what is myofascial pain?
Myofascial pain syndrome is a relatively common chronic pain disorder, where pressure on sensitive points in your muscles (trigger points) causes pain in the muscle. This syndrome typically occurs after a muscle is subjected to frequent and prolonged repetitive motions. This may be related to certain repetitive jobs like typing or in a factory production line, or sports and hobbies such as cycling or long-distance running. Stress-related muscle tension is also a factor that can be related to myofascial pain, particularly if prolonged.
While nearly everyone has experienced muscle tension pain, the discomfort associated with myofascial pain syndrome persists or worsens, particularly if the repetitive nature of the pain is not addressed.
Myofascial pain can exist in more extreme forms in association with a constellation of physical and cognitive symptoms in conditions such as fibromyalgia (See More), whiplash associated disorder (WAD) and temporo-mandibular joint disorder (TMD)
Several risk factors may lead to the development of muscle trigger points and subsequent myofascial pain. These fall into 2 broad groups and include:
- Injury- This can be either as a single, one-off acute muscle injury, such as a sporting injury or after a road traffic accident. Alternatively, it can be related to continuous repetitive muscle stress such as in endurance sports or certain jobs, and this may lead to the development of trigger points. Poor posture also may increase this risk.
- Stress and anxiety- Stress and anxiety may also be factors that increase the chances of developing muscle trigger points. Persistant stress and anxiety may lead to frequent clenching of the muscles, becoming a form of repeated strain that leaves muscles susceptible to trigger points. This may also explain the presence of this type of pain in conditions such as fibromyalgia, whiplash associated disorder and temporomandibular joint disorder (TMD)
treatment of myofascial pain
Management can be grouped 4 main areas. There is little or no evidence to state that one approach is better than another, and the treatment strategy is often tailored to the individual needs and preferences of the sufferer.
Pharmaco-Therapy – Drugs commonly used to treat myofascial pain include, in the first instance, simple analgesics such as paracetamol, ibuprofen and low dose codeine. Other options may include tri-cyclic antidepressants, muscle relaxing drugs or capsaicin. Current medical practice is moving away from prescribing strong opioid drugs for chronic non-cancer pain
Manual Therapy – A physiotherapist may devise a plan to help relieve your pain based on your signs and symptoms. Such a plan may involve strategies such as gentle stretching, work to improve posture, deep tissue massage and local application of heat and ultrasound.
Injection Therapy – Injections would not be seen as a long term solution for chronic myofascial pain, but may offer a temporary reprieve from intense pain to facilitate or initiate physiotherapy. Trigger point injections may contain cortisone (steroid), local anaesthetic only or botulinium toxin A. Injections for myofascial pain may lead to rapid symptomatic relief that can last anywhere from 3-6 months.
Psychological Support – There is no doubt that stress and anxiety are strongly linked with myofascial pain. It is not clear which is the cause and which is the effect, but the association is strong. For this reason, a clinical psychologist has a lot to offer in the management of myofascial pain, either in an individual setting, or in group therapy in the form of a pain management programme. This incorporates psychological techniques such as mindfulness and acceptance and conditioning therapy (ACT)
Other frequently seen chronic pain conditions
i am happy to consult on a number of other chronic pain conditions, including:-