Myofascial pain syndrome

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Myofascial pain syndrome

Definition
Myofascial pain syndrome is a chronic form of muscle pain. The pain of myofascial pain syndrome centers around sensitive points in your muscles called trigger points. The trigger points in your muscles can be painful when touched. And the pain can spread throughout the affected muscle.

Nearly everyone experiences muscle pain from time to time that generally resolves in a few days. But people with myofascial pain syndrome have muscle pain that persists or worsens. Myofascial pain caused by trigger points has been linked to many types of pain, including headaches, jaw pain, neck pain, low back pain, pelvic pain, and arm and leg pain.

Treatment for myofascial pain syndrome can bring pain relief in many cases. Options for myofascial pain syndrome treatment may include physical therapy, trigger point injections or medications.

Symptoms
Signs and symptoms of myofascial pain syndrome may include:

-Deep, aching pain in a muscle
-Pain that persists or worsens
-Muscle stiffness
-Joint stiffness near the affected muscle
-Area of tension in your muscle that may feel like a knot or tight spot and may be particularly sensitive to touch
-Difficulty sleeping due to pain

Causes
Sensitive areas of tight muscle fibers can form in your muscles after injuries or overuse. These sensitive areas are called trigger points. A trigger point in a muscle can cause strain and pain throughout the muscle. When this pain persists and worsens, doctors call it myofascial pain syndrome.

Risk factors
Myofascial pain syndrome is caused by trigger points in your muscles. Factors that may increase your risk of muscle trigger points include:

Muscle injury. Stress on your muscles can cause trigger points to form. For example, an injury in your muscle may cause trigger points. Repetitive stress also may increase your risk.
Inactivity. If you've been unable to use a muscle, such as after surgery or after a stroke, you may experience trigger points in your muscle as you start to move it during your recovery.
Stress and anxiety. People who frequently experience stress and anxiety may be more likely to develop trigger points in their muscles. One theory holds that these people may be more likely to clench their muscles, a form of repeated strain that leaves muscles susceptible to trigger points.
Age. Myofascial pain syndrome is more likely in middle-aged adults. It's thought that younger people's muscles better cope with stress and strain, so they aren't as likely to experience myofascial pain syndrome.
Sex. Women are more likely than men to experience myofascial pain syndrome. It isn't clear why.

When to seek medical advice
Make an appointment with your doctor if you experience muscle pain that doesn't go away. Nearly everyone experiences muscle pain from time to time. But if the typical self-care measures you use in these situations, such as rest or massage, aren't working, make an appointment with your doctor.

Tests and diagnosis
In order to determine the cause of your pain, your doctor will ask you questions about your signs and symptoms. The area where you're feeling pain may be examined. During the physical exam, your doctor may:

Feel for trigger points. Your doctor may apply gentle finger pressure to the painful area, feeling for tense areas. Your doctor also watches your reaction to determine when a sensitive area is reached. You may feel a jolt of pain when your doctor finds a trigger point, and you may flinch.
Manipulate trigger points. Your doctor may apply pressure on or around the trigger points. Certain ways of pressing on (palpating) the trigger point can elicit specific responses. For instance, you may experience a muscle twitch. Your doctor uses these responses to diagnose myofascial pain syndrome.
Muscle pain has many possible causes. Your doctor may recommend other tests and procedures to rule out other causes of muscle pain before diagnosing myofascial pain syndrome.

Complications
Myofascial pain syndrome can lead to other complications over time. Complications may include:

Muscle weakness
Myofascial pain syndrome may lead to muscle weakness over time due to inactivity. Though trigger points generally don't hurt your muscles, the pain you feel may make you reluctant to use your affected muscle. This can lead to muscle weakness.

Sleep problems
Signs and symptoms of myofascial pain syndrome may make it difficult to sleep at night. You may have trouble finding a comfortable sleep position. And, if you move at night, you might hit a trigger point and wake up. Talk to your doctor about medications that can help you sleep at night.

Fibromyalgia
Some research suggests that myofascial pain syndrome may develop into fibromyalgia in some people. Fibromyalgia is a chronic condition that causes widespread pain. It's believed that the brains of people with fibromyalgia become more sensitive to pain signals over time. Some doctors believe myofascial pain syndrome may play a role in starting this process.

Treatments and drugs
Treatment for myofascial pain syndrome typically includes physical therapy, trigger point injections or medications. No conclusive evidence supports using one therapy over another. Discuss your options and treatment preferences with your doctor. You may need to try more than one approach to find pain relief.

Physical therapy
A physical therapist can devise a plan to help relieve your pain based on your signs and symptoms. Physical therapy to relieve myofascial pain syndrome may involve:

Stretching. A physical therapist may lead you through gentle stretching exercises to help ease the pain in your affected muscle. If you feel trigger point pain when stretching, the physical therapist may spray a numbing solution on your skin.
Massage. A physical therapist may massage your affected muscle to help relieve your pain. The physical therapist may use long hand strokes along your muscle or place pressure on specific areas of your muscle to release tension.
Finding causes of pain. A physical therapist can help you identify and correct factors that may contribute to your pain. For instance, if poor posture is causing muscle stress in your lower back, the physical therapist may guide you through exercises to correct your posture.
Trigger point injections
During a trigger point injection, your doctor inserts a needle into a trigger point in your muscle. The needle may be inserted into several places in and around your trigger point. Trigger point injections, sometimes called needling, may relieve the tension in your muscle that causes the trigger point.

Your doctor may inject a small amount of a numbing medication, such as an anesthetic, each time the needle is inserted. Corticosteroid medications also may be used to relieve pain and inflammation around the trigger point.

Medications
Medications may help treat the signs and symptoms of myofascial pain syndrome, including:

Nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs may relieve muscle pain, though some people find they aren't helpful. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin, others) and naproxen (Aleve). Other NSAIDs are available by prescription.
Depression medications. A class of medications for depression called tricyclic antidepressants may help relieve pain and help you sleep.

Lifestyle and home remedies
Take care of yourself if you have myofascial pain syndrome. Self-care measures to keep your body healthy may make it easier for you to concentrate on coping with your pain. Try to:

Exercise. Gentle exercise can help you cope better with pain. When your pain allows, get moving. Ask your doctor or physical therapist about appropriate exercises.
Relax. If you're stressed and tense, you may experience more pain. Find ways to relax. Meditating, writing in a journal or talking with friends can all be helpful.
Take care of your body. Eat a healthy diet full of fruits and vegetables. Get enough sleep so that you wake rested. Take care of your body so that you can put your energy toward coping with your pain.