Myofascial pain syndrome

Definition

Myofascial pain syndrome is a chronic form of muscle pain. The pain of myofascial pain syndrome centers around sensitive points in your muscles called trigger points. The trigger points can be painful when touched. And the pain can spread throughout the affected muscle.

Nearly everyone experiences muscle pain from time to time that generally resolves in a few days. But people with myofascial pain syndrome have muscle pain that persists or worsens. Myofascial pain caused by trigger points has been linked to many types of pain, including headaches, jaw pain, neck pain, low back pain, pelvic pain, and arm and leg pain.

Treatment for myofascial pain syndrome can bring relief in many cases. Treatment options include physical therapy, trigger point injections or medications.

Symptoms

Signs and symptoms of myofascial pain syndrome may include:

• Deep, aching pain in a muscle
• Pain that persists or worsens
• Muscle stiffness
• Joint stiffness near the affected muscle
• Area of tension in your muscle that may feel like a knot or tight spot and may be particularly sensitive to touch
• Difficulty sleeping due to pain

When to see a doctor
Make an appointment with your doctor if you experience muscle pain that doesn't go away. Nearly everyone experiences muscle pain from time to time. But if the typical self-care measures you use in these situations, such as rest or massage, aren't working, make an appointment with your doctor.

Causes

Sensitive areas of tight muscle fibers can form in your muscles after injuries or overuse. These sensitive areas are called trigger points. A trigger point in a muscle can cause strain and pain throughout the muscle. When this pain persists and worsens, doctors call it myofascial pain syndrome.

Risk factors

Myofascial pain syndrome is caused by trigger points in your muscles. Factors that may increase your risk of muscle trigger points include:

• Muscle injury. Stress on your muscles can cause trigger points to form. For example, an injury in your muscle may cause trigger points. Repetitive stress also may increase your risk.
• Inactivity. If you've been unable to use a muscle, such as after surgery or after a stroke, you may experience trigger points in your muscle as you start to move it during your recovery.
• Stress and anxiety. People who frequently experience stress and anxiety may be more likely to develop trigger points in their muscles. One theory holds that these people may be more likely to clench their muscles, a form of repeated strain that leaves muscles susceptible to trigger points.
• Age. Myofascial pain syndrome is more likely in middle-aged adults. It's thought that younger people's muscles better cope with stress and strain, so they aren't as likely to experience myofascial pain syndrome.
• Sex. Women are more likely than men to experience myofascial pain syndrome. It isn't clear why.

Complications

Myofascial pain syndrome can lead to other complications over time. Complications may include:

• Muscle weakness. Myofascial pain syndrome may lead to muscle weakness over time due to inactivity. Though trigger points generally don't hurt your muscles, the pain you feel may make you reluctant to use your affected muscle. This can lead to muscle weakness.
• Sleep problems. Signs and symptoms of myofascial pain syndrome may make it difficult to sleep at night. You may have trouble finding a comfortable sleep position. And if you move at night, you might hit a trigger point and wake up. Talk to your doctor about medications that can help you sleep at night.
• Fibromyalgia. Some research suggests that myofascial pain syndrome may develop into fibromyalgia in some people. Fibromyalgia is a chronic condition that causes widespread pain. It's believed that the brains of people with fibromyalgia become more sensitive to pain signals over time. Some doctors believe myofascial pain syndrome may play a role in starting this process.

Preparing for your appointment

Because many of the signs and symptoms of myofascial pain syndrome are similar to various other disorders, you may see several doctors before receiving a diagnosis. Your family physician may refer you to a rheumatologist, a doctor who specializes in the treatment of arthritis and other inflammatory conditions.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance to prepare for your evaluation.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Make a list of your key medical information, including any other conditions for which you're being treated, and the names of any medications, vitamins or supplements you're taking.
• Consider questions to ask your doctor and write them down. Bring along notepaper and a pen to jot down information as your doctor addresses your questions.

For myofascial pain syndrome, some basic questions to ask your doctor include:

• What are the possible causes of my symptoms?
• Is my condition temporary?
• Will I need treatment?
• What treatments are available?
• Do you have any brochures or other printed material that I can take home with me? What Web sites do you recommend?

In addition to the questions that you've prepared, don't hesitate to ask questions during your appointment if you don't understand something.

What to expect from your doctor
Your doctor or health care provider is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on.

Questions your doctor might ask include:

• What symptoms are you experiencing?
• Where do you feel the most intense area of pain?
• How long have you been experiencing these symptoms?
• Do your symptoms seem to come and go or are they persistent?
• Does anything seem to make your symptoms better?
• Does anything seem to make your symptoms worse?
• Are your symptoms worse in the morning or at any particular time of the day?
• Do you perform repetitive tasks on the job or for hobbies?
• Have you had any recent injuries?
• Does your pain cause you to limit your activities?

