What Is Myofascial Pain Syndrome?
Myofascial pain syndrome is chronic pain experienced as coming from muscle tissue, but may also emanate from fascia. Fascia is a type of tissue similar to connective tissue that exists to surround, protect, and allow the appropriate movement of various muscles in the body. The pain associated with myofascial pain syndrome may be felt in many parts of the body. This may take the form of constant, low-to-moderately dull, or aching muscle pain. It may also have specific “trigger points” in which flares of acute pain may signify an attack of the condition.
Trigger points are specific body regions that may differ from patient to patient, in which the underlying structure of muscles, or muscle fibers, experience increased tension. This tension may be associated with many factors, including stress and injury, and may become so extreme that the muscle fibers form a visible or palpable nodule or “knot.” These abnormal nodules may react to touch or pressure with twitching (or muscle tissue spasm), tenderness, or pain that may radiate outward into areas close to, or occasionally not even related to, the muscle in which the knots are present.
Causes Of Myofascial Pain Syndrome
An exact singular cause for myofascial pain syndrome has not yet been discovered. It is currently linked to a number of risk factors, as mentioned above (i.e. stress, muscle damage, or injury). Myofascial pain syndrome may also be associated with diseases or disorders of the fascia, which include connective tissue disorder.
Conditions in which the immune system attacks body tissues such as fascia (i.e. autoimmune disorders) may also play a role in myofascial pain syndrome. Another condition that may increase the risk of developing this disorder is cancer. Tumors may cause mechanical or chemical damage to surrounding muscles or fascia, as may chemotherapy drugs or surgery, thus resulting in chronic myofascial pain.
Treatments For Myofascial Pain
Trigger point injections are associated with efficacy in the inactivation of trigger points, and pain relief in myofascial pain syndrome. The injection delivers a dose of anesthetic medication to relieve pain and relax the affected muscle(s). Repeat injections to the same area, to ensure that all or the vast majority of muscle tissue in the trigger point receives the optimum effect, may be required. Most trigger point injection procedures take no more than several minutes.
This procedure may result in immediate, but temporary, side effects such as acute pain or muscle spasms. Other side effects that may be experienced due to the use of anesthetics include chest discomfort, numbness, and temporary headache. Patients are typically instructed to take it easy post-injection. The pain specialist may also recommend appropriate stretching and light exercise of the muscles, in order to enhance relaxation and prevent a relapse into knotting and tightening.
An alternative to injection with anesthetics is the simple insertion of a needle into the trigger point, also known as “dry needling.” The premise behind this practice is that the extreme tension or tightness in the affected muscle fibers may respond to the simple counter-pressure of an accurately-placed needle. Dry needling requires execution by a trained, skilled pain specialist or physician to ensure appropriate and exact needle placement and the proper quality and sterility of the equipment used. There is an increasingly large body of research to support the effectiveness of dry needling in the treatment of conditions such as myofascial pain syndrome. However, the side effects and recovery time associated with dry needling may differ in comparison to that of needling with anesthetic. Some patients report that the resulting pain was greater in duration after dry needling in comparison to the pain experienced after traditional trigger point injection.
There are certain risks associated with trigger point injections and dry needling, mainly those of bleeding and infection at the sites of needling. However, these may be avoided by following the instructions of the specialist or physician after the procedure. Patients may also be screened for conditions that increase the risk of bleeding (such as coagulation disorders) or for current medications that may do the same. In the latter case, patients may be required to discontinue this treatment in order to be eligible for the procedure.
Acupuncture, an ancient Chinese medical practice that involves the insertion of thin needles to relieve pain or stress, may also be effective as a treatment for myofascial pain syndrome. As with dry needling, acupuncture should be performed by licensed, competent professionals and pain specialists. Dry needling may seem to be similar to acupuncture, however, there are differences; a major difference being that acupuncture needles tend not to be inserted muscle-deep. In addition, the goal of acupuncture is to stimulate the release of natural pain-relieving molecules in the body, not the mechanical or pharmacological release of muscle tension.
Acupuncture has been found to be effective in cases of myofascial pain syndrome, as have its more modern derivatives, electroacupuncture and laser acupuncture. The latter uses laser beams, directed at muscle fibers, to relax them and restore them to their normal conformation. Laser acupuncture has demonstrated the ability to restore muscle health and flexibility, and therefore may be useful in cases of myofascial pain syndrome. As with needling, patients may be encouraged to keep up a program of light stretching after acupuncture to perpetuate its beneficial effects on pain or muscle structure.
Other treatments associated with effective pain relief in myofascial pain syndrome include certain antidepressant drugs, massage therapy, and exercise-based therapies. Consultations with your pain specialist may be helpful in deciding the best treatment option for you.