Myofascial pain syndrome (MPS)

Myofascial pain syndrome (MPS) is characterized by acute or chronic regional muscle pain associated with single or multiple restricted painful regions (trigger points) within muscle taut bands

• also associated with stiffness and local twitch response when stimulated by digital pressure or during located needling generating local or referred pain
  
  
• individuals who have regional pain present with a high prevalence of MPS
  • studies carried out in pain management centers and clinics of different specialities have shown prevalence ranging from 30% to 93% in patients complaining of regionalized pain
  • high prevalence of MPS in people in their mature years of maximum activity, and in women
  • the trapezius, levator scapula, infra-spinatus, and scalenes are the most frequently affected areas by MPS
    
    
• a number of causal factors associated with MPS have been suggested such as:
  • acute physical overload,
  • deep pain impulse,
  • emotional tension,
  • postural habits,
  • fatigue,
  • hypovitaminosis,
  • infections,
  • physical inactivity,
  • poor physical conditioning,
  • repetitive musculoskeletal microtraumas and trauma
    
    
• diagnosis of MPS is based on
  • exclusion of other causes of regional muscle pain
  • identification of trigger points in the taut band through palpation of sensible nodules, local twitch response and specific patterns of pain referral associated with each trigger point
    
    
• treatment
  • MPS treatment consists of trigger points inactivation, and breaks the vicious cycle of pain-spasm-pain
  • also includes reassurance (patient education, self care and behaviour therapy), physiotherapy (ultrasound, megapulse, low-level laser therapy, heat exercises, biofeedback, spray and stretch technique), acupuncture, dry needling, injections of anaesthetic, drug therapy and combined treatments
  • medicine used to treat MPS includes analgesics, non-steroidal anti-inflammatory drugs (NSAIDS), muscle relaxants and tricyclic antidepressants

For NICE guidance regarding management of chronic pain (pain that lasts for more than 3 months) then see linked item.

Reference:

• Ernberg M. The physiopathological mechanisms behind chronic myofacial pain. Lakartidningen 2002;99(32-33):3206-10.
• Esenyel M, Caglar N, Aldemir T. Treatment of Myofascial Pain. Lippincott Williams & Wilkins 2000;79(1):48-52
• Bron C, Wensing M, Franssen JL, Oostendorp RA. Treatment of myofascial trigger points in common shoulder disorders by physical therapy: a randomized controlled trial . BMC Musculoskeletal Disorders 2007;5(8):107