Tests and diagnosis

In order to determine the cause of your pain, your doctor will ask you questions about your signs and symptoms. The area where you're feeling pain may be examined. During the physical exam, your doctor may:

• Feel for trigger points. Your doctor may apply gentle finger pressure to the painful area, feeling for tense areas. Your doctor will watch your reaction to determine when a sensitive area is reached. You may feel a jolt of pain when your doctor finds a trigger point, and you may flinch.
• Manipulate trigger points. Your doctor may apply pressure on or around the trigger points. Certain ways of pressing on (palpating) the trigger point can elicit specific responses. For instance, you may experience a muscle twitch. Your doctor uses these responses to diagnose myofascial pain syndrome.

Muscle pain has many possible causes. Your doctor may recommend other tests and procedures to rule out other causes of muscle pain before diagnosing myofascial pain syndrome.

Treatments and drugs

Treatment for myofascial pain syndrome typically includes physical therapy, trigger point injections or medications. No conclusive evidence supports using one therapy over another. Discuss your options and treatment preferences with your doctor. You may need to try more than one approach to find pain relief.

Physical therapy
A physical therapist can devise a plan to help relieve your pain based on your signs and symptoms. Physical therapy to relieve myofascial pain syndrome may involve:

• Stretching. A physical therapist may lead you through gentle stretching exercises to help ease the pain in your affected muscle. If you feel trigger point pain when stretching, the physical therapist may spray a numbing solution on your skin.
• Massage. A physical therapist may massage your affected muscle to help relieve your pain. The physical therapist may use long hand strokes along your muscle or place pressure on specific areas of your muscle to release tension.
• Finding causes of pain. A physical therapist can help you identify and correct factors that may contribute to your pain. For instance, if poor posture is causing muscle stress in your lower back, the physical therapist may guide you through exercises to correct your posture.

Trigger point injections
During a trigger point injection, your doctor inserts a needle into a trigger point in your muscle. The needle may be inserted into several places in and around your trigger point. Trigger point injections, sometimes called needling, may relieve the tension in your muscle that causes the trigger point.

Your doctor may inject a small amount of a numbing medication, such as an anesthetic, each time the needle is inserted. Corticosteroid medications also may be used to relieve pain around the trigger point.

Medications
Medications may help treat the signs and symptoms of myofascial pain syndrome, including:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs may relieve muscle pain, though some people find they aren't helpful. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin, others) and naproxen (Aleve). Other NSAIDs are available by prescription.
• Depression medications. A class of medications for depression called tricyclic antidepressants may help relieve pain and help you sleep.

Lifestyle and home remedies

Take care of yourself if you have myofascial pain syndrome. Self-care measures to keep your body healthy may make it easier for you to concentrate on coping with your pain. Try to:

• Exercise. Gentle exercise can help you cope better with pain. When your pain allows, get moving. Ask your doctor or physical therapist about appropriate exercises.
• Relax. If you're stressed and tense, you may experience more pain. Find ways to relax. Meditating, writing in a journal or talking with friends can all be helpful.
• Take care of your body. Eat a healthy diet full of fruits and vegetables. Get enough sleep so that you wake rested. Take care of your body so that you can put your energy toward coping with your pain.

Alternative medicine

You may be interested in trying complementary and alternative medicine if your pain isn't controlled with conventional treatments. Discuss the options with your doctor. Though you may be reluctant to bring up herbs, supplements or other complementary therapies when talking with your doctor, you may be surprised to find that many doctors are becoming more willing to discuss these treatments.

Discuss any complementary and alternative treatments you're considering with your doctor. Some treatments may interfere with your medications.

Many complementary and alternative treatments are touted as good options for controlling chronic pain. But most claims aren't supported with studies that show any benefit.

Acupuncture
During an acupuncture session, a practitioner places numerous thin needles in your skin at specific points on your body. According to traditional Chinese medicine, precisely placed acupuncture needles relieve pain and other symptoms by rebalancing the currents of life energy always coursing through your body. Some evidence exists to support the use of acupuncture in people with myofascial pain syndrome. However, studies have been small and limited.

When administered by a reputable practitioner using sterile needles, acupuncture can be safe. Ask your doctor for names of certified practitioners in your area. Acupuncture isn't safe if you have a bleeding disorder or take blood thinners.

Coping and support

Having a chronic pain condition such as myofascial pain syndrome can be frustrating. Treatment may be only moderately successful for you. Family, friends and co-workers may misunderstand your condition. In addition to educating yourself about myofascial pain syndrome, you may find it helpful to provide your family, friends and co-workers with information.

It's also helpful to know that you're not alone. Organizations such as the Arthritis Foundation and the American Chronic Pain Association provide educational classes and support groups. These groups can often provide a level of help and advice that you might not find anywhere else. They can also help put you in touch with others who have had similar experiences and can understand what you're going through.