Skip to main content

Chronic Myofascial Pain, Fibromylagia, and Myofascial Trigger Points

  • Chapter
  • First Online:
Evaluation and Management of Chronic Pain for Primary Care

Abstract

Musculoskeletal pain is one of the most common sources of chronic pain in primary care. Myofascial trigger points can be a source of chronic pain. Myofascial trigger points are hyperirritable nodules of skeletal muscle that can cause not only chronic pain, but also decreased range of motion, autonomic phenomenon, and referred pain. Though their role is still debatable amongst certain clinicians, myofascial trigger points can contribute to chronic pain syndrome, especially for those who have already undergone extensive evaluation with no substantial etiology for their pain. It is reasonable to consider their contribution because treatments are generally musculoskeletal based, readily implemented, and do not require surgery or very invasive treatments.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Centers for Disease Control and Prevention, Ambulatory and Hospital Care Statistics Branch. National ambulatory medical care survey: 2010 summary tables [Internet]. Atlanta: Centers for Disease Control and Prevention; 2011.

    Google Scholar 

  2. Gerwin RD. Classification, epidemiology, and natural history of myofascial pain syndrome. Curr Pain Headache Rep. 2001;5(5):412–20.

    Article  CAS  Google Scholar 

  3. Fleckenstein J, Zaps D, Rüger LJ, Lehmeyer L, Freiberg F, Lang PM, Irnich D. Discrepancy between prevalence and perceived effectiveness of treatment methods in myofascial pain syndrome: results of a cross-sectional, nationwide survey. BMC Musculoskelet Disord. 2010;11:32.

    Article  Google Scholar 

  4. Centers for Disease Control and Prevention. Prevalence of disabilities and associated health conditions among adults—United States, 2005. MMWR Morb Mortal Wkly Rep. 2009;58:421–6.

    Google Scholar 

  5. Bagg JE Jr. The President’s physician. Tex Heart Inst J. 2003;30(1):1–2.

    Google Scholar 

  6. Travell JG, Simons DG. Myofascial pain and dysfunction: the trigger point manual. Baltimore: Williams and Wilkins; 1983.

    Google Scholar 

  7. Lavelle ED, Lavelle W, Smith HS. Myofascial trigger points. Med Clin North Am. 2007;91(2):229–39.

    Article  Google Scholar 

  8. Alvarez DJ, Rockwell PG. Trigger points: diagnosis and management. Am Fam Physician. 2002;65(4):653–60.

    Google Scholar 

  9. Roldan CJ, Hu N. Myofascial pain syndromes in the emergency department: what are we missing? J Emerg Med. 2015;49(6):1004–10. https://doi.org/10.1016/j.jemermed.2015.04.027.

    Article  Google Scholar 

  10. Srbely JZ, Kumbhare D, Grosman-Rimon L. A narrative review of new trends in the diagnosis of myofascial trigger points: diagnostic ultrasound imaging and biomarkers. J Can Chiropr Assoc. 2016;60(3):220–5.

    Google Scholar 

  11. Bourgaize S, Newton G, Kumbhare D, Srbely J. A comparison of the clinical manifestation and pathophysiology of myofascial pain syndrome and fibromyalgia: implications for differential diagnosis and management. J Can Chiropr Assoc. 2018;62(1):26–41.

    Google Scholar 

  12. Quintner JL, Bove GM, Cohen ML. A critical evaluation of the trigger point phenomenon. Rheumatology (Oxford). 2015;54(3):392–9. https://doi.org/10.1093/rheumatology/keu471.

    Article  Google Scholar 

  13. Denneny D, Frawley HC, Petersen K, McLoughlin R, Brook S, Hassan S, Williams AC. Trigger point manual therapy for the treatment of chronic noncancer pain in adults: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2019;100(3):562–77. https://doi.org/10.1016/j.apmr.2018.06.019.

    Article  Google Scholar 

  14. Barbero M, Schneebeli A, Koetsier E, Maino P. Myofascial pain syndrome and trigger points: evaluation and treatment in patients with musculoskeletal pain. Curr Opin Support Palliat Care. 2019;13(3):270–6. https://doi.org/10.1097/SPC.0000000000000445.

    Article  Google Scholar 

  15. Till SR, Wahl HN, As-Sanie S. The role of nonpharmacologic therapies in management of chronic pelvic pain: what to do when surgery fails. Curr Opin Obstet Gynecol. 2017;29(4):231–9. https://doi.org/10.1097/GCO.0000000000000376.

    Article  Google Scholar 

  16. Falsiroli Maistrello L, Geri T, Gianola S, Zaninetti M, Testa M. Effectiveness of trigger point manual treatment on the frequency, intensity, and duration of attacks in primary headaches: a systematic review and meta-analysis of randomized controlled trials. Front Neurol. 2018;9:254. https://doi.org/10.3389/fneur.2018.00254.

