Brief Overview: According to Cleveland Clinic, “myofascial pain syndrome is a chronic condition that affects your muscles and the fascia (thin connective tissue) around them. With myofascial pain syndrome, pressing on trigger points (knots) in your muscle causes localized or referred pain.”
Prevalence: Prevalence estimates vary widely.
Etiology: According to Cleveland Clinic, “Experts are still learning why some people are more prone to myofascial pain. Some of the most common causes seem to include: muscle injury, repetitive motions (like hammering), and poor posture.”
Risk Factors: According to Cleveland Clinic, risk factors include
- Muscle weakness.
- Lack of muscle activity (like having your leg in a cast).
- Working in or living in a cold environment.
- Emotional stress (can cause muscle tension).
- Pinched nerves.
- Metabolic or hormonal issues like thyroid diseaseor diabetes-related neuropathy.
- Vitamin deficiencies, including vitamin Dand folate.
- Chronic infections.
Commonly Associated Conditions:
- tension headaches
- idiopathic low back and cervical strain disorders
- repetitive strain syndromes
- occupational overuse syndrome
- cumulative trauma disorder
- work-related musculoskeletal disorder
- temporomandibular joint (TMJ) syndrome
Common Medications:
- NSAIDs or acetaminophen for pain relief.
- Muscle relaxants (cyclobenzaprine, tizanidine) for short-term relief.
- Antidepressants (amitriptyline, duloxetine) for chronic pain modulation.
- Anticonvulsants (gabapentin, pregabalin) if neuropathic features present.
- Topical agents (lidocaine patches, diclofenac gel).
- Trigger point injections with local anesthetic or corticosteroid.
Common Labs, Imaging, and Tests:
- Diagnosis is typically made clinically. Typically, no other testing is needed.
Common Symptoms:
- Pain
- Trigger points
- Sore, tender muscles
- Muscle weakness
- Decreased range of motion
- Headaches, fatigue, depression, anxiety, poor sleep quality, stress
Common Treatments:
- “Spray and stretch” = cold spray, then passive stretching
- Physical therapy
- Trigger point injections
- Dry needling
- Botox
- TENS
- Acupuncture
- CBT, biofeedback, relaxation
- Ultrasound therapy
Physical Findings:
- Palpable taut bands or “knots” in affected muscles.
- Local tenderness at trigger points.
- Referred pain pattern elicited by palpation.
- Decreased range of motion in affected muscle groups.
Potential Complications and Contraindications:
- Complications:
- Chronic disability, reduced mobility.
- Poor sleep, fatigue, depression.
- Deconditioning due to activity avoidance.
- Medication overuse (NSAIDs, muscle relaxants).
- Contraindications:
- Long-term NSAID use in seniors with GI, renal, or cardiovascular disease.
- Muscle relaxants in older adults: risk of falls, confusion.
- Frequent corticosteroid injections: tendon weakening, tissue damage.
General Health and Lifestyle Guidance:
- Encourage daily gentle stretching and low-impact activity (walking, yoga).
- Emphasize good posture and ergonomics (chairs, computer setup).
- Use heat therapy for muscle relaxation.
- Incorporate stress management (breathing exercises, meditation).
- Avoid prolonged inactivity - alternate activity and rest.
- Balanced diet and adequate hydration.
- Sleep hygiene to improve restorative rest.
Suggested Questions to Ask Patients:
- Where do you feel the pain, and what does it feel like?
- Do you notice “knots” or tender spots in your muscles?
- Does pressing on certain points make the pain radiate elsewhere?
- How does the pain affect your sleep or daily activities?
- What makes your pain better or worse (stress, activity, rest)?
- Do you take pain medications or muscle relaxers? How often?
- Have you tried physical therapy, stretching, or relaxation techniques?
Suggested Talking Points:
- Myofascial pain is caused by tight knots in the muscles that can refer pain to other areas.
- Treatment typically focuses on gentle exercise, stretching, posture, and stress reduction.
- Pain medications can help, but physical therapy and lifestyle changes are the most effective long-term.
- Using heat, massage, or relaxation techniques can help calm tense muscles.
- Staying active, even with light walking or stretching, can prevent pain from worsening.
Sources:
- https://www.uptodate.com/contents/overview-of-soft-tissue-musculoskeletal-disorders?search=myofascial%20pain%20syndrome&source=search_result&selectedTitle=1~50&usage_type=default&display_rank=1#H3
- https://my.clevelandclinic.org/health/diseases/12054-myofascial-pain-syndrome
- https://www.mayoclinic.org/diseases-conditions/myofascial-pain-syndrome/symptoms-causes/syc-20375444
This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.