Muscle Pain (Myofascial Pain Syndrome)

Optimal treatment of muscle pain (myofascial pain syndrome) can be a multifaceted approach.

• Muscle pain, tenderness, and spasm are characteristics of myofascial pain syndrome.
• Myofascial pain syndrome typically affects muscle in asymmetric areas of the body.
• The precise cause of myofascial pain syndrome is not known.
• Myofascial pain syndrome leads to localized pain in the muscle tissue.
• Poor sleep, fatigue, and stiffness are common in myofascial pain syndrome.
• Myofascial pain syndrome is simply diagnosed based on the areas of complaints of muscle pain and associated tenderness upon examination.
• Patients have the best prognosis when one physician oversees a multifaceted treatment approach and monitors the response to various therapies.

Myofascial pain syndrome is characterized by muscle pain, tenderness, and spasm. Myofascial pain syndrome usually involves muscle in body areas that are asymmetric or focal, whereas fibromyalgia is typically a diffuse and symmetric muscle pain syndrome that involves both sides of the body.

The cause of myofascial pain syndrome is unknown. Nevertheless, prior injury, poor sleep patterns, stressful life situations, and depression are common underlying conditions that may play a role in inciting and exacerbating myofascial pain syndrome. It is currently felt that risk factors such as these may lead to a change in the ability of the brain to properly process pain perception (referred to as central pain processing).

Myofascial pain may develop from a muscle injury or from excessive strain on a particular muscle or muscle group, ligament or tendon. Other causes include:

• Injury to intervertebral disc
• General fatigue
• Repetitive motions
• Medical conditions (including heart attack, stomach irritation)
• Lack of activity (such as a broken arm in a sling)

Myofascial pain syndrome causes localized muscle pain. Affected muscles cause the following:

• neck pain,
• upper back pain, and
• lower back pain, generally affecting one side of the body or one side of the body much more than the other.
• There is commonly tenderness and spasm in the painful areas and there may be tenderness in areas that are not feeling chronic pain.

It is also common for patients with myofascial pain syndrome to have poor sleep patterns with decreased recovery sleep (non-rapid-eye movement sleep). This is associated with awakening feeling unrested and daytime fatigue. Stiffness after inactivity is common.

Myofascial pain syndrome is commonly treated by primary-care physicians, including family medicine doctors, general practitioners, and internists. Other physicians who treat myofascial pain syndrome include physiatrists, orthopedists, and rheumatologists.

Physicians diagnose myofascial pain syndrome based on the areas of complaints of muscle pain and associated tenderness during a physical examination. Extensive laboratory testing is usually unnecessary. There are no appearance changes (redness, warmth, swelling, etc.) in areas of involvement. The appearance is the same as similar areas on the other side of the body. The widespread, diffuse body involvement that is typical of fibromyalgia is not present.

Optimal treatment of myofascial pain syndrome can be a multifaceted approach. This can include education of the patient,

• stress reduction,
• stretching and exercise programs as well as physical therapy rehabilitation,
• sleep improvement, and
• medications all best organized by a single physician who tailors the therapies over time by customizing them for the individual patient.

Medications used to treat myofascial pain syndrome can be directed toward various features of the individual's condition and may be used temporarily or longer term. Often trials of medications are used to find the best treatment for the particular patient. For example, trazodone (Serzone) or amitriptyline (Elavil) may be used at bedtime to improve sleep as well as relieve pain; cyclobenzaprine (Flexeril) or orphenadrine (Norflex) can be used at bedtime to relax muscles and to aid sleep; and antidepressants such as sertraline (Zoloft), fluoxetine (Prozac), duloxetine (Cymbalta) can be used to help control pain as can gabapentin (Neurontin) and pregabalin (Lyrica).

Home remedies for myofascial pain syndrome include

• exercise,
• massage,
• hot water soaks, and
• resting.

Ibuprofen (Motrin, Advil), acetaminophen (Tylenol), or naproxen (Aleve) can be beneficial in relieving symptoms of myofascial pain syndrome.

Myofascial pain syndrome can resolve with ideal treatment regimens. However, many patients with myofascial pain syndrome have symptoms for years. Outcomes are best when a multifaceted treatment approach is guided by a single physician who is monitoring the response to various therapies employed.

While myofascial pain syndrome cannot be prevented, it is certainly possible to avoid factors that make the condition worse. This includes avoiding reinjury, minimizing stress, maximizing optimal sleep, and treating any underlying depression.