In previous posts, we have discussed the challenges attendant to chronic pain, including how dentists often experience pain due to the unnatural and static positions they must maintain for extended periods of time (which place stress on their musculoskeletal and muscular systems). This post will delve further into one such chronic pain condition, myofascial pain syndrome (MPS).
Myofascial pain syndrome is a chronic pain condition that affects the fascia (the connective tissues that spreads throughout the body). Specifically, myofascial pain syndrome refers to the pain and inflammation of muscles and soft tissue.
With someone suffering from myofascial pain syndrome, pressure on sensitive points in muscles (trigger points) can cause pain in seemingly unrelated parts of their body (called referred pain). A single muscle or a muscle group may be involved. Typically, the pain affects one side of the body only, or one side significantly more than the other. There may also be tenderness in areas not experiencing chronic pain.
While many people experience muscle pain or tension, those who suffer from myofascial pain syndrome experience persistent and worsening pain. Additional symptoms include:
- Deep and aching pain at specific trigger or tender points
- A knot or clump in a muscle area
- Insomnia or sleep disturbances
- Depression (which often co-occurs with MPS)
The pain and strain in a muscle caused by a trigger point associated with MPS can be attributed to numerous sources, including:
- Injury or prior injury
- Excessive strain or overuse of a muscle or muscle group
- Unnatural movements
- Repetitive motions
- Poor sleep schedules and sleeping positions
- Certain medical conditions (e.g. heart attack)
- Lack of activity
- Stress or anxiety
Because there are no visual indicators such as redness or swelling associated with MPS, doctors typically will perform a physical exam that includes applying pressure to the painful area. A doctor will feel for trigger points, which are divided into four types:
- Active – an area of extreme tenderness associated with local or regional pain.
- Latent – a dormant area that has the potential to act like a trigger point, and may be associated with numbness or restriction of movement.
- Secondary – a highly irritable spot in a muscle that may become active due to a trigger point, or if there is overload on another muscle.
- Satellite Myofascial Point – a highly irritable spot that becomes inactive because the muscle is in the region of another trigger point.
Although not as common, physicians may use Electromyography (EMG) to locate trigger points. In addition, doctors will usually conduct additional tests and procedures to rule out other causes of the muscle pain (e.g., lab tests to rule out vitamin deficiency).
Myofascial pain is treated using a variety of techniques, often in conjunction, such as:
- Medication (e.g. pain medications, medication for muscle spasm, antidepressants)
- Trigger point injections (which typically contain a local anesthetic or saline, sometimes with corticosteroid)
- Physical Therapy
- Spray and stretch (a treatment where a cooling agent is sprayed on the sore muscle, followed by gentle stretching)
- Massage Therapy
- Heat Therapy
- Posture and Stretching Training
Exercise, relaxation, and a healthy diet are also recommended techniques to help alleviate MPS pain.
These posts are for informative purposes only and should not be used as a substitute for consultation with and diagnosis by a medical professional. If you are experiencing any of the symptoms described below and have yet to consult with a doctor, do not use this resource to self-diagnose. Please contact your doctor immediately and schedule an appointment to be evaluated for your symptoms.
Mayo Clinic, http://www.mayoclinic.org/
Cleveland Clinic, clevelandclinic.org
Chowdhury, Nayeema, OMS IV and Leonard Be. Goldstein, DDS, PhD, Diagnosis and Management Of Myofascial Pain Syndrome, Practical Pain Management, last updated March 19, 2012, https://www.practicalpainmanagement.com/pain/myofascial/diagnosis-management-myofascial-pain-syndrome.