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Myofascial pain: Diagnosis and management

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Abstract

Clinical understanding and management of myofascial pain is overlooked frequently when dealing with pain. Myofascial pain is defined as pain or autonomic phenomena referred from active trigger points, with associated dysfunction. The trigger point is a focus of hyperirritability in the muscle that, when compressed, is locally tender and, if sensitized, gives rise to referred pain and tenderness. The pain quality is dull or achy and associated with autonomic changes. Myofascial pain is poorly understood, which results too often in underdiagnosis and poor management. The pathogenesis likely has a central mechanism with peripheral clinical manifestations. The therapy for myofascial pain requires enhancing central inhibition through pharmacology or behavioral techniques and simultaneously reducing peripheral inputs through physical therapies including exercises and trigger point-specific therapy.

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References and Recommended Reading

  1. Scher AI, Stewart WF, Liberman J, Lipton RB: Prevalence of frequent headache in a population sample. Headache 1998, 38:497–506.

    Article  PubMed  CAS  Google Scholar 

  2. Olesen J, Jensen R: Getting away from simple muscle contraction as a mechanism of tension-type headache. Pain 1991, 46:123–124.

    Article  PubMed  CAS  Google Scholar 

  3. Headache Classification Committee of the International Headache Society: International Classification of Headache Disorders II. Cephalalgia 2004, 24(suppl):1–160. Important in the understanding of myofascial pain.

    Google Scholar 

  4. Schoenen J, Bottin D, Hardy F, Gerard P: Cephalic and extracephalic pressure pain thresholds in chronic tensiontype headache. Pain 1991, 46:145–149.

    Article  Google Scholar 

  5. Reeves JL, Jaeger B, Graff-Radford SB: Reliability of the pressure algometer as a measure of myofascial trigger point sensitivity. Pain 1986, 24:313–321.

    Article  PubMed  CAS  Google Scholar 

  6. Steinder A: The interpretation of the sciatic radiation and the syndrome of low back pain. J Bone Joint Surg 1940, 22:28–34.

    Google Scholar 

  7. Drewes AM, Jennum P: Epidemiology of myofascial pain, low back pain, morning stiffness, and sleep-related complaints in the general population. J Musculoskel Pain 1995, 3(suppl 1):68.

    Google Scholar 

  8. Rivner MH: The neurophysiology of myofascial pain syndrome. Curr Pain Headache Rep 2001, 5:432–440.

    Article  PubMed  CAS  Google Scholar 

  9. Gerwin RD: Classification, epidemiology, and natural history of myofascial pain syndrome. Curr Pain Headache Rep 2001, 5:412–420. Critical study.

    Article  PubMed  CAS  Google Scholar 

  10. Simons DG, Travell JG, Simons LS: The Trigger Point Manual, vol 1, edn 2. Baltimore: Lippincott Williams and Wilkins; 1998.

    Google Scholar 

  11. Fricton JR: Masticatory myofascial pain: an explanatory model integrating clinical, epidemiological, and basic science research. Bull Group Int Rech Sci Stomatol Odontol 1999, 41:14–25.

    PubMed  CAS  Google Scholar 

  12. Svensson P, List T, Hector G: Analysis of stimulus-evoked pain in patients with myofascial temporomandibular pain disorders. Pain 2001, 92:399–409.

    Article  PubMed  CAS  Google Scholar 

  13. Fricton JR, Kroening R, Haley D, Siegert R: Myofascial pain syndrome of the head and neck: a review of clinical characteristics of 164 patients. Oral Surg Oral Med Oral Pathol 1985, 60:615–623.

    Article  PubMed  CAS  Google Scholar 

  14. Fricton JR: Myofascial pain: clinical characteristics and diagnostic criteria. J Musculoskel Pain 1993, 1:37–47.

    Article  Google Scholar 

  15. Han SC, Harrison P: Myofascial pain syndrome and triggerpoint management. Reg Anesth 1997, 22:89–101.

    Article  PubMed  CAS  Google Scholar 

  16. Fricton JR, Olsen T: Predictors of outcome for treatment of temporomandibular disorders. J Orofac Pain 1996, 10:54–65.

