Myofascial Pain Syndromes

Author: R. Norman Harden

R. Norman Harden, MD

Myofascial pain syndrome is a very common diagnosis in pain clinics.  We know that probably 85% of the people seen in a tertiary care pain clinic have myofascial pain syndrome either as a primary or a secondary diagnosis, and pretty much everything that we see, such as radiculopathy and nerve damage into the leg is going to be associated ultimately with bracing and spasm of the muscles around the back, which ultimately lead to myofascial pain syndrome.  So it’s very, very common.

It’s also easy to identify and treat. On examination, you’ll find these taut bands of muscle and in the middle of the taut band you’re going to find one of these trigger points.  What that means is as you push on the point, it’s going to trigger a sensory phenomena elsewhere, usually a referred pain phenomena.  If you inject lidocaine into that trigger point, that’s going to stop all neural transmission at that point. If the pain goes away, you know exactly what you’re dealing with. Treatment of myofascial pain syndrome is relatively simple physical therapy.  Stretching, strengthening, postural correction, some hands-on techniques like myofascial release are very, very effective. The injections can be very powerful in terms of diagnosing myofascial pain syndrome although not so much with the treatment unless you use it is a window of opportunity so you can begin physical therapy in a relatively pain-free state or begin psychotherapy where the patient can focus and really apply themselves to those techniques.

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