Myofascial pain syndrome

Abstract

Myofascial pain syndrome (MPS) is a pain condition that may be acute, but it is most commonly chronic. MPS is often associated with myofascial trigger points (MTrPs) in muscle and connective tissue including fascia. Active MTrPs are one of the major peripheral pain generators for musculoskeletal pain conditions. The continual bombardment of primary afferent activity over time leads to abnormal functional and structural changes in the dorsal root ganglia and dorsal horn. Sensitization is consistently associated with chronic musculoskeletal pain states, underscoring its significance. In addition, regions of the brain associated with stress, emotions, and hormonal regulation may play a role in top-down events leading to MPS. Palpation of the skeletal muscle for the objective physical findings associated with MTrPs is the gold standard for diagnosis of myofascial pain. Comprehensive management should focus on deactivating painful MTrPs and addressing sensitization at the peripheral and central levels through methods such as manual therapies, dry needling, trigger point injections, paraspinous injection blocks, electrical modalities, centrally acting pharmacologic agents, and biofeedback, among others. It is also important to address perpetuating factors, such as nutritional deficiencies and postural abnormalities.