MYOFASCIAL PAIN
Myofascial pain syndromes are common
dis-orders characterized by aching muscle pain,muscle spasm, stiffness,
weakness, and, occasion-ally, autonomic dysfunction. Patients have discrete
areas (trigger points) of marked tenderness in one or more muscles or the
associated connective tissue. Palpation of the involved muscles may reveal
tight, ropy bands over trigger points. Signs of autonomic dysfunction
(vasoconstriction or piloerection) in the overlying muscles may be present. The
pain characteristically radiates in a fixed pattern that does not follow
dermatomes.
Gross trauma or repetitive microtrauma is thought to play a major role
in initiating myofas-cial pain syndromes. Trigger points develop follow-ing
acute injury; stimulation of these active trigger points produces pain, and the
ensuing muscle spasm sustains the pain. When the acute episode subsides, the
trigger points become latent (tender, but not pain producing) only to be
reactivated at a later time by subsequent stress. The pathophysiology is poorly
understood.
The diagnosis of a myofascial pain syndrome
is suggested by the character of the pain and by palpation of discrete trigger
points that reproduce it. Common syndromes produce trigger points in the
levator scapulae, masseter, quadratus lumbo-rum, and gluteus medius muscles.
The latter two syndromes produce low back pain and should be considered in all
patients with back pain; moreover, gluteal trigger points can mimic S1 radiculopathy.
Although myofascial pain may spontaneously resolve without sequelae, many patients continue to have latent trigger points. When trigger
points are active, treatment is directed at regaining muscle length and
elasticity. Analgesia may be provided uti-lizing local anesthetic (1–3 mL)
trigger point injec-tions. Topical cooling with either an ethyl chloride or
fluorocarbon (fluoromethane) spray can also induce reflex muscle relaxation, facilitating
massage (“stretch and spray”) and ultrasound therapy. Physi-cal therapy is
important in establishing and main-taining normal range of motion for affected
muscles, and biofeedback may be helpful.
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