Myofascial Pain Syndrome

Myofascial pain syndrome is a long-term pain condition affecting muscles and the thin tissue that surrounds them. It causes deep, aching pain that doesn’t go away with rest, often centered around sensitive knots in the muscles called trigger points.

Table of contents

• What is Myofascial Pain Syndrome?
• Common Symptoms
• Understanding Trigger Points
• Causes and Risk Factors
• How Common is This Condition?
• Difference from Fibromyalgia
• How Doctors Diagnose This Condition
• Treatment Options
• Living with Myofascial Pain Syndrome

What is Myofascial Pain Syndrome?

Myofascial pain syndrome is a long-term pain condition that affects muscles and the thin tissue covering them, called fascia. The word “myo” means muscle and “fascial” refers to fascia, the thin connective tissue that surrounds your muscles^[2]. This condition involves some muscles and the thin cover of tissue that holds muscles in place. When pressure is applied to certain areas called trigger points, it causes pain^[1].

Think of your body like an orange. Your skin would be the outside peel, your muscles would be the fleshy fruit, and the thin white membrane surrounding each orange segment would be the fascia. Fascia surrounds every level of muscle tissue, from individual muscle fibers to single muscles and muscle groups^[2].

This syndrome can happen after a muscle has been tensed over and over. Repeated motions used in jobs or hobbies can be the cause. Stress-related muscle tension, poor posture, and weak muscles can also lead to this condition. In some cases, the cause of myofascial pain is unknown^[1].

For most people, myofascial pain occurs in one specific area. However, in some cases, it can affect multiple areas, usually on the same side of your body^[2].

Common Symptoms

Symptoms of myofascial pain syndrome are different for each person. Sometimes the pain happens suddenly and all at once. At other times it’s a constant, dull pain that lingers in the background^[2].

The main symptoms include^[1][2]:

• Deep, aching pain in a muscle
• Pain that doesn’t go away or gets worse
• A tender knot in a muscle
• Pain that’s aching, throbbing, tight, stiff or vice-like
• Sore, tender muscles
• Weak muscles
• Reduced range of motion (for example, you might not be able to completely rotate your shoulder)
• Trouble sleeping due to pain
• A general feeling of being unwell, called malaise
• Tiredness

Sometimes, the pain is felt in other parts of the body. This is called referred pain. The pain often is felt as shoulder pain, back pain, tension headaches and face pain^[1][4].

Sometimes, people with myofascial pain syndrome have other health conditions too. Common issues include headaches, poor sleep, stress, anxiety, depression, and feeling tired^[2].

Understanding Trigger Points

The pain in myofascial pain syndrome is typically associated with trigger points in muscles. These trigger points are small bumps, nodules or knots in your muscle that cause pain when touched and sometimes even when they’re not touched. These commonly develop as the condition worsens^[2].

Trigger points are hyperirritable areas within tight bands of skeletal muscle. Physical examination reveals these tight muscle bands that can be felt under the skin^[3]. These trigger points radiate pain to the affected area when pressure is applied to them, and sometimes spontaneously with no pressure^[4].

There are four types of trigger points^[2]:

• An active trigger point typically lies within a muscle. Applied pressure results in pain at the site of the trigger point or along that same muscle
• A latent trigger point is inactive (dormant) but could become active
• A secondary trigger point is a knot in a muscle other than the one with the active trigger point. An active trigger point and secondary trigger point can become irritated at the same time
• A satellite trigger point is one that becomes inactive because it overlaps with the region of another trigger point

Causes and Risk Factors

The exact cause of myofascial pain syndrome is not fully known. However, areas of tight muscle fibers, called trigger points, form in muscles. Too much use of the muscles, most often with poor form, injury to the muscle and mental stress are believed to contribute^[1].

The condition often presents with localized or referred pain, typically associated with hyperirritable trigger points within taut bands of skeletal muscle. Muscle overload due to overuse or disuse is a key factor^[3].

Experts are still learning why some people are more prone to myofascial pain. Some of the most common causes seem to include^[2]:

• Muscle injury
• Repetitive motions (like hammering)
• Poor posture

Risk factors that might contribute to the development of myofascial pain syndrome include^[2][3]:

• Muscle weakness
• Lack of muscle activity (like having your leg in a cast)
• Working in or living in a cold environment
• Emotional stress (can cause muscle tension)
• Pinched nerves
• Metabolic or hormonal issues like thyroid disease or diabetes-related neuropathy
• Vitamin deficiencies, including vitamin D and folate
• Chronic infections
• Trauma
• Structural abnormalities

How Common is This Condition?

Myofascial pain syndrome is common. Experts estimate that up to 85% of the general population will develop the condition at some point^[2].

Myofascial pain syndrome can be divided into acute and chronic forms. Acute myofascial pain syndrome frequently resolves spontaneously or after simple treatments. In contrast, chronic myofascial pain syndrome typically lasts for 6 months or longer and has a worse prognosis^[3].

Difference from Fibromyalgia

Myofascial pain syndrome should not be confused with fibromyalgia, which has similar symptoms. Some people confuse myofascial pain syndrome with fibromyalgia, but they’re two different conditions^[2].

Fibromyalgia is a chronic condition that causes pain and tenderness throughout the body, not just in particular areas, and does not include trigger points. Myofascial pain syndrome is distinguished by the presence of discrete trigger points, while fibromyalgia is associated with a broader range of symptoms in addition to pain^[4][5].

A person can have both fibromyalgia and myofascial pain syndrome. That makes it especially important to consult with a medical specialist who can diagnose the difference and apply the proper treatments for each condition^[4].

How Doctors Diagnose This Condition

Myofascial pain syndrome is often underdiagnosed and overlooked. This is because many of its symptoms overlap with other conditions that affect your nerves, bones, ligaments or tendons^[2].

There is no imaging or lab test that can identify myofascial pain syndrome. Instead, the syndrome is diagnosed by conducting a thorough examination^[4]. During a physical exam, your healthcare professional may put gentle finger pressure on the affected muscle, feeling for painful areas. Certain ways of pressing on the trigger point can cause certain responses. For instance, you might have a muscle twitch^[8].

The examination may include^[4]:

• Imaging and diagnostic tests to rule out other conditions that may be causing the pain
• A physical exam in which the physician applies gentle pressure to feel for tight muscle bands that trigger the pain or muscle twitches
• A visual exam to look for postural abnormalities
• Questions about when, how, and how often you experience the pain, and whether there are things that seem to make it better or worse; the doctor will also ask about repetitive activities or recent injuries that may be factors

Diagnosis is primarily clinical, based on the presence of trigger points, specific pain referral patterns, and local twitch responses. Imaging and electrophysiological tests can help rule out other musculoskeletal conditions^[3].

Muscle pain has many possible causes. Your healthcare professional uses other tests and procedures to rule out other causes of muscle pain^[8].

Treatment Options

Treatment for myofascial pain syndrome typically includes medicines, shots into the trigger points and physical therapy. Exercise is a big part of any treatment plan. Discuss treatment options and what you prefer with your healthcare professional. You may need to try more than one approach to find pain relief^[8].

Treatment aims to relieve pain and address underlying causes through both pharmacological and nonpharmacological approaches. Effective management often requires a multimodal approach to prevent symptom recurrence, including ergonomic, psychological, and nutritional interventions^[3].

Medications

Medicines used for myofascial pain syndrome include^[8][4]:

• Pain relievers: Pain relievers you can get without a prescription, such as ibuprofen and naproxen sodium, may help. Some come in the form of creams or patches that you put on the skin. Your healthcare professional may prescribe stronger pain relievers
• Antidepressants: Many types of antidepressants can help relieve pain. For some people with myofascial pain syndrome, certain antidepressants seem to reduce pain and improve sleep
• Muscle relaxers: Some medicines help treat the anxiety and poor sleep that sometimes come with myofascial pain syndrome. These medicines can cause sleepiness and can be habit-forming
• Nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen
• Lidocaine patch
• Steroids

Researchers are investigating the effectiveness of anticonvulsants, antidepressants, and botulinum toxin type A^[4].

Physical Therapy

A physical therapist can help relieve your pain based on your symptoms. Treatment might involve^[8]:

• Stretching: A physical therapist may lead you through gentle stretches to help ease the pain in your sore muscle
• Posture training: Correcting postural imbalances that may contribute to the development of trigger points
• Exercise programs: Regular exercise can help better cope with pain and strengthen muscles around the affected area

Trigger Point Treatments

Many of the treatments for myofascial pain syndrome are focused on the trigger points. These treatment options include^[4]:

• Dry needling: The doctor inserts a thin needle into and around the trigger point
• Wet needling (also known as trigger point injections): The same as dry needling except the doctor simultaneously injects a numbing agent or steroid
• Massage: Including passive rhythmic, active rhythmic, and trigger point pressure release
• Electrical stimulation: Involves placing an electrode across the muscle affected by a trigger point to cause rapid contractions
• Transcutaneous electrical nerve stimulation: Involves sending low-voltage electric signals from a small device to the painful area through pads attached to your skin
• Ultrasound: Uses sound waves to penetrate soft tissues
• Cold laser (also known as low-level light therapy): The trigger point is exposed to near-infrared light

Other Treatment Options

Additional treatment approaches include^[4]:

• Heat therapy
• Dietary changes to reduce inflammation and avoid ingredients that seem to trigger pain
• Behavior modification (exercise, posture, work station setup, yoga, meditation, sleep habits)
• Acupuncture

Living with Myofascial Pain Syndrome

An individual with chronic myofascial pain may approach their condition with a multi-part approach such as treating myofascial trigger points, managing ongoing pain, and reducing any contributing factors of the condition. It’s important that the person take an active role in his or her treatment^[20].

A patient should take care to follow recommendations made by a doctor by doing exercises and movement programs at home and conducting self-therapy on trigger points. Along with following the prescribed treatment regimen, a myofascial pain sufferer should remove potential contributing factors from his or her life^[20].

This includes^[20]:

• Having an ergonomic evaluation of the workstation and other regular activities
• Making adjustments that may improve the quality of sleep and overall physical health
• Regular exercise to help better cope with pain and strengthen muscles
• Quality restorative sleep
• A healthy and balanced diet
• Reducing stress through meditation, journaling, social interactions and other means to help relax muscle tension

A patient can gain peace of mind by becoming educated about the causes and treatments of myofascial pain. Support groups and educational classes can provide assistance, advice and encouragement from others living with similar challenges. Speaking with dependable and trustworthy friends, family and colleagues can help both the patient and their loved ones better understand each other^[20].

Myofascial pain can have a strong impact on a person’s lifestyle, behavior and mood. An active treatment effort, the elimination of contributing factors and a supportive network can help relieve some of the distress of life with chronic myofascial pain^[20].

Most people have muscle pain at times. But if your muscle pain doesn’t go away with rest, massage and other self-care measures, make an appointment with your healthcare professional^[1].