiltration with local anesthetics, such as mepivacaine and lidocaine. The procedure also helps diagnose the syndrome, stimulating a local contractile response and decreasing pain due to a mechanical effect.


Treatment involves correcting muscle strain


The treatment of the disease is done by correcting the causes, which may or may not be medication and rehabilitation.

If the problem is postural, it is essential to correct the patient’s posture and movement daily to resolve the cause. Therefore, patients with this syndrome need to be aware that they must collaborate with the treatment. This collaboration is essential, as a large part of the treatment is done by correcting the cause, and the only person who can resolve this is the patient.

Thus, it is necessary to improve the ergonomics of the work and personal environments of patients with the syndrome. They should be analyzed and corrected, as well as the patient’s posture and daily habits (eating, sleeping, working, participating in leisure activities, etc.).

It is essential to rule out other causes of pain perpetuation, such as joint hypermobility syndrome.


Recommendations on treatment of Myofascial Pain Syndrome


There are several treatment possibilities for the pain resulting from the syndrome:


Awareness of the need for improvement in lifestyle


Include or increase physical activity, fighting sedentary lifestyle (with the help of a health professional); abolition of the smoking habit; moderation in the consumption of alcoholic and caffeine-based beverages. If the patient does not cooperate, the pain may be aggravated.


Use of relaxation techniques


Yoga, meditation, etc. They will be effective in relieving emotional stress.


Postural correction


Myofascial pain can be treated by applying posture correction techniques, thereby relieving stress and tension in the muscles.


Inactivation of trigger points


Local treatment can be performed with minimally invasive procedures, such as dry needling (dry needling), acupuncture, infiltration of trigger points with local anesthetics.


Shockwave Treatment


Treatment based on the emission of high-energy acoustic waves, with an effect on local muscle microcirculation, and analgesic, anti-inflammatory and muscle relaxant effects. Recent evidence points to its effectiveness as a complementary treatment for chronic myofascial pain, in addition to its effect on joints and tendinopathies.


Botulinum toxin type A


Treatment with the injection of low doses of botulinum toxin type A (a neurotoxin) can be performed due to its local anti-nociceptive effect and because it reduces muscle spasms. It is generally indicated for refractory cases, with an effect on decreasing the production of substance P and glutamate.


Drug treatment with analgesics


The use of analgesics aims to relieve tension at trigger points. In addition, anti-inflammatory drugs, muscle relaxants, and antidepressants may also be indicated, depending on the case. They will alleviate pain and improve the patient’s quality of life.


Drug treatment with anticonvulsants


Anticonvulsant drugs can be used due to their analgesic and anxiety properties, reducing the release of several neurotransmitters, such as noradrenaline, glutamate, and substance P.


Drug treatment with antidepressants


Antidepressant drugs are indicated at lower doses, as they have neuromodulatory and pain processing effects in the central nervous system. They are indicated for chronic pain, with an effect on serotoninergic and noradrenergic pathways.


Topical drug treatment


Recently, adhesives (patches) for anesthetic and anti-inflammatory drugs have emerged. It can be used in the acute phase. The anesthetic alters the transmission of painful nerve impulses, increasing the pain threshold and improving muscle functionality. As they are of local and topical use, they have fewer adverse effects than oral medications.


Motor physiotherapy


Motor physiotherapy (kinesiotherapy) is essential in the chronic myofascial treatment protocol. The physiotherapist will treat the musculature by correcting the perpetuating factors and perform muscle stretching and strengthening work, in addition to using physical means (such as ultrasound and TENS) to relieve pain.


Myofascial release


Manual therapy, associated with stretching and myofascial release, is commonly used to improve muscle tension bands. It has an important role in complementing the treatment.


Transcutaneous electrical stimulation (TENS)


Applying a small electrical current to the trigger points relieves pain and tension.


Psychological support


Patients who undergo specialized treatment with a psychologist have shown very positive results.


Dental support


In cases where there is bruxism, the use of a plate between the teeth can alleviate the symptoms of pain in the joint between the temples and jaw.


Rest (relative)


Rest should be done until the pain improves in acute cases. Therefore, activities that overload the sore muscle must be avoided during this period. It is not necessary to immobilize the area, but physiotherapy and rehabilitation sessions must be carried out.


Make an appointment with Dr. Munish Lal if you experience muscle pain that doesn’t go away.

Almost everyone experiences muscle pain from time to time. But if muscle pain persists despite rest, use of analgesic medications, and other measures (such as massage and a hot water bottle), seek expert evaluation.


CALL 424-254-3592