Focused review: myofascial pain.

Myofascial pain is defined as pain that originates from myofascial trigger points in skeletal muscle. It is prevalent in regional musculoskeletal pain syndromes, either alone or in combination with other pain generators. The appropriate evaluation and management of myofascial pain is an important part of musculoskeletal rehabilitation of regional axial and limb pain syndromes. This article reviews the current hypotheses regarding the pathophysiology of myofascial trigger points and muscle pain. A critical evidence-based review of the pharmacologic, nonpharmacologic, alternative medicine, and exercise treatments of myofascial pain is provided, as well as future research directions. OVERALL LEARNING OBJECTIVE: To review critically the state of the art knowledge of myofascial pain, including pathophysiology and comprehensive management. Areas of future research are identified.

[1]  Xian-Min Yu,et al.  Appearance of new receptive fields in rat dorsal horn neurons following noxious stimulation of skeletal muscle: a model for referral of muscle pain? , 1993, Neuroscience Letters.

[2]  T. Kuan,et al.  Phentolamine effect on the spontaneous electrical activity of active loci in a myofascial trigger spot of rabbit skeletal muscle. , 1998, Archives of physical medicine and rehabilitation.

[3]  D. Goldenberg,et al.  The impact of a meditation-based stress reduction program on fibromyalgia. , 1993, General hospital psychiatry.

[4]  P. Goolkasian,et al.  A Randomized, Double‐Blind, Prospective Pilot Study of Botulinum Toxin Injection for Refractory, Unilateral, Cervicothoracic, Paraspinal, Myofascial Pain Syndrome , 1998, Spine.

[5]  J. Hilden,et al.  Spontaneous Needle Electromyographic Activity in Myofascial Trigger Points in the Infraspinatus Muscle: A Blinded Assessment , 2001 .

[6]  F. Hoehler,et al.  Interexaminer reliability of the palpation of trigger points in the trunk and lower limb muscles. , 2000, Archives of physical medicine and rehabilitation.

[7]  D. Laskin,et al.  Personality Characteristics of Patients with Myofascial Pain-Dysfunction (MPD) Syndrome Unresponsive to Conventional Therapy , 1979, Journal of dental research.

[8]  J. Chu.  Twitch-Obtaining Intramuscular Stimulation: Observations in the Management of Radiculopathic Chronic Low Back Pain , 1999 .

[9]  J. Reeves,et al.  Effects of transcutaneous electrical nerve stimulation on myofascial pain and trigger point sensitivity , 1989, Pain.

[10]  H. Fukuda,et al.  α2-AGONIST-INDUCED REDUCTION OF NORADRENALINE RELEASE FROM DESCENDING NORADRENERGIC TERMINALS IN RAT SPINAL CORD: FUNCTIONAL RELATION TO SPINAL MOTOR SYSTEM , 1988 .

[11]  B. Jaeger,et al.  Management of Chronic Head and Neck Pain: Effectiveness of Altering Factors Perpetuating Myofascial Pain , 1987, Headache.

[12]  C. Hong.  LIDOCAINE INJECTION VERSUS DRY NEEDLING TO MYOFASCIAL TRIGGER POINT: The Importance of the Local Twitch Response , 1994, American journal of physical medicine & rehabilitation.

[13]  J. H. Andersen,et al.  Musculoskeletal disorders of the neck and shoulders in female sewing machine operators: prevalence, incidence, and prognosis , 2000, Occupational and environmental medicine.

[14]  D. Felson,et al.  A randomized, controlled trial of amitriptyline and naproxen in the treatment of patients with fibromyalgia. , 1986, Arthritis and rheumatism.

[15]  L. Bendtsen,et al.  Amitriptyline Reduces Myofascial Tenderness in Patients with Chronic Tension-Type Headache , 2000, Cephalalgia : an international journal of headache.

[16]  K. Raphael,et al.  Why is depression comorbid with chronic myofascial face pain? A family study test of alternative hypotheses , 1999, PAIN.

[17]  A. Starr,et al.  Do cerebral potentials to magnetic stimulation of paraspinal muscles reflect changes in palpable muscle spasm, low back pain, and activity scores? , 2000, Journal of manipulative and physiological therapeutics.

[18]  B. Jensen,et al.  Treatment of myofascial trigger-points with ultrasound combined with massage and exercise – a randomised controlled trial , 1998, Pain.

[19]  J. Davies,et al.  SELECTIVE DEPRESSION OF SYNAPTIC TRANSMISSION OF SPINAL NEURONES IN THE CAT BY A NEW CENTRALLY ACTING MUSCLE RELAXANT, 5‐CHLORO‐4‐(2‐IMIDAZOLIN‐2‐YL‐AMINO)‐2, 1, 3‐BENZOTHIODAZOLE (DS103–282) , 1982, British journal of pharmacology.

[20]  W. P. Cheshire,et al.  Botulinum toxin in the treatment of myofascial pain syndrome , 1994, Pain.

[21]  B. Feinberg,et al.  Persistent Pain After Total Knee Arthroplasty: Treatment with Manual Therapy and Trigger Point Injections , 1998 .

[22]  R. Jensen,et al.  Pathophysiological Mechanisms of Tension-Type Headache: A Review of Epidemiological and Experimental Studies , 1999, Cephalalgia : an international journal of headache.

[23]  C. Schmid,et al.  A randomized, double-blind crossover trial of fluoxetine and amitriptyline in the treatment of fibromyalgia. , 1996, Arthritis and rheumatism.

[24]  R. Edwards,et al.  Hypotheses of peripheral and central mechanisms underlying occupational muscle pain and injury , 2004, European Journal of Applied Physiology and Occupational Physiology.

