Myofascial pain is pain which originates from skeletal muscular in the body. Skeletal muscle is the most abundant tissue in the human body. More than 600 muscles work to aid the body in movement and stability. When muscle tissue is healthy, movement can be performed through a wide range of positions without discomfort or pain. Any injury to the skeletal muscle will produce a condition called myofascial pain syndrome (pain from muscles or associated connective tissue, known as fascia). This condition may be may be primary or secondary. Primary myofascial pain is when the condition is entirely muscular in nature, and secondary myofascial pain is muscle pain associated with or a secondary affect from spinal or other maladies.
Symptoms of myofascial pain include muscle which is tender to palpation, pain from being in certain positions for a period of time, or pain which can be reproduced upon movement. Primary myofascial pain may be caused by injury, over utilization, emotional distress, poor posture, exposure to extreme temperatures, or even lack of regular exercise. Damage to the muscle leads to inflammation, swelling, and pain. If this becomes persistent, muscle fibers can contract making the area feel very tender, firm, or like a hard lump. This is called a myofascial trigger point.
As with most pain conditions, most of the time healing will occur spontaneously or with conservative treatment. However at times healing is not complete, or if the damage is beyond what the body’s normal healing mechanisms can treat, the condition becomes chronic. If left untreated, this can lead to dysfunction within the musculoskeletal system, leading to chronic pain. Symptoms may include tingling, numbness, loss of range of motion, function, and mobility.
Most joint and spine conditions will have a component of secondary myofascial pain. It is very difficult to differentiate primary versus secondary myofascial pain in the acute phase (first one to two months) of the injury. Fortunately, whether the condition involves a muscle sprain or strain, internal joint derangement, or spinal injury, initial treatment is similar. It usually involves first cold then heat application, anti-inflammatory and other medications, and physical therapy. If symptoms persist then an appropriate work up and pain management evaluation is in order. If the muscular pain is felt to be primarily in nature, and trigger points exist, then trigger point therapy can be very beneficial. Trigger points maybe treated with pressure therapy, whereby one tries to break up the trigger point externally with pressure treatment. However this can be somewhat uncomfortable. More commonly, interventional therapy involve “breaking up” the trigger point with an ejection of anesthetic and corticosteroid. An injection into the trigger point may be both diagnostic and therapeutic. If the injection relieves the pain then a myofascial component has been established. Most patients will also see a 50% reduction of their pain from a single treatment. Additional treatment should bring additional benefit.
If temporary benefit is achieved then an ablation techniques may be utilized. More permanent ablation techniques which are most appropriate for these conditions include botulism toxin injections or cryoablation. Botox is FDA indicated for specific myofascial conditions such as cervical dystonesia and cervical myofascial headaches. However, I have also utilized this for general cervical tension headache, and cervical and lumbar myofascial pain conditions. Cryoablation is a freezing technique whereby a probe which cools to minus 60 degrees Celsius is placed into a painful area. This may be utilized for more localized myofascial trigger points, but can also be used for pain in various ligaments. Other indications may be for supporting structures of various joints, pain within scar tissue, and neuromas of the hand and feet.
In conclusion, myofascial pain is extremely common, as either a primary condition, or secondary to other injuries. If conservative and other treatments fail, trigger point injection therapy may be indicated. These treatments are extremely simple and safe to administer in the office setting. Any patient who has residual pain after physical therapy, epidural or other spinal injections, or even surgery may be an appropriate candidate. I have aided a great number of patient with these conditions. The risk of such treatments are extremely low and the benefits may be extremely great.