Chronic Myofascial Pain

Condition Basics

What is myofascial pain syndrome?

Most people have muscle pain from time to time. But the pain from myofascial pain syndrome is an ongoing or longer-lasting pain. With myofascial pain, there are areas called trigger points. Trigger points are usually in the connective tissue (fascia) or in a tight muscle.

Myofascial pain often goes away with treatment.

What causes it?

Experts don't know exactly what causes myofascial pain syndrome. It may start after:

• Strain or injury to the muscles, ligaments, or tendons.
• Overuse of the muscle. For example, doing the same movement over and over.

What are the symptoms?

The main symptom of myofascial pain syndrome is ongoing or longer-lasting muscle pain in areas such as the low back, neck, shoulders, and chest. You might feel the pain or the pain may get worse when you press on a trigger point. The muscle may be swollen or hard—you may hear it called a "taut band" of muscle or "knot" in the muscle. Symptoms of myofascial pain syndrome may include:

• A muscle that is sensitive or tender when touched.
• Muscle pain that happens with pressure on a trigger point.
• Referred pain.
• Pain that feels like aching, burning, stinging, or stabbing.
• Reduced range of motion in the affected area.
• A feeling of weakness in the affected muscle.

People with chronic myofascial pain may have other health problems, such as tension headaches, depression, sleep problems, and fatigue. These problems are common in people who have chronic pain.

How is it diagnosed?

To diagnose myofascial pain syndrome, your doctor will ask if you have had a recent injury or do any repetitive activities. Your doctor will also ask where the pain is, how long you have had the pain, what makes it better or worse, and if you have any other symptoms.

You will also have a physical exam. Your doctor will press on different areas to see if the pressure causes pain.

You may have tests to see if some other condition is causing your pain.

How is myofascial pain syndrome treated?

Talk to your doctor about the best way to treat your pain. The main treatment may include any of the following:

• Cooling spray. This involves using a cooling spray (such as Biofreeze) directly on the skin from the trigger point to the painful area and then gently stretching the muscle. This may be repeated several times.
• Massage therapy.
• Physical therapy, which may include stretching and strengthening exercises. It may also include counseling about how to change the things that make the pain worse. For example, you may learn how to adjust your workstation, improve your posture, or change your sleep position to avoid muscle tension.
• Trigger point shots (injections). A doctor inserts a needle into the trigger point and injects medicine such as a local anesthetic.
• Dry needling. A doctor inserts a needle into the trigger point several times to help with tightness in the muscle and pain.
• Cognitive behavioral therapy (CBT). Cognitive behavioral therapy can teach you how to change your negative thoughts about pain. This can also help you be more active.
• Transcutaneous electrical nerve stimulation (TENS).
• Ultrasound.

Your doctor may also recommend nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin. Or your doctor may recommend medicines you can put on your skin, such as lidocaine patches or creams. These medicines may help with your symptoms. Be safe with medicines. Read and follow all instructions on the label.

Sometimes doctors prescribe certain antidepressants or muscle relaxants that help relax muscles and relieve sleep problems related to myofascial pain.