Myofascial Pain

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Routine X-rays, EMG, or MRI studies do not provide specific clues to myofascial pain. Myofascial trigger points is aggravated by dry,cold, or humid weather, overuse or over activity, stress, anxiety or depression. Poor sleep is also common in people with myofascail pain.

In response to the question "Do you sleep well?" 66% of patients describe their sleep to be poor. However 90% of patients complain of "morning fatigue". Poor sleep may be indicated by difficulty falling asleep, waking up frequently, light sleep, increased dreams and morning fatigue. Approximately 85% of patients with myofascial pain complain of general tiredness, generalized weakness. This fatigue is aggravated by physical activity and can cause significant dysfunction in daily activity.

Pain caused by myofascial TPs can reveal itself to the physician in various ways. The most common symptoms relate to the neck, shoulders, upper extremity, fascial area, low back and lower extremity. In one study of 164 patients done by Fricton, et al, the pain was variously described as pressure (48%) dull (26%) sharp (18%) and heavy (14%).

Myofascial pain can also manifest itself as dizziness, tingling sensation, or headaches.

The neck muscles are a frequent and vastly overlooked cause of headaches. Patients are diagnosed with "migraine headaches" and treated unsuccessfully with a long list of pain medication or migraine medications. Frequently, careful examination reveals that the patient's pain originates from trigger points in the neck muscles.

The most important part of the treatment is to make the patient understand that the pain he is suffering is not from a pinched nerve or arthritic joint. It is not coming from inflamed tendons or bursae, but is arising from his muscles. More important is to re-assure patients that trigger point pain can be relieved by specific treatments.

The treatment involves multi-modality treatments. These treatments may begin by identifying the factors which perpetuate and complement the pain. Then the pain physician may continue with trigger point injections, and non narcotic pain medication. Of course since the problem involves every aspect of the patient's life, the physician will treat the patient's entire body by treating sleep disturbance, and then by assisting in neuromuscular conditioning, flexibility of muscles, and endurance. Finally, the psychic parts of the problem may be addressed; secondary depression is alleviated and cognition is improved by mediation while stress and anxiety are treated with supportive psychotherapy.