Abstract
Myofascial pain syndrome presents a significant physical and financial burden to society. In view of the aging demographics, myofascial pain promises to be an even greater challenge to health care in the future. Myofascial trigger points have been identified as important anatomic and physiologic phenomena in the pathophysiology of myofascial pain. While their pathophysiologic mechanisms are still unclear, emerging research suggests that trigger points may be initiated by neurogenic mechanisms secondary to central sensitization, and not necessarily by local injury. A variety of treatments are employed in the management of trigger points, including manual therapy, electrotherapy, exercise, and needle therapy. Therapeutic ultrasound demonstrates significant potential as a safe, cost-effective, and relatively noninvasive therapeutic alternative in the treatment and management of this modern day medical enigma.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance
Gerwin RD: A review of myofascial pain and fibromyalgia—factors that promote their persistence. Acupunct Med 2005, 23:121–134.
Wheeler AH, Aaron GW: Muscle pain due to injury. Curr Pain Headache Rep 2001, 5:441–446.
Staud R: Future perspectives: pathogenesis of chronic muscle pain. Best Pract Res Clin Rheumatol 2007, 21:581–596.
Health Canada: Economic Burden of Illness in Canada. Ottawa: Health Canada; 1998.
Jonsson E, Nachemson A: Collected knowledge about back pain and neck pain. What we know--and what we don’t know. Lakartidningen 2000, 97:4974–4980.
Drewes AM, Jennum P: Epidemiology of myofascial pain, low back pain, morning stiffness and sleep-related complaints in the general population. J Musculoskelet Pain 1995, 3(Suppl 1):121.
Podichetty VK, Mazanec DJ, Biscup RS: Chronic non-malignant musculoskeletal pain in older adults: clinical issues and opioid intervention. Postgrad Med J 2003, 79:627–633.
Simons DG: Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction. J Electromyogr Kinesiol 2004, 14:95–107.
Melzack R, Stillwell D, Fox E: Trigger points and acupuncture points for pain: correlations and implications. Pain 1977, 3:3–23.
Kao MJ, Hsieh YL, Kuo FJ, Hong CZ: Electrophysiological assessment of acupuncture points. Am J Phys Med Rehabil 2006, 85:443–448.
Srbely J, Dickey J, Lee D, Lowerison M: Needle stimulation of a myofascial trigger point causes segmental antinociceptive effects. J Rehabil Med 2010, 42:463–468.
Simons DG: New aspects of myofascial trigger points: etiological and clinical. J Musculoskelet Pain 2004, 12:15–21.
Hong CZ: Pathophysiology of myofascial trigger point. J Formos Med Assoc 1996, 95:93–104.
Couppe C, Midttun A, Hilden J, et al.: Spontaneous needle electromyographic activity in myofascial trigger points in the infraspinatus muscle: a blinded assessment. J Musculoskelet Pain 2001, 9:7–16.
Shah JP, Phillips TM, Danoff JV, Gerber LH: An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. J Appl Physiol 2005, 99:1977–1984.
McNulty WH, Gevirtz RN, Hubbard DR, Berkoff GM: Needle electromyographic evaluation of trigger point response to a psychological stressor. Psychophysiol 1994, 31:313–316.
Jarrell J: Myofascial dysfunction in the pelvis. Curr Pain Headache Rep 2004, 8:452–456.
Chen SM, Chen JT, Kuan TS, Hong CZ: Myofascial trigger points in intercostal muscles secondary to herpes zoster infection of the intercostal nerve. Arch Phys Med Rehabil 1998, 79:336–338.
Tsai WC, Wang TG, Hong CZ: Myofascial trigger points in the ipsilateral gluteal muscles associated with pyogenic sacroiliitis: a case report. J Musculoskelet Pain 1999, 7:73–82.
Hong CZ: New trends in myofascial pain syndrome. Zhonghua Yi Xue Za Zhi (Taipei) 2002, 65:501–512.
Svensson P, Rendt-Nielsen L, Houe L: Muscle pain modulates mastication: an experimental study in humans. J Orofac Pain 1998, 12:7–16.
Kuan TS, Hong CZ, Chen JT: The spinal cord connections of the myofascial trigger spots. Eur J Pain 2007, 11:624–634.
Woolf CJ, Salter MW: Neuronal plasticity: increasing the gain in pain. Science 2000, 288:1765–1769.
Coderre TJ, Katz J, Vaccarino AL, Melzack R: Contribution of central neuroplasticity to pathological pain: review of clinical and experimental evidence. Pain 1993, 52:259–285.
Richardson JD, Vasko MR: Cellular mechanisms of neurogenic inflammation. J Pharmacol Exp Ther 2002, 302:839–845.
Giamberardino MA, Affaitati G, Lerza R: Relationship between pain symptoms and referred sensory and trophic changes in patients with gallbladder pathology. Pain 2005, 114:239–249.
Janig W: Relationship between pain and autonomic phenomena in headache and other pain conditions. Cephalalgia 2003, 23(Suppl 1):43–48.
Wesselmann U, Lai J: Mechanisms of referred visceral pain: uterine inflammation in the adult virgin rat results in neurogenic plasma extravasation in the skin. Pain 1997, 73:309–317.