    PubMed  CAS  Google Scholar 

  17. Graff Radford SB, Reeves JL, Jaeger B: Management of chronic head and neck pain: effectiveness of altering factors perpetuating myofascial pain. Headache 1987, 27:186–190.

    Article  PubMed  CAS  Google Scholar 

  18. Kraft GH, Johnson EW, Laban MM: The fibrocytis syndrome. Arch Phys Med Rehabil 1968, 49:155–162.

    PubMed  CAS  Google Scholar 

  19. Cairns BE, Sim Y, Bereiter DA, et al.: Influence of sex on reflex jaw muscle activity evoked from rat temporomandibular joint. Brain Res 2002, 957:338–344.

    Article  PubMed  CAS  Google Scholar 

  20. List T, Wahlund K, Wenneberg B, Dworkin SF: TMD in children and adolescents: prevalence of pain, gender differences, and perceived treatment need. J Orofac Pain 1999, 13:9–20.

    PubMed  CAS  Google Scholar 

  21. Riley JL, Gilbert GH, Heft MW: Orofacial pain symptom prevalence: selective sex differences in the elderly? Pain 1998, 76:97–104.

    Article  PubMed  Google Scholar 

  22. Kellgren JH: Observations on referred pain arising from muscle. Clin Sci 1938, 3:175–190.

    Google Scholar 

  23. Dohrenwend BP, Raphael KG, Marbach JJ, Gallagher RM: Why is depression comorbid with chronic myofascial face pain? A family study test of alternative hypotheses. Pain 1999, 83:183–192.

    Article  PubMed  CAS  Google Scholar 

  24. Gallagher RM, Verma S: Managing pain and comorbid depression: a public health challenge. Semin Clin Neuropsychiatry 1999, 4:203–220.

    PubMed  CAS  Google Scholar 

  25. Michelotti A, Martina R, Russo M, Romeo R: Personality characteristics of temporomandibular disorder patients using M.M.P.I. Cranio 1998, 16:119–125.

    PubMed  CAS  Google Scholar 

  26. Esenyel M, Caglar N, Aldemir T: Treatment of myofascial pain. Am J Phys Med Rehabil 2000, 79:48–52.

    Article  PubMed  CAS  Google Scholar 

  27. Buskila D: Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome. Curr Opin Rheumatol 2001, 13:117–127.

    Article  PubMed  CAS  Google Scholar 

  28. Frank EM: Myofascial trigger points diagnostic criteria in the dog. J Musculoskel Pain 1999, 7:231–237.

    Article  Google Scholar 

  29. Okeson JP: Orofacial Pain: Guidelines for Assessment, Diagnosis, and Management. Chicago: Quintessence Books; 1996.

    Google Scholar 

  30. Fisher AA, Chang CH. Objective documentation of myofascial trigger points by thermography. Pain 1984, 1(suppl):S137.

    Article  Google Scholar 

  31. Sola AE, Williams RL: Myofascial pain syndromes. Neurology 1956, 6:91–95.

    PubMed  CAS  Google Scholar 

  32. Simons DG, Hong CZ, Simons LS: Endplate potentials are common in midfiber myofascial trigger points. Am J Phys Med Rehabil 2002, 81:212–222.

    Article  PubMed  Google Scholar 

  33. McNulty W, Gevirtz RN, Hubbard DR, Berkoff GM: Needle electromyographic evaluation of trigger point response to a psychological stressor. Psychophysiology 1994, 31:313–316.

    Article  PubMed  CAS  Google Scholar 

  34. Awad EA: Interstitial myofibrositis: hypothesis of the mechanism. Arch Phys Med 1973, 54:440–443.

    Google Scholar 

  35. Fassbender HG: Pathology of Rheumatic Diseases. New York: Springer-Verlag; 1975.

    Google Scholar 

  36. Shah JP, Phillips T, Danoff JV, Gerber L: Novel microanalytical technique distinguishes three clinically distinct groups: 1) subjects without pain and without myofascial trigger points; 2) subjects without pain and with myofascial trigger point; 3) subjects with pain and myofascial trigger point. Am J Phys Med Rehabil 2004, 83:231.

    Google Scholar 

  37. Mense S: Referral of muscle pain new aspects. Pain Forum 1994, 3:1–9.

    Google Scholar 

  38. Mense S: Considerations concerning the neurobiological basis of muscle pain. Canad J Physiol Pharm 1991, 9:610–616.

    Google Scholar 

  39. Mense S: Nociception from skeletal muscle in relation to clinical muscle pain. Pain 1993, 54:241–289.

    Article  PubMed  CAS  Google Scholar 

  40. Simons DG: Neurophysiological basis of pain caused by trigger points. APS Journal 1994, 3:17–19.

    Article  Google Scholar 

  41. Pedersen-Bjergaard U, Nielsen LB, Jensen K, et al.: Calcitonin gene related peptide, neurokinin A and substance P on nociception and neurogenic inflammation in human skin and temporal muscle. Peptides 1991, 12:333–337.

    Article  PubMed  CAS  Google Scholar 

  42. Fields HL, Heinricher M: Brain stem modulation of nociceptor-driven withdrawal reflexes. Ann NY Acad Sci 1989, 563:34–44.

    Article  PubMed  CAS  Google Scholar 

  43. Ernberg M, Hadenberg-Magnusson B, Alstergren P, et al.: Pain, allodynia, and serum serotonin level in orofacial pain of muscular origin. J Orofac Pain 1999, 13:56–62.

    PubMed  CAS  Google Scholar 

  44. Graff Radford SB, Reeves JL, Jaeger B: Management of headache: the effectiveness of altering factors perpetuating myofascial pain. Headache 1987, 27:186–190.

    Article  PubMed  CAS  Google Scholar 

  45. Mennell JM: Spray-stretch for relief of pain from muscle spasm and myofascial trigger points. J Am Pod Assoc 1976, 66:873–876.

    CAS  Google Scholar 

  46. Jaeger B: Myofascial referred pain patterns: the role of trigger points. CDA J 1985, 13:27–32.

    PubMed  CAS  Google Scholar 

  47. Graff-Radford SB: Principals of orofacial pain management. CDA J 2003, 31:428–433.

    Google Scholar 

  48. Maitland GD: Vertebral Manipulation, edn 4. London: Butterworths; 1977.

    Google Scholar 

  49. Solberg WK: Temporomandibular disorders: masticatory myalgia and its management. Br Dent J 1986, 160:379–385.

    Article  PubMed  CAS  Google Scholar 

  50. Reeves JL. EMG-biofeedback reduction of tension headaches: a cognitive skills training approach. Biofeedback Self Regul 1976, 1:217–225.

    Article  PubMed  CAS  Google Scholar 

  51. Holroyd KA, Andresik F, Westbrook T: Cognitive control of tension headaches: a cognitive skills training approach. Cognit Ther Res 1977, 1:121–133.

    Article  Google Scholar 

  52. Graff-Radford SB: P Regional myofascial pain syndromes and headache, principals of diagnosis, and management. Curr Pain Headache Rep 2001, 5:376–381.

    Article  PubMed  CAS  Google Scholar 

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  1. The Pain Center, Cedars-Sinai Medical Center, 444 South San Vicente Blvd., #1101, 90048, Los Angeles, CA, USA

    Steven B. Graff-Radford DDS

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  1. Steven B. Graff-Radford DDS
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Graff-Radford, S.B. Myofascial pain: Diagnosis and management. Current Science Inc 8, 463–467 (2004). https://doi.org/10.1007/s11916-004-0068-y

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  • DOI: https://doi.org/10.1007/s11916-004-0068-y

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