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| Myofascial Pain Syndrome (MPS) is a is a painful
musculoskeletal condition, a common cause of musculoskeletal pain. MPS is
characterized by the development of Myofascial trigger points (TrPs) that
are locally tender when active, and refer pain through specific patterns
to other areas of the body. A trigger point or sensitive, painful area in
the muscle or the junction of the muscle and fascia (hence, myofascial pain)
develops due to any number of causes. Trigger points are usually associated
with a taut band, a ropey thickening of the muscle tissue. Typically a trigger
point, when pressed upon, will cause the pain to be felt elsewhere. This
is what is considered "referred pain".
•Sudden trauma to musculoskeletal tissues (muscles, ligaments, tendons,
bursae) The fascia is a tough connective tissue which spreads throughout the body in a three dimensional web from head to foot without interruption. The fascia surrounds every muscle, bone, nerve, blood vessel and organ of the body, all the way down to the cellular level. Therefore, malfunction of the fascial system due to trauma, posture, or inflammation can create a binding down of the fascia, resulting in abnormal pressure on nerves, muscles, bones or organs.
Many of the standard tests, such as x-rays, myelograms, CAT scans, eletromyography, etc., do not show the fascia. (John Barnes, P.T., 1992) Occassionally, trigger points produce autonomic nervous system changes such as flushing of the skin, hypersensitivity of areas of the skin, sweating in areas, or even "goose bumps." The trigger points cause localized pain, although TrPs can involve the whole body. In three studies, the prevalence of myofascial TrPs among patients complaining of pain anywhere in the body ranged from 30% to 93%; (among patients with chronic craniofacial pain, 55%; and for lumbogluteal pain, 21%.) The characteristic electrical activity of myofascial TrPs most likely originates at dysfunctional endplates of extrafusal muscle fibers. This dysfunction appears to play a key role in the pathophysiology of TrPs. (Simons 1996) Subjective shortness of breath can be part of the myofascial pain syndrome of the levator scapulae muscle. In one study, 75 patients who reported neck pain & shortness of breath were examined. Trigger points were located and inactivated with acupuncture needles (dry needling). 68 of the 75 patients in the study reported that their shortness of breath and soreness were abolished immediately after inactivation of the TrPs. The other 7 patients needed a second trial of inactivation. Eliminating the trigger points eliminated the symptoms. (Journal of Muskuloskeletal Pain, 1996) Like fibromyalgia, Myofascial Pain syndrome is an often misunderstood condition. Even today, some doctors either don't believe that MPS exists or they don't understand its symptoms and treatment.
• Trigger Point Therapy {Myofascial release therapy, myotherapy,
massotherapy (medical massage therapy)} An active trigger point when treated well or with rest will become latent (quiet, or not causing active symptoms). It can often resurface after trauma after acute overload or fatigue, or even sudden exposure to cold. Conversely, new trigger points may arise elsewhere, or at least become more sinificant as others become latent. For MPS, you should see a doctor knowledgeable in chronic pain such as a physical medicine doctor (a physiatrist), or a neurologist. The diagnosis is made by the history and physical exam. There is no lab test nor imaging studies to confirm the diagnosis. A history of acute trauma or chronic overuse should be looked for.. On exam, there is typically restricted motion with pain of the affected muscle. Other medical problems need to be ruled out with imaging or other studies. For instance, if a patient presents with back pain, disc and other problems need to be ruled out.
Altered Pain Perception Accompanies MPS: A Danish study indicates that people
with chronic myofascial pain perceive and transmit pain differently than
people without the syndrome. As many as 72 percent of people with fibromyalgia
may have trigger points associated with myofascial pain.
HOW TO TEACH DOCTOR ABOUT MPS NOT SERIOUSLY RECOMMENDED. Hanna Jones went to see Doc Smith, her internist. The receptionist asked the nature of the visit and she stated it was Myofascial Pain Syndrome. The receptionist took her blood pressure and got her ready for the doc. Ten minutes later Dr. Smith entered the room. "Hello Hanna, what are we seeing you for today?" Hanna replied, "Myofascial Pain Syndrome." Dr. Smith looked up from his chart and said, "That's a waste-basket diagnosis. I don't believe it exists." Hanna motioned for him to come toward her. She said, "Put your right thumb and first finger on this wad of muscle at the outside of my left forearm (a brachioradialis muscle), and gently squeeze it." He was facing her, and as he did so, she drew back her right fist and socked him across the mouth as hard as she could. Dr. Smith went reeling out of the exam roon door into the nurses arms. The nurse said, "So what does she have?" Dr.Smith said, "Myofascial Pain Syndrome." The nurse replied, " I thought you don't believe in that diagnosis." Dr. Smith said, holding his lip,"I've never had it explained to me that way before."
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For more information on Myofascial Pain Syndrome, please visit the following websites:
Chronic pain is the major complaint of myofascial pain dysfunction syndrome (MPDS) and is a complex problem which involves physical, psychological and social aspects. The etiology of MPDS is multifactorial and the multidisciplinary approach is essential for differential diagnosis and for comprehensive treatment planning. In 1993, the Dental School of Piracicaba-UNlCAMP, Brazil, opened a Center for Pain Studies (CPS), staffed by health care providers including, dentists, psychologists, physicians, physiotherapists and phonoaudiologists. The major aims of the CPS are to provide clinical care and to develop basic and applied research. Sixty-two MPDS patients had been admitted to the CPS by 1997. There were 60 females and 2 males, mean age - 32.5 years. The mean duration of chronic pain was 48 months. Pain intensity and unpleasantness were measured employing the Visual Analogue Scale. The tendency to develop stress-related diseases was assessed by the Social Readjustment Scale. There was a mean reduction of chronic pain of 69.89% and 71.78% relative to intensity and unpleasantness, respectively. The experience of clinical attendance at a multidisciplinary center showed the relevance of a team consisting of health care providers from different specialties with well- established aims, completely integrated and sensitive enough to understand the painful complaints of MPDS patients.
Gil, Ivana.
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This can create pain or malfunction throughout the body, sometimes
with bizarre side effects and seemingly unrelated symptoms. It is thought
that an extremely high percentage of people suffering with pain and/or lack
of motion may be having myofascial problems; but most go undiagnosed, as
the importance of fascia is just now being recognized.
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