Myofascial pain syndrome

Myofascial pain syndrome is a long-term pain condition. It involves some muscles and the thin cover of tissue that holds muscles in place, called fascia. Pressure on these areas, called trigger points, causes pain.

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.

This syndrome can happen after a muscle has been tensed over and over. Repeated motions used in jobs or hobbies can be the cause. So can stress-related muscle tension, poor posture and weak muscles. In some cases, the cause of myofascial pain is unknown.

Almost everyone has felt muscle tension pain. But the pain of myofascial pain syndrome doesn't go away. Treatment options include exercise, massage, physical therapy and shots in the trigger points. Pain medicines and finding ways to relax also can help.

Symptoms of myofascial pain syndrome may include:

• Deep, aching pain in a muscle.
• Pain that doesn't go away or gets worse.
• A tender knot in a muscle.
• Trouble sleeping due to pain.
• A general feeling of being not well, called malaise.
• Tiredness.

When to see a doctor

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.

The exact cause of myofascial pain syndrome is not known. 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 likely help cause trigger points.

In myofascial pain syndrome, something such as muscle tightness sets off trigger points in the muscles. Factors that may increase the risk of muscle trigger points include:

• Muscle injury. A muscle injury or ongoing muscle stress may lead to the forming of trigger points. For instance, a spot in or near a strained muscle may become a trigger point. Repeat motions and poor posture also can increase the risk.
• Stress and anxiety. People who often feel stressed and anxious may be more likely to get trigger points in their muscles. One theory is that these people may be more likely to clench their muscles. Clenching is a form of repeated strain that leaves muscles open to trigger points.

Complications linked to myofascial pain syndrome include:

• Sleep problems. Symptoms of myofascial pain syndrome may make it hard to sleep. It might be hard to find a good sleep position. And if you move while sleeping, you might hit a trigger point and awaken.

• Fibromyalgia. Some research suggests that myofascial pain syndrome may lead to fibromyalgia in some people. Fibromyalgia is a long-term condition of widespread pain.

  It's believed that the brains of people with fibromyalgia respond more to pain signals over time. Some experts believe myofascial pain syndrome might help start this process.

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.

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

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.

Medications

Medicines used for myofascial pain syndrome include:

• Pain relievers. Pain relievers you can get without a prescription, such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), may help. Some come in the form of creams or patches that you put on the skin. Or your healthcare professional may prescribe stronger pain relievers.
• Antidepressants. Many types of antidepressants can help relieve pain. For some people with myofascial pain syndrome, amitriptyline seems to reduce pain and improve sleep.
• Muscle relaxers. Clonazepam (Klonopin) and other medicines called benzodiazepines help treat the anxiety and poor sleep that sometimes come with myofascial pain syndrome. These medicines can cause sleepiness and can be habit-forming.

Therapy

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

• Stretching. A physical therapist may lead you through gentle stretches to help ease the pain in your sore muscle. If you feel trigger point pain when stretching, the therapist may put a numbing spray on your skin.
• Massage. A physical therapist may massage your affected muscle to help relieve your pain. The therapist may use long hand strokes along your muscle or place pressure on areas of your muscle to release tension.

Procedures

• Shots, also called injections, into trigger points. A shot of a numbing medicine or a steroid into a trigger point can help relieve pain. OnabotulinumtoxinA (Botox) also might be used.
• Dry needling. In some people, just putting the needle into the trigger point helps break up the muscle tension. This is called dry needling. Acupuncture also appears to help some people who have myofascial pain syndrome.
• Transcutaneous electronic nerve stimulation (TENS). This sends a tiny electrical current to painful areas. The current is sent using electrodes taped to the skin. It's not known how TENS relieves the pain. More study is needed.
• Ultrasound. This type of therapy uses sound waves to increase blood flow and warmth. This may reduce pain in the muscles affected by myofascial pain syndrome.
• Extracorporeal shock wave therapy. Sound waves are directed at the area of pain. Some studies have shown it to ease pain in myofascial pain syndrome.

Keeping your body healthy may make it easier for you to cope with your pain. Try to:

• Exercise. Gentle exercise can help you cope with pain. When your pain allows, get moving. Ask your physical therapist or another member of your healthcare team about good exercises for you.
• Relax. If you're tense, you may feel more pain. Find ways to relax. Do deep breathing. Meditate. Write in a journal. Talk with friends. Do what helps ease your stress.
• Take care of your body. Eat a healthy diet full of fruits and vegetables. Get enough sleep.

Having a long-term pain condition such as myofascial pain syndrome can be upsetting. It may help to talk to a counselor about what you're facing. Online or in-person support groups also can be helpful. They can link you to people who know what you're going through.

The symptoms of myofascial pain syndrome are like those of other disorders. So you may see more than one healthcare professional before getting a diagnosis.

What you can do

You're likely to start with a visit to your primary healthcare professional. You might then be sent to a specialist in muscle and joint conditions, called a rheumatologist.

Here are some things you can do to get ready for your appointment.

Make a list of:

• Your symptoms and when they began.
• Your key medical information. Include other conditions you have. List all medicines, vitamins or supplements you take, including doses.
• Questions to ask your healthcare professional.

For myofascial pain syndrome, some basic questions to ask include:

• What might be causing my symptoms?
• Is my condition likely to go away on its own?
• Do I need treatment?
• What treatments are there?
• Do you have brochures or other printed material that I can have?

What to expect from your doctor

Your healthcare professional is likely to ask you questions, such as:

• Where do you feel the most pain?
• Do your symptoms o come and go, or do you always have them?
• Does anything seem to make your symptoms better?
• Does anything seem to make your symptoms worse?
• Are your symptoms worse in the morning or at any other time of the day?
• Do you use repeated motions on the job or for hobbies?
• Have you been injured recently?
• How does your pain limit what you can do?