[25]  R. Roth,et al.  Chronic myofascial pain: knowledge of diagnosis and satisfaction with treatment. , 1998, Archives of physical medicine and rehabilitation.

[26]  M. Hernandez-Reif,et al.  Lower Back Pain is Reduced and Range of Motion Increased After Massage Therapy , 2001, The International journal of neuroscience.

[27]  M. Eisemann,et al.  Predictive factors for the outcome of a multidisciplinary pain rehabilitation programme on sick-leave and life satisfaction in patients with whiplash trauma and other myofascial pain: a follow-up study , 1998, Clinical rehabilitation.

[28]  R. Gevirtz,et al.  Interrater reliability in myofascial trigger point examination , 1997, Pain.

[29]  R. Miledi,et al.  Effect of lanthanum ions on function and structure of frog neuromuscular junctions , 1971, Proceedings of the Royal Society of London. Series B. Biological Sciences.

[30]  C. Hong,et al.  Endplate Potentials Are Common to Midfiber Myofacial Trigger Points , 2002, American journal of physical medicine & rehabilitation.

[31]  D. Hubbard,et al.  Chronic and Recurrent Muscle Pain , 1996 .

[32]  W. Jänig,et al.  Do dichotomizing afferent fibers exist which supply visceral organs as well as somatic structures? A contribution to the problem of referred pain , 1981, Neuroscience Letters.

[33]  M. Vasko,et al.  Inhibitory effects of clonidine and tizanidine on release of substance P from slices of rat spinal cord and antagonism by α-adrenergic receptor antagonists , 1991, Neuropharmacology.

[34]  R. Gevirtz,et al.  Needle electromyographic evaluation of trigger point response to a psychological stressor. , 1994, Psychophysiology.

[35]  I. Russell.  Reliability of Clinical Assessment Measures for the Classification of Myofascial Pain Syndrome , 1999 .

[36]  Kevin Ball,et al.  Clinical precision of myofascial trigger point location in the trapezius muscle , 2001, Pain.

[37]  A. W. Liley,et al.  An investigation of spontaneous activity at the neuromuscular junction of the rat , 1956, The Journal of physiology.

[38]  B. Blasberg,et al.  A comparison of treatment modes in the management of myofascial pain dysfunction syndrome , 1986, Biofeedback and self-regulation.

[39]  E. Does,et al.  The occurrence and inter-rater reliability of myofascial trigger points in the quadratus lumborum and gluteus medius: A prospective study in non-specific low back pain patients and controls in general practice , 1994, Pain.

[40]  R. Melzack,et al.  Trigger points and acupuncture points for pain: Correlations and implications , 1977, Pain.

[41]  J. Fricton,et al.  Myofascial pain syndrome of the head and neck: a review of clinical characteristics of 164 patients. , 1985, Oral surgery, oral medicine, and oral pathology.

[42]  I. Russell,et al.  Treatment of primary fibrositis/fibromyalgia syndrome with ibuprofen and alprazolam. A double-blind, placebo-controlled study. , 1991, Arthritis and rheumatism.

[43]  H. Berry,et al.  A Multicentre Placebo-Controlled Study in General Practice to Evaluate the Efficacy and Safety of Tizanidine in Acute Low-Back Pain , 1988, The Journal of international medical research.

[44]  R. Bennett.  Fibromyalgia, chronic fatigue syndrome, and myofascial pain. , 1998, Current opinion in rheumatology.

[45]  C. Wilder-Smith,et al.  Treatment of severe pain from osteoarthritis with slow-release tramadol or dihydrocodeine in combination with NSAID's: a randomised study comparing analgesia, antinociception and gastrointestinal effects , 2001, Pain.

[46]  I. Story,et al.  Inter-therapist reliability in locating latent myofascial trigger points using palpation. , 1997, Manual therapy.

[47]  H. Berry,et al.  Tizanidine and Ibuprofen in Acute Low-Back Pain: Results of a Double-Blind Multicentre Study in General Practice , 1988, The Journal of international medical research.

[48]  F. Wolfe,et al.  Preference for nonsteroidal antiinflammatory drugs over acetaminophen by rheumatic disease patients: a survey of 1,799 patients with osteoarthritis, rheumatoid arthritis, and fibromyalgia. , 2000, Arthritis and rheumatism.

[49]  M. Porta.  A comparative trial of botulinum toxin type A and methylprednisolone for the treatment of myofascial pain syndrome and pain from chronic muscle spasm , 2000, Pain.

[50]  B. R. Brown,et al.  Cyclobenzaprine in intractable pain syndromes with muscle spasm. , 1978, JAMA.

[51]  O. Komiyama,et al.  Posture correction as part of behavioural therapy in treatment of myofascial pain with limited opening. , 1999, Journal of oral rehabilitation.

[52]  C G Drury,et al.  Posture, Postural Discomfort, and Performance , 1985, Human factors.

[53]  S. Birch,et al.  Controlled trial of Japanese acupuncture for chronic myofascial neck pain: assessment of specific and nonspecific effects of treatment. , 1998, The Clinical journal of pain.

[54]  J. Cassisi,et al.  Pain, disability, and psychological functioning in chronic low back pain subgroups: myofascial versus herniated disc syndrome. , 1993, Neurosurgery.

[55]  M. Giamberardino,et al.  Referred muscle pain: Clinical and pathophysiologic aspects , 1999, Current review of pain.

[56]  A. White,et al.  Needling therapies in the management of myofascial trigger point pain: a systematic review. , 2001, Archives of physical medicine and rehabilitation.