Myofascial pain syndromes (MPS) are a group of illnesses and diagnoses that involve tender, tight, and painful parts of the body. The cause is often a combination of a number of factors. The MPS has many types and each class of syndromes can have different treatments.\n
About 10 million people in the U.S. are diagnosed with myofascial pain or tension-type headaches every year, and there are over 25 million people who suffer with myofascial pain. The prevalence of myofascial pain in North American populations is high enough to suggest that a significant number of people in the U.S. may have myofascial pain.
The common treatments used by MPS specialists include intra-articular injections with local anesthetics and corticosteroids; massage/myofascial trigger point therapy; chiropractic manipulation; acupuncture; and transcutaneous electrical nerve stimulation.\n
Myofascial pain syndromes can be painful and debilitating or painless and asymptomatic. In many cases, patients describe either a referral pattern or a pattern of referral and clinical response that are consistent with myofascial pain syndromes but are difficult to explain using the International Association for the Study of Pain's diagnostic criteria. Because patients describe this referral pattern, they can be treated in a standardized manner.
Based on this limited evidence, most MPSs are noncurable and most can be managed to a minimum of clinical symptoms, even though all patients have a substantial pain burden. Further research and experience from other medical communities will be needed to determine if MPS symptoms are more or less self-limited than many chronic pain conditions and whether MPS pain responds to conservative and non-pharmacological techniques.
Myofascial pain can occur due to a variety of causes, yet the most common is an overuse injury. Some of the secondary causes are non-injury, and are most common in younger persons. Most commonly, myofascial pain is due to weakness of the myofascial compartment because of a history of an overuse injury. However, a few secondary causes are as a result of injury. The most common form of an overuse injury is a frozen shoulder that develops because of weakness in the shoulder and forearm muscles. However, most patients are symptomatic before being diagnosed with frozen shoulder. Many physicians will not suspect overuse injury when a history of overuse injury is not present, and do not consider this option.
Current scientific findings highlight the effectiveness and safety of botulinum toxin type a (Botox®) as a first-line, most effective and most efficacious treatment for various pain syndromes, such as myofascial pain syndrome, neuromuscular disorders and migraines.
The injection of BTXA into muscles can produce acute relief of a variety of muscle soreness syndromes, but the magnitude of effect is negligible. The use of BTXA is contraindicated in individuals with known myofascial pain syndrome. BTXA should be carefully considered for management of chronic myofascial pain syndrome.
A primary myofascial pain syndrome is caused by an overactive myofascial trigger point. Patients usually do not have a palpable trigger point; however, there may be an associated tension-type trigger point nearby. Secondary myofascial pain syndromes are more of a secondary problem of the muscles and tendons rather than the muscles themselves.
There has been relatively little data collected regarding this subgroup of patients. Most studies have reported patients within the age of 25 to 50 years. While the reasons for this age range remain uncertain, it seems common that the pain is caused by a myofascial injury as opposed to an unrelated pathology. Further research is needed to gather more data.
[Botulinum toxin type A injections into the face cause painful nodules to form at their delivery sites. These may last up to 4 months after the injection, and can be very painful. This is not necessarily a problem unless the patient believes it to be. For a quick fix, the drug usually works for a few days or weeks, and so they can then be used repeatedly to help with the effect. Occasionally, the nodules spontaneously disappear so they are only painful after injection. In most cases, this requires some treatment and often requires multiple treatments. If the nodules recur after a long time, this is usually when the patient is not taking the drug.
• Biotoxin type A is a neurotoxin found in the bacteria Clostridium botulinum. • Botulinum toxin type A is one of the treatments for focal dystonias. • A case report shows that botulinum toxin type A, along with botulinum toxin type A and botulinum toxin type B, is an effective, long-term treatment for myofascial pain and myofascial trigger point syndrome.