    Article  Google Scholar 

  17. Do TP, Heldarskard GF, Kolding LT, Hvedstrup J, Schytz HW. Myofascial trigger points in migraine and tension-type headache. J Headache Pain. 2018;19(1):84. https://doi.org/10.1186/s10194-018-0913-8.

    Article  Google Scholar 

  18. Bartley J, Han E, Gupta P, Gaines N, Killinger KA, Boura JA, Farrah M, Gilleran J, Sirls LT, Peters KM. Transvaginal trigger point injections improve pain scores in women with pelvic floor hypertonicity and pelvic pain conditions. Female Pelvic Med Reconstr Surg. 2019;25(5):392–6. https://doi.org/10.1097/SPV.0000000000000581.

    Article  Google Scholar 

  19. Moldwin RM, Fariello JY. Myofascial trigger points of the pelvic floor: associations with urological pain syndromes and treatment strategies including injection therapy. Curr Urol Rep. 2013;14:409. https://doi.org/10.1007/s11934-013-0360-7.

    Article  Google Scholar 

  20. Patel VB, Wasserman R, Imani F. Interventional therapies for chronic low back pain: a focused review (efficacy and outcomes). Anesth Pain Med. 2015;5(4):e29716. https://doi.org/10.5812/aapm.29716.

    Article  Google Scholar 

  21. Grover C, Christoffersen K, Clark L, Close R, Layhe S. Atraumatic back pain due to quadratus lumborum spasm treated by physical therapy with manual trigger point therapy in the emergency department. Clin Pract Cases Emerg Med. 2019;3(3):259–61. https://doi.org/10.5811/cpcem.2019.4.42788.

    Article  Google Scholar 

  22. Ribeiro DC, Belgrave A, Naden A, Fang H, Matthews P, Parshottam S. The prevalence of myofascial trigger points in neck and shoulder-related disorders: a systematic review of the literature. BMC Musculoskelet Disord. 2018;19(1):252. https://doi.org/10.1186/s12891-018-2157-9.

    Article  Google Scholar 

  23. Simons DG, Travell JG, Simons LS. Travell and Simons’ myofascial pain and dysfunction the trigger point manual. In: Upper half of body, vol. 1. 2nd ed. Baltimore: Williams & Wilkins; 1999.

    Google Scholar 

  24. Sikdar S, Shah JP, Gebreab T, et al. Novel applications of ultrasound technology to visualize and characterize myofascial trigger points and surrounding soft tissue. Arch Phys Med Rehabil. 2009;90:1829–38.

    Article  Google Scholar 

  25. Meister MR, Shivakumar N, Sutcliffe S, Spitznagle T, Lowder JL. Physical examination techniques for the assessment of pelvic floor myofascial pain: a systematic review. Am J Obstet Gynecol. 2018;219(5):497.e1–497.e13. https://doi.org/10.1016/j.ajog.2018.06.014. http://www.sciencedirect.com/science/article/pii/S0002937818305301.

    Article  Google Scholar 

  26. Bourgaize S, Newton G, Kumbhare D, Srbely J. A comparison of the clinical manifestation and pathophysiology of myofascial pain syndrome and fibromyalgia: implications for differential diagnosis and management. J Can Chiropr Assoc. 2018;62(1):26–41.

    Google Scholar 

  27. Gerwin RD. Classification, epidemiology, and natural history of myofascial pain syndrome. Curr Pain Headache Rep. 2001;5(5):412–20.

    Article  CAS  Google Scholar 

  28. Grosman-Rimon L, Clarke H, Chan AK, Mills PB, Rathbone ATL, Kumbhare D. Clinicians’ perspective of the current diagnostic criteria for myofascial pain syndrome. J Back Musculoskelet Rehabil. 2017;30(3):509–14. https://doi.org/10.3233/BMR-150380.

    Article  Google Scholar 

  29. Bourgaize S, Janjua I, Murnaghan K, Mior S, Srbely J, Newton G. Fibromyalgia and myofascial pain syndrome: two sides of the same coin? A scoping review to determine the lexicon of the current diagnostic criteria. Musculoskeletal Care. 2019;17:3–12. https://doi.org/10.1002/msc.1366.

    Article  Google Scholar 

  30. Donnelly JM, editor. Travell, Simons and Simons’ myofascial pain and dysfunction: the trigger point manual. Philadelphia: Wolters Kluwer Health; 2019.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Hall, B.H. (2020). Chronic Myofascial Pain, Fibromylagia, and Myofascial Trigger Points. In: Hall, B.H. (eds) Evaluation and Management of Chronic Pain for Primary Care. Springer, Cham. https://doi.org/10.1007/978-3-030-47117-0_18

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-47117-0_18

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-47116-3

  • Online ISBN: 978-3-030-47117-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics