Myofascial pain syndrome (MPS) is a chronic pain condition thought to be caused by the contraction of muscles. It is often mistaken for—and thought by some to be a subtype of—fibromyalgia.
The hallmark of myofascial pain syndrome is trigger points. MPS trigger points are tender spots on the tight, ropey muscle connective tissue called the fascia. These trigger points cause both localized pain—pain at the trigger point—and referred pain, which is pain that has spread beyond the trigger point.
Causes and Risk Factors
MPS and trigger points are caused by a number of factors. Most often, MPS arises from muscle overuse or acute injury to a muscle. Other causes and risk factors include:
- Damage to intervertebral discs
- Poor posture
- Psychological stress and anxiety
- Sedentary lifestyle
Pain from trigger points is the main symptom of myofascial pain syndrome. Unlike fibromyalgia, which can produce localized tender spots, trigger points in MPS will often cause referred pain. This is one of the reasons that MPS is difficult to diagnose. It can be hard to tell if pain is being caused by, for example, sciatica—where irritated or compressed nerve roots in the spine cause pain in the legs and buttocks—or if the pain is being caused by a trigger point at another site.
Characteristics of MPS pain can be:
- Deep, persistent muscle aches
- Pain that prevents the patient from sleeping
- Pain that worsens over time
- Tender, ropey muscle knots that cause localized or referred pain
Chronic pain conditions are especially difficult. Not only do they adversely affect patients’ daily lives, but doctors often struggle to make an accurate diagnosis. Symptoms are often shared with many other conditions.
A myofascial pain syndrome diagnosis usually starts with physical and neurological exams. During a physical exam, doctors will press on (palpitate) any trigger points they find and see if palpitation causes referred pain. A neurological exam might involve electromyography, a test that can assess the health of muscles and nerves. Other tests, such as imaging studies or lab assessments, can be useful in ruling out other conditions that may be causing symptoms.
Treatment for myofascial pain syndrome is typically nonsurgical and can encompass medication, physical therapy techniques, lifestyle changes and needling techniques.
Some medicines commonly used to treat myofascial pain syndrome include:
- Muscle relaxers
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Sedatives to help patients sleep or deal with their anxiety
Exercise and physical therapy can be effective for treating MPS, especially stretching. One technique from which many patients have good results is known as stretch and spray, in which the patient stretches an area around a trigger point and a doctor or physical therapist sprays a numbing agent on the area. Heat and massage therapy can also be effective.
Needling techniques involve putting a needle directly into a trigger point, with or without injecting a solution. Using needles only is called dry needling, and it may be enough to break up the trigger point. Injections can include Botox, lidocaine (a pain killer), corticosteroids (an anti-inflammatory) or both lidocaine and steroids.
If you have chronic pain and suspect you may have myofascial pain syndrome, request an appointment. At Nova we specialize in nonoperative pain management techniques. We can help you diagnose your condition and come up with a treatment plan that’s right for you.