Disease Description (Causes and Symptoms)
- Definition summary: Myofascial pain syndrome is a clinical syndrome in which localized pain trigger points develop in muscles and their fascia, causing tenderness, spontaneous pain, referred pain (radiating pain), and restricted movement in the affected muscles.
- Main causes: It is associated with overuse of muscles (repetitive work, overtraining), acute trauma, poor posture and functional loading, sustained muscle contraction, and psychological stress.
- Pathophysiology (brief): Excessive muscle contraction and localized changes at the neuromuscular junction are described as causing excessive acetylcholine secretion and reduced blood flow within the muscle, leading to the formation of pain trigger points that cause local and referred pain.
- Main symptoms: Localized tenderness (hard, band-like muscle), pain triggered by pressure or radiating to surrounding areas, deep and dull pain, limited range of motion, and fatigue. Depending on the location, associated symptoms such as headache, dizziness, tingling, and visual or auditory symptoms may occur.
- Diagnostic points: If there are no specific imaging or test findings and no neurological abnormalities (such as muscle weakness, sensory loss, or abnormal reflexes), the condition is diagnosed clinically when tenderness and referred pain are reproduced by pressing the pain trigger point.
Treatment Methods
- Basic principles: Use a multimodal approach (medication + physical therapy/injection treatment + stretching, exercise, and posture correction). Eliminating the cause (posture correction, improving the work environment, and stress management) is important.
- Medication
- Analgesic anti-inflammatory drugs (NSAIDs), acetaminophen: Short-term pain relief.
- Muscle relaxants (e.g., the cyclobenzaprine class): May help relieve muscle stiffness.
- Antidepressants (such as tricyclic antidepressants, or TCAs, or SNRIs): May be used to improve chronic pain and sleep (at the physician’s discretion).
- Topical agents: Lidocaine patches or topical NSAIDs may be used for symptom relief.
- Injections/Procedures
- Trigger point injection: Injecting the trigger point with a local anesthetic (sometimes excluding a small amount of steroid) to relax the muscle and relieve pain. Dry needling is also commonly used.
- Botulinum toxin: May be considered in some patients, but evidence is limited and cost and adverse effects should be taken into account.
- Physical Therapy and Rehabilitation
- Stretching (intentional relaxation), massage, manual therapy, heat and cold therapy, and electrotherapy such as ultrasound, low-intensity laser, and TENS.
- Prevent recurrence with muscle-strengthening, flexibility, and posture-correction exercise programs.
- Lifestyle Management and Other Measures
- Improve work and sleep posture, stretch regularly, and manage stress (rest, psychotherapy, and relaxation techniques).
- Prohibitions/precautions: Be aware of the risks of infection, vascular injury, and pneumothorax with injections (especially deep injections in the chest area), as well as medication side effects (gastrointestinal problems, drowsiness, and drug interactions).
- Treatment effects and course: Most patients improve with multimodal therapy, but if the cause is not eliminated or treatment is delayed, the pain may spread or become chronic.
Checklist Before an Outpatient Visit (Including Items to Bring and Sample Questions)
- Items to bring (recommended)
- A list of all medications and supplements currently being taken (including dosage and timing)
- A pain diary (when the pain began, location, intensity (e.g., 0–10), triggers, and relieving factors)
- Previous test results (electromyography, imaging tests) or medical records/prescriptions from other departments
- A body diagram showing the pain in detail (if possible)
- Things to check before the outpatient visit
- When the pain began and how it has progressed (acute vs. chronic)
- Whether it worsens with specific movements or postures
- Neurological symptoms (muscle weakness, decreased sensation, urinary or bowel problems, or worsening at night)
- Previous treatments (medication, physical therapy, injections, etc.) and whether they were effective
- Emergency signs that should be reported promptly (immediate referral required)
- Sudden, rapidly worsening pain, fever or systemic symptoms, definite muscle weakness or sensory loss, and urinary or bowel problems require immediate evaluation because they may indicate another serious disease (such as an infection or nerve root lesion).
Examples of General Questions to Ask the Doctor
- What are the possible side effects of this medication (or prescribed treatment)? What precautions should I take when using it?
- What specific self-care measures (stretching and exercise) are recommended, and when and for how long should I do them?
- If the pain does not improve, what is the next step in treatment (e.g., injections, botulinum toxin, or imaging evaluation)?
- What is the prognosis after treatment, and how can recurrence be prevented?
Examples of Condition-Specific Questions
- For a specific pain trigger point (e.g., the neck or scapular area), can you identify which postures or movements may trigger recurrence? (e.g., armrest use and monitor height during computer work)
- How long can the effects of a trigger point injection (or dry needling) be expected to last, and how often can the treatment be repeated?