Myofascial syndrome is a pain disorder that affects the muscles and fascia throughout the body. Fascia is like a web that surrounds the bones, tissues, organs, and blood vessels throughout the body. MPS can attack and cause degeneration of certain areas of the fascia, resulting in chronic pain and a variety of other symptoms. Pain usually originates in specific areas of the body, called myofascial trigger points (TrPs), which feel like tiny nodules under the skin. These trigger points commonly develop throughout the body, typically where the fascia comes into contact with a muscle.
MPS is a very common illness, and most people will develop at least one trigger point in their body at some point in their lives. The majority of these people will not develop severe symptoms and will be able to continue with their normal routines. However, about 14 percent of the population will develop a chronic form of the syndrome, resulting in persistent pain and discomfort.
MPS is very common in fibromyalgia sufferers. It was once thought that MPS was actually a kind of fibromyalgia. However, this is now known not to be the case. It is possible to have both fibromyalgia and MPS, and therefore it is important to be diligent when analyzing the symptoms. The most common sign of myofascial pain is the presence of palpable trigger points in the muscles. Trigger points are areas of extreme tenderness and sensitivity, and usually form in bands of muscle underneath the skin. They are similar to the tender points caused by fibromyalgia, only trigger points can be felt beneath the skin. When touched, trigger points will produce pain and twitching in the muscles. Often, pain is felt in an area distinct from the trigger point that is actually affected which is called referred pain.
The pain of MPS is typically a dull ache, but can also produce a throbbing, stabbing, or burning sensation. Pain is often located in the jaw area, though any part of the body can be affected. One-third of myofascial pain sufferers report localized pain, while two-thirds report having pain all over their bodies. Myofascial pain can also produce a variety of other symptoms, many of which may appear unrelated. These include numbness in the extremities, popping or clicking of the joints, limited movement of joints, particularly the jaw, muscle weakness (manifested in dropping things,) migraine or headache, disturbed sleep, balance problems, tinnitus and ear pain, double vision or blurred vision, problems with memory as well as unexplained nausea, dizziness, and sweating.
The causes of MPS can be numerous and depend upon the individual. Generally, myofascial pain is caused by some sort of trauma to the muscles and skeleton in the body. Overworking of the muscles can cause damage to certain areas resulting in the development of a trigger point. Poor posture can also trigger myofascial pain in certain individuals. Skeletal abnormalities, such as having different sized feet, toes, or legs, can also contribute to the development of myofascial pains. Frequent exposure to cold weather may also increase the risk of developing MPS.
People with fibromyalgia may get MPS as a result of their fibromyalgia pain. Compensating for pain can often cause reduced movement or an unhealthy posture, leading to the formation of trigger points. The severe pain caused by fibromyalgia also causes muscle contractions around tender points, referred to as guarding. Eventually these muscle contractions cause trigger points to form in addition to the tender points of fibromyalgia. The depression associated with fibromyalgia may also cause myofascial pain to develop. At least 30 percent of fibromyalgia patients suffer from depression, which causes low levels of serotonin in the brain. Serotonin is a neurotransmitter responsible for regulating mood and pain in the body. Depression may interfere with the process of regulating pain, causing MPS.
Having both MPS and fibromyalgia can be quite trying at times. Symptoms of MPS and fibromyalgia are very similar, making it difficult for medical professionals to properly diagnose many people. Without proper diagnosis, a patient may not receive appropriate treatment, causing his or her symptoms to become even worse. In addition, myofascial pain can often contribute to the pain caused by fibromyalgia, making life much more difficult to enjoy.
An empathetic physician who is knowledgeable about the diagnosis and treatment of FM and MPS and who will listen to and work with the patient is an important component of treatment. It may be a family practitioner, an internist, or a specialist (rheumatologist or neurologist, for example). Conventional medical intervention may be only part of a potential treatment program. Alternative treatments, nutrition, relaxation techniques, and exercise play an important role in FM and MPS treatment as well. Each patient should, with the input of a healthcare practitioner, establish a multifaceted and individualized approach that works for them. An important aspect of FM and MPS pain management is a regular program of gentle exercise and stretching, which helps maintain muscle tone and reduces pain and stiffness.
Improved sleep can be obtained by implementing a healthy sleep regimen such as going to bed and getting up at the same time every day; making sure that the sleeping environment is conducive to sleep (i.e. quiet, free from distractions, a comfortable room temperature, a supportive bed); avoiding caffeine, sugar, and alcohol before bed; doing some type of light exercise during the day; avoiding eating immediately before bedtime; and practicing relaxation exercises to fall asleep. When necessary, there are new sleep medications that can be prescribed, some of which can be especially helpful if the patient’s sleep is disturbed by restless legs or periodic limb movement disorder.
Other conventional pain management techniques include over-the-counter pain medications, such as acetaminophen or ibuprofen, or one of the newer non-narcotic pain relievers (e.g. tramadol) or low doses of antidepressants (e.g. tricyclic antidepressants, serotonin reuptake inhibitors) or benzodiazepines. Many medical professionals also prescribe stronger narcotic pain relievers to manage the pain of these syndromes however, over time, the individual usually requires higher doses to achieve the same pain relief. As a result, addiction and physical dependency are critical issues that must be paid attention to. In addition, narcotic pain relievers can cause negative affects in the body including elevated liver enzymes and compromised kidney function. Long term narcotic use also stimulates the body’s pain neurotransmitters to fire even more, creating more pain.
Trigger point injection (TPI) is a procedure also used to treat both FM and MPS. In the TPI procedure, a health care professional inserts a small needle into the patients trigger point. The injection contains a local anesthetic that sometimes includes a corticosteroid. With the injection, the trigger point can be made inactive and the pain is alleviated. Usually, a brief course of treatment will result in sustained relief. Injections are given in a doctors office and usually take just a few minutes. TPI is used to treat many muscle groups, especially those in the arms, legs, lower back, and neck. The effectiveness of TPI for treating myofascial pain is still under study however.
Complementary therapies can be very beneficial. These include: physical therapy, therapeutic massage, myofascial release therapy, water therapy, light aerobics, acupressure, application of heat or cold, acupuncture, yoga, relaxation exercises, breathing techniques, aromatherapy, cognitive therapy, biofeedback, herbs, nutritional supplements, and osteopathic or chiropractic manipulation.