Myofascial Pain Syndrome

Aka: Myofascial Pain Syndrome, Myofascial Pain, Myofascial Spasm

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II. Definitions

  1. Myofascial Pain Syndrome (MPS)
    1. Localized musculoskeletal pain, typically to a few regional Trigger Points
    2. Contrast with Fibromyalgia which is diagnosed with multiple generalized Tender Points and constitutional symptoms

III. Epidemiology

  1. Peak onset: ages 30 to 60 years
  2. Very common cause of Chronic Pain
  3. Very common syndrome in general population
    1. In one outpatient studty, Myofascial Pain was responsible for 30% of musculoskeletal pain presentations
    2. Skootsky (1989) West J Med 151(2): 157-60 [PubMed]

IV. Symptoms

  1. Localized pain, limited to a few tight regions of spasm and Trigger Points
  2. Constitutional symptoms (Fatigue, Insomnia, Headache, gastrointestinal upset) are typically absent

V. Signs

  1. See Chronic Pain Evaluation
  2. Trigger Points
    1. See Trigger Point Location
    2. Trigger Points are central to Myofascial Pain Syndrome
    3. Back Muscles are most commonly involved (esp. trapezius Muscle)

VI. Differential Diagnosis

  1. See Chronic Pain Causes
  2. Fibromyalgia

VII. Associated Conditions

  1. Tension Headache

VIII. Management (See Chronic Pain)

  1. Fibromyalgia Non-Pharmacologic Management
  2. Fibromyalgia Pharmacologic Management
  3. See Stretch and Spray
  4. See Trigger Point Injection
  5. Deep Massage Therapy (20-30 pounds of force)
    1. Reduces overall Trigger Point related pain, but variable effect on Tension Headache
    2. Moraska (2015) Clin J Pain 31(2): 159-68 [PubMed]
    3. Moraska (2017) Am J Phys Med Rehabil 96(9): 639-45 [PubMed]
  6. Osteopathic Manipulative Treatment
    1. Muscle Energy Technique
      1. Stretches tight Muscles and fascia
      2. Examiner applies counter force against a patient's isometric contraction of involved Muscles
      3. Patient holds each contraction for 3-5 seconds and repeats the maneuver 3-5 times
    2. Counter Strain Technique
      1. Joints and Muscles are manipulated away from a restrictive barrier toward a less restrictive position
      2. Once Trigger Point pain decreases, position is held for 90 seconds, and then return to a neutral position
  7. Physical Therapy
    1. Overall reduction in Trigger Point related pain
    2. Guzman-Pavon (2022) Pain Med 23(1): 137-43 [PubMed]
  8. Regular Exercise Program
    1. Aerobic Exercise
    2. Active and Passive Stretching
    3. Posture enhancing Exercises
  9. Medications
    1. NSAIDs or COX2 Inhibitors
    2. Tricyclic Antidepressants

IX. References

  1. Fomby (1997) Physician and Sports Med 25(2):67-75
  2. Shipton (2023) Am Fam Physician 107(2): 159-64 [PubMed]

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