Myofascial Trigger Points
Section snippets
Definitions
Myofascial pain syndrome is defined as sensory, motor, and autonomic symptoms that are caused by myofascial trigger points. The sensory disturbances that are produced are dysesthesias, hyperalgesia, and referred pain. Coryza, lacrimation, salivation, changes in skin temperature, sweating, piloerection, proprioceptive disturbances, and erythema of the overlying skin are autonomic manifestations of myofascial pain.
Travell and Simons [1] defined the myofascial trigger point as âa hyperirritable
Etiology
Trigger points may develop after an initial injury to muscle fibers. This injury may include a noticeable traumatic event or repetitive microtrauma to the muscles. The trigger point causes pain and stress in the muscle or muscle fiber. As the stress increases, the muscles become fatigued and more susceptible to activation of additional trigger points. When predisposing factors combine with a triggering stress event, activation of a trigger point occurs. This theory is known as the âinjury pool
Pathophysiology
There is no pathologