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Myofascial Pain Syndrome resulting from extended periods of poor posture during work

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Overview

Myofascial pain syndrome is a chronic pain condition affecting the musculoskeletal system.

Most people experience muscle pain at some time that typically resolves on its own after a few weeks. But for some people, muscle pain persists.

In people with myofascial pain syndrome (MPS), sensitive spots are known as trigger points. These areas develop in the taut, ropey bands of the muscles (the fascia). When pressure is applied to these trigger points there is pain (called referred pain) in a different part of the body.

Symptoms

Common symptoms of MPS include:

  • deep pain in localized areas of muscles
  • pain that gets worse when the affected muscle is stretched or strained
  • muscle pain that gets worse or fails to improve with time
  • presence of painful knots in muscles that when pressed produce intense localized or referred pain
  • muscles that are weak, stiff, inflexible, or have reduced range of motion
  • mood or sleep disturbances
Myofascial pain syndrome vs. fibromyalgia

Most people with pain and fatigue in their skeletal muscles have either fibromyalgia or MPS. Fibromyalgia is a disorder of widespread muscular pain. It can be felt throughout the entire body. But, people with MPS feel localized pain in regional groups of muscles, like the lower back, neck, or jaw.

MPS is characterized by a few localized trigger points in the taut ropey bands of the muscles. These trigger points are tender and can produce localized pain. But their defining characteristic is that they trigger referred pain. Fibromyalgia is associated with multiple, more widespread tender points. These differ from trigger points because they don’t produce referred pain.

Causes and risk factors

Most points occur because of muscle overuse, muscle trauma (injury), or psychological stress. Trigger points often arise from sustained repetitive activities, like lifting heavy objects at work or working on a computer all day. No single factor is responsible for the development of myofascial trigger points. A combination of contributing factors may include:

  • poor posture
  • sitting for a long time in awkward positions
  • nutritional deficiencies
  • serious lack of exercise or movement
  • any injury to the musculoskeletal system or intervertebral disks
  • generalized fatigue
  • lack of sleep
  • hormonal changes (menopause)
  • intense cooling of muscles (such as when sleeping in front of an air conditioner)
  • emotional problems (depression, anxiety)
  • other pain or inflammation conditions
  • obesity
  • smoking
Diagnosis

Your doctor will perform a physical exam to look for myofascial trigger points. Your doctor will look for tender nodules in the taut bands of your muscles and press them to find a pain response. When pressing a trigger point, your doctor will feel for a twitch in the muscle (also called a “jump sign”).

There are no other tests that can show the presence of MPS. Your doctor will rely on you to describe where and how you’re experiencing pain. It’s important to tell your doctor about all your current symptoms and any past injuries or surgeries.

There are several different types of myofascial trigger points that your doctor may find, including:

  • active trigger points: These trigger points are nodules within a taut band of muscle. They’re typically the source of muscular pain. They’re very tender, cause referred pain, and produce a twitch when touched.
  • latent trigger points: These nodules do not cause pain when touched. They can remain dormant for years and become active when there is stress or trauma.
  • secondary trigger point: This is a painful point in the muscle that becomes active when you stress another muscle.
  • satellite myofascial point: This is a painful spot that becomes active because it’s located near another trigger point.
Myofascial pain syndrome trigger points chart
Treatments

Myofascial pain syndrome requires a multipronged treatment plan. Many people combine medications with other therapies that relieve muscle stiffness and pain.

Medications

There are several medications that can ease the symptoms of MPS, including:

  • nonsteroidal anti-inflammatory drugs (NSAIDs): Over-the-counter drugs like acetaminophen (Tylenol) and ibuprofen (Advil) can relieve pain and swelling.
  • analgesics: Pain relievers such a lidocaine or diclofenac patch, tramadol, COX-2 inhibitors, and tropisetron (not available in the United States) may be considered.
  • muscle relaxants: Benzodiazepines and tizanidine (Zanaflex) can reduce muscle spasms.
  • anticonvulsants: Gabapentin (Neurontin) and pregabalin (Lyrica) may relieve pain and reduce muscle spasms.
  • tricyclic antidepressants: These are indicated to treat chronic pain, fibromyalgia, and nerve pain, which are conditions that resemble MPS.
  • Botox injections: Botulinum type A is a potent neurotoxin that prevents muscle contractions and may have pain-relieving effects.

Dry needling

Dry needling is one of the quickest ways to inactivate myofascial trigger points. Your doctor will insert a needle directly into your trigger point, move it around, and poke it in and out. It can be quite painful, but it’s one of the most effective ways to inactivate a trigger point and reduce the pain. Some clinicians use acupuncture needles, which are smaller and less painful than hypodermic needles. There are a number of key differences between dry needling and acupuncture.

Trigger point injections

Trigger point injections are like dry needling, but only a solution is injected into the tissue. Typically, doctors inject saline or a local anesthetic like lidocaine. The effects are comparable to dry needling, but the procedure may cause less discomfort. Trigger point injections with steroids are also an option.

Ultrasound therapy

Ultrasound machines transmit sound waves into tissue through a sound-conducting gel applied to the skin. The sounds waves can heat up and relax muscles, improve blood flow, and remove scar tissue. The pain-relieving effects may be minimal. But, this treatment may reduce stiffness and increase mobility if done before stretching. Ultrasound therapy has been successfully used for pain associated with rheumatoid arthritis, so it may be worth discussing with your doctor.

Massage therapy

There are several types of massage treatments that can relax myofascial trigger points. These include:

Massage therapy increases blood flow and warms up muscles. This can help reduce stiffness and ease pain. The massage therapist may use their thumb to put pressure on your trigger points, which will aggravate pain and then release the muscle tension.

Spray and stretch

Stretching helps many people with MPS. Some physical therapists apply a cold, numbing spray to the muscle area before leading someone through stretches. There are also some gentle exercises and stretches you can try at home to reduce pain.

Home Remedies

There are several steps you can take at home to reduce pain and improve your quality of life.

  • Choose a better chair at work and improve your posture.
  • Try adjusting the height of your computer so that it falls in your natural eye line.
  • Try a new mattress, or adjust your sleeping position.
  • Practice yoga, Pilates, or another stretching technique. These Pilates exercises for people with fibromyalgia symptoms may also help your MPS symptoms.
  • Wear a back brace when doing heavy lifting.
  • Use a personal massager or vibrating device.
  • Start an exercise program and get your muscles moving every day.
  • See a mental health professional and reduce your stress level.
  • Use an ice pack immediately after any muscle injury.
  • Use moist heat to treat muscle inflammation. Learn how to make your own heating pad.
  • Take a hot bath.
  • Use a traction device.
  • Practice mindfulness to manage pain.
Complications

Myofascial pain syndrome can affect your quality of life. You may not be able to participate in physical activities that you used to enjoy. This could lead to depression and isolation. MPS can also impact your mobility. Seeking treatment when symptoms first develop, finding a support group, and talking with friends and family can help.

What’s the outlook?

MPS can be a challenging condition to live with. The key to managing your pain will be comprehensive treatment. There’s no single treatment that works best for everyone, so don’t be discouraged if one treatment doesn’t work. But with some form of treatment and healthy lifestyle choices, the pain of MPS can be managed successfully.

 

Symptoms

The exact symptoms of myofascial pain syndrome can be different for each person. Sometimes, a person might have symptoms that show up for a while and then go away. Other times, things that didn’t cause any pain before can cause pain all of a sudden, especially if the person is already stressed.

The most common symptoms of myofascial pain syndrome are:

  • Pain. Sometimes, this pain can be felt in a part of the body that has been used a lot (for instance, the back after lifting heavy things or hands after typing too much).
  • Referred pain. This happens because sensitive parts of a muscle, called “trigger points,” send pain signals to unrelated parts of the body.
  • Trouble sleeping. Problems with sleeping can happen because pain points can be triggered when someone moves during their sleep.

Some doctors also think that myofascial pain syndrome can lead to fibromyalgia.

When to See a Doctor

Sometimes, muscle pain is normal, especially if you have been working hard or had a minor injury. However, if you have muscle pain that is worse than normal or doesn’t go away, you should talk to a doctor.

Causes

Doctors aren’t sure what causes myofascial pain syndrome, but the pain can be caused by different factors, including:

  • Muscle injury. Putting muscles under too much stress for a long time can create a trigger point. For instance, one might have a part of their hand that can trigger pain in other parts of the body if the person is stressed or if they use their hands too much for a repetitive or straining motion.
  • Stress. People who are very stressed are more likely to have trigger points in their muscles. Some doctors think that this happens because they clench their muscles when they are stressed, which can make them tight and easier to trigger.

Diagnosis and Tests

If the doctor suspects myofascial pain syndrome, they might ask questions to help them understand where the pain is coming from. Some questions they might ask include:

  • What symptoms do you have?
  • Where is the pain the worst?
  • How long have you had the symptoms?
  • Does anything make the symptoms better or worse?
  • Do the symptoms get better in the morning or the evening?
  • Have you had any injuries in any part of the body?

The doctor may also do a physical exam to look for trigger points or tense areas in the body. They might push on the trigger points with their fingers, which can cause a small amount of pain or can make the muscle twitch.

There are many other problems that can have the same symptoms as myofascial pain syndrome, so the doctor might need to do more tests to rule out other conditions.

Treatments

Many myofascial pain syndrome treatments can help reduce pain and the number of triggers or trigger points that one has. Some common treatments include:

  • Medication. The doctor might prescribe some medicines that can help reduce pain and how easy it is to trigger pain in the muscles. Medicines that can help include pain relievers like ibuprofen [ay-byoo-PROH-fen] and naproxen [nah-PROCKS-en] sodium. Sometimes, the doctor may prescribe an antidepressant that can help relieve pain, like amitriptyline [am-i-TRIP-tuh-leen], or a sedative that can relax the muscles, like clonazepam [kloh-NEY-zuh-pam].
  • Physical therapy, stretching, posture training, massage, and heat therapy can help relax muscles and reduce pain during a flare-up.
  • Needle procedures. The doctor might inject a steroid or numbing medicine into the trigger point that is causing pain. Sometimes, just putting the needle into the muscle is enough to help lower the amount of tension.

Prevention

Doctors don’t know exactly what causes myofascial pain syndrome, so they can’t always prevent it. There are some steps to take to help reduce the pain or lower the chance of getting more trigger points. These include:

  • Exercise. Exercising can help reduce pain and give the person something to focus on during mild-to-moderate pain.
  • Relax. Finding ways to relax, like meditating, writing in a journal, or talking to friends and family, might make it easier to better cope with pain.
  • Stay healthy. Eating a healthy diet, getting enough sleep, and trying to avoid stress whenever possible can help prevent flare-ups.

What is Myofascial Pain Syndrome?

Myofascial [my-oh-FASH-ee-ahl] pain syndrome is a disorder that can cause pain throughout the body, especially in muscles and fascia [FASH-ee-ah]. Fascia is the thin, tough tissues that wrap around and helps protect most parts of the body, including muscles.

For those with this disorder, pain occurs when one is stressed or if a muscle has been used too much for a job or hobby. While everyone has had muscle pain in these situations, people with myofascial pain syndrome have persistent pain or knots in their muscles. This pain can last a long time and might be hard to reduce.

Sometimes, myofascial pain syndrome is confused with fibromyalgia [fahy-broh-may-AL-juh]. Both are chronic pain disorders and have some of the same symptoms. Some researchers also think that myofascial pain syndrome can turn into fibromyalgia, but they are not the same condition. Fibromyalgia has other symptoms, like tiredness, headaches, and mental fog that makes it hard to think clearly.

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