The MYOFASCIAL PAIN SYNDROME is now a well-accepted disease entity as one can find this term in the International Classification of Diseases (ICD.9.CM: 729.1). It is usually caused by trauma (such as strain, sprain, or contusion), inflammatory diseases (such as tendinitis, bursitis, synovitis or arthritis), or spinal discogenic diseases (such as disc herniation or even just only disc bulging). It can also be caused by the cumulative effect of long standing repetitive minor trauma or long standing muscle tension due to poor posture, occupational diseases (such as that requiring repetitive use of certain muscle groups), or emotional stress.
Certain bands of the muscle fibers respond to the trauma or abnormal stress by tightening. This impairs local circulation leading to the accumulation of metabolic waste products and further tightening occurs. This, then, becomes a vicious cycle.
The hyperirritable spots within the taut bands of muscle fibers are called TRIGGER
POINTS that are painful on compression and that can cause characteristic referred pain,
tenderness, and autonomic phenomena.
Many medical conditions (PERPETUATING FACTORS), including mechanical
stress, nutritional inadequacies, metabolic and endocrine inadequacies, chronic infections, or
psychological factors
may perpetuate myofascial pain syndrome or may aggravate the severity of myofascial pain
syndrome.
The DIAGNOSIS of myofascial pain syndrome is based on patients symptoms and
objective findings including:
Instruction in, and consistent performance of a home program is also required to facilitate
recovery. The home programs usually include self-stretching techniques, maintaining proper
postures and therapeutic exercises. Repeated stretching is usually required if the lesion is chronic
in nature.
Trigger point injections with 0.5% Lidocaine at an interval of once per week are necessary if
physical therapy programs cannot effectively relieve the chronic trigger points. The trigger point
injection is a special technique requiring high skill. It is quite different from tender point injection
which can be done by any physician. The taut band should be injected at a certain degree of angle
with a certain speed of needle movement to obtain an optimal effect. The total number required
for injection depends on the nature and the chronicity of the disease, but the frequency for
injection is usually reduced gradually.
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The principal TREATMENT of myofascial pain syndrome is stretching and
relaxation of tight
muscles to break the vicious cycle. This can usually be done with spray and stretch technique
(with Flouri-methane) and/or with deep pressure soft tissue massage, combined with
thermotherapy with hydrocollator hot pack (superficial moist heat) and/or ultrasound (deep heat).
Elimination of perpetuating factors (if any) is also very important to avoid frequent recurrence.