Understanding the Musculoskeletal Pain Syndrome – Myofascial Pain Syndrome

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In order to understand the musculoskeletal pain syndrome, we must examine fibromyalgia, which we have already done. Now, we will examine the other half of this very complex pain syndrome, the myofascial pain syndrome or MPS. The myofascial pain syndrome describes and defines a condition characterized by chronic pain, often associated with neck pain and back pain, as well as sciatica. Myofascial pain syndrome is best known for pain caused by “trigger points” or TrPs. Trigger points are localized pain centers or points, at times expressed as painful knots or contractures found in any skeletal muscle, anywhere on the body. Researchers have visibly napped and identified these “knots” which may express pain as anything from referred pain to very specific and intense pain in other parts of the body. In other words, myofascial pain syndrome symptoms may vary from referred pain at various myofascial trigger point,s to specific and localized pain in other areas of the body.

As noted above, MPS is closely related to the complex musculoskeletal pain syndrome known as fibromyalgia. Whereas fibromyalgia pain is expressed generally and occurs above and below the waist, on the right and left sides of the body, MPS, with its associated pain syndrome, is often more localized and found in more circumscribed areas of the body. Myofascial pain is more frequently expressed around the neck and shoulders, and is usually found on only one side of the body.

In both myofascial pain syndrome (MPS) and fibromyalgia (FMS) there appears to be an alteration or a problem with the pain threshold, perceived versus actual pain. In other words, there appears to be a difference between pain reported and the actual amount of painful stimuli. MPS appears to be a problem of pain perception and expression. Some of the symptoms associated with myofascial pain syndrome include increased muscle soreness and tenderness, particularly in certain and very specific areas (muscles of the upper back, trapezius). Interestingly, as with fibromyalgia, MPS is found more frequently in women than men, the reason for this is unknown. In addition to chronic and more localized pain expression, the syndrome is also known to be associated with sleep disturbances and fatigue. The pain associated with this condition also appears to persist, and often worsen, over time. While pain appears to be specific and localized, it is also chronic and may express itself as headaches, neck, pelvic or hip, jaw, and even arm and leg pain. The leg pain may be mistaken for or diagnosed as sciatica. Which is a mistake or misdiagnosis, sciatica is a symptom, not a diagnosis!

The pain associated with MPS is generally expressed as an aching, deep, almost throbbing pain. Often, the pain in the lower back or hips is described as an aching or throbbing pain. As noted above, the pain often worsens and persists longer than expected, given the diagnosis and the underlying cause or suspected cause. The pain is also expressed as a stiffness in the muscles, and the joints adjacent to the affected muscle. The painful contracture or knot is often expressed as an area of stiffness or tension. The affected area feels very much like a tight spot or and knot and may be sensitive to the touch.

Factors that may be instrumental in bringing on myofascial pain syndrome may include muscle injury, continued stress, both psychological and physical stress to a localized muscle or muscle area, age (MPS is more likely to be diagnosed in middle age women but is also diagnosed in men), a sedentary lifestyle and/or inactivity may bring on pain at certain trigger points in the muscle, and finally, anxiety and stress. Individuals under a great deal of stress often express pain at various trigger points, perhaps due to muscle tension as a result of stress. Some researchers have suggested that the clenching or tightening of muscles associated with stress is a factor.

If pain persists or worsens, or seems to have no real reason for being there or appears to be localized, as with trigger points or knots, then a medical specialist should be consulted. Complications of myofascial pain syndrome may include muscle weakness, particularly due to inactivity as the pain sufferer is on able or unwilling to tax the painful muscle area. Additionally, as noted above, sleep may be a problem, as it is often difficult to get relief from the pain long enough to fall a sleep. Lack of sleep or sleep disturbances may be one of the reasons why chronic fatigue also seems to be related to this condition. Finally, it has been suggested that myofascial pain syndrome may evolve into fibromyalgia in some patients. While MPS is localized and unilateral in its pain expression, fibromyalgia is widespread and chronic, and it is thought myofascial pain syndrome may play a role in this condition.

Myofascial pain syndrome treatment generally includes some sort of trigger point injection and/or oral medications, as well as physical therapy, exercise, stretching, and massage. Once trigger points are identified, the medical practitioner may use an injection strategy called “needling” to localize pain at various trigger points. Stretching is generally done to ease the pain at the affected muscle trigger point by gently stretching the area. At times, medical practitioners employ a freezing lotion, spray or solution to numb the affected area or trigger point while treating it. Gentle massage also appears to be effective in some instances, although trigger point sensitivity is a problem. Finally, medications are often used, to include NSAIDs and depression medications, particularly tricyclic antidepressants. Depressants seem to help with chronic pain symptoms and with sleep disturbances, thus reducing stress.

Ultimately, taking care of your self, relieving or alleviating stress, combined with a strategy of exercise, relaxation, and a healthy diet has been shown to be effective. Taking care of one’s self may go a long way towards effectively dealing with myofascial pain syndrome. Exercise, particularly a program that allows for gentle stretching and controlled movement, is effective. Walking has also been shown to alleviate tension, improve muscle tone, and reduce over all pain sensitivity in many patients. If the myofascial pain syndrome patient is tense, anxious, depressed, and/or stressed more pain may be experienced, particularly neck pain, back pain, hip pain, and sciatica or sciatica-like pain. Meditation, social interaction, either in person or online, writing, journaling, acupuncture, and, in some instances hypnosis, have all been demonstrated to alleviate stress and reduce pain levels. Finally, take care of yourself! Taking care of your body, eat the right kinds of foods, as in a healthy diet full of vegetables and fruit, combined with enough sleep, will help the MPS sufferer cope with the chronic pain, fatigue, and stiffness associated with myofascial pain syndrome.

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