Barnes PJ: Asthma as an axon reflex. Lancet 1986, 1:242–245.
Alagiri M, Chottiner S, Ratner V, et al.: Interstitial cystitis: unexplained associations with other chronic disease and pain syndromes. Urology 1997, 49(Suppl 5A):52–57.
Noronha R, Akbarali H, Malykhina A, et al.: Changes in urinary bladder smooth muscle function in response to colonic inflammation. Am J Physiol Renal Physiol 2007, 293:F1461–F1467.
Dmitrieva N, Johnson OL, Berkley KJ: Bladder inflammation and hypogastric neurectomy influence uterine motility in the rat. Neurosci Lett 2001, 313:49–52.
Hsueh TC, Yu S, Kuan TS, Hong CZ: Association of active myofascial trigger points and cervical, disc lesions. J Formos Med Assoc 1998, 97:174–180.
• Srbely J, Dickey J, Bent L, Lee D: Capsaicin induced central sensitization evokes segmental increases in trigger point sensitivity in humans. J Pain 2009 Dec 14 (Epub ahead of print). This article describes the segmental relationship between central sensitization and trigger point sensitivity. It provides important insight into potential neurogenic origins of trigger points and myofascial pain.
Tsai CT, Hsieh LF, Kuan TS, et al.: Injection in the cervical facet joint for shoulder pain with myofascial trigger points in the upper trapezius muscle. Orthopedics 2009, 32. http://www.orthosupersite.com/view.asp?rID=41914.
Majlesi J, Unalan H: High-power pain threshold ultrasound technique in the treatment of active myofascial trigger points: a randomized, double-blind, case-control study. Arch Phys Med Rehabil 2004, 85:833–836.
Streitberger K, Ezzo J, Schneider A: Acupuncture for nausea and vomiting: an update of clinical and experimental studies. Auton Neurosci 2006, 129:107–117.
Tougas G, Yuan LY, Radamaker JW, et al.: Effect of acupuncture on gastric acid secretion in healthy male volunteers. Dig Dis Sci 1992, 37:1576–1582.
Lundeberg T, Eriksson SV, Theodorsson E: Neuroimmunomodulatory effects of acupuncture in mice. Neurosci Lett 1991, 128:161–164.
• Chou LW, Hsieh YL, Kao MJ, Hong CZ: Remote influences of acupuncture on the pain intensity and the amplitude changes of endplate noise in the myofascial trigger point of the upper trapezius muscle Arch Phys Med Rehabil 2009, 90:905–912. This article describes the segmental effects of stimulating remote acupoints and provides important evidence supporting the paradigm of segmental acupuncture.
Lin JG, Lo MW, Wen YR, et al.: The effect of high and low frequency electroacupuncture in pain after lower abdominal surgery. Pain 2002, 99:509–514.
Lee J, Dodd M, Dibble S, Abrams D: Review of acupressure studies for chemotherapy-induced nausea and vomiting control. J Pain Symptom Manage 2008, 36:529–544.
Smania N, Corato E, Fiaschi A, et al.: Repetitive magnetic stimulation: a novel therapeutic approach for myofascial pain syndrome. J Neurol 2005, 252:307–314.
• Srbely JZ, Dickey JP, Lowerison M, et al.: Stimulation of myofascial trigger points with ultrasound induces segmental antinociceptive effects: a randomized controlled study. Pain 2008, 139:260–266. This article describes the segmental therapeutic antinociceptive effects of ultrasound stimulation of trigger points. It provides important evidence to support the use of therapeutic ultrasound in the treatment of trigger points and myofascial pain.
Rickards LD: The effectiveness of non-invasive treatments for active myofascial trigger point pain: a systematic review of the literature. Int J Osteopath Med 2006, 9:120–136.
Kamanli A, Kaya A, Ardicoglu O, et al.: Comparison of lidocaine injection, botulinum toxin injection, and dry needling to trigger points in myofascial pain syndrome. Rheumatol Int 2005, 25:604–611.
Dorsher PT: Myofascial referred-pain data provide physiologic evidence of acupuncture meridians. J Pain 2009, 10:723–731.
• Srbely JZ, Dickey JP, Lee D, Lowerison M: Dry needle stimulation of Myofascial trigger points evokes segmental anti-nociceptive effects. J Rehabil Med 2010, 42:463–468. This article highlights the segmental antinociceptive effects of dry needling trigger points. It provides important evidence to support the paradigm of segmental trigger point therapy.
Tsui PH, Wang SH, Huang CC: In vitro effects of ultrasound with different energies on the conduction properties of neural tissue. Ultrasonics 2005, 43:560–565.
Srbely JZ, Dickey JP: Randomized control study of the antinociceptive effect of ultrasound on trigger point sensitivity: novel applications in myofascial therapy? Clin Rehabil 2007, 21:411–417.
Disclosure
No potential conflicts of interest relevant to this article have been reported.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Srbely, J.Z. New Trends in the Treatment and Management of Myofascial Pain Syndrome. Curr Pain Headache Rep 14, 346–352 (2010). https://doi.org/10.1007/s11916-010-0128-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11916-010-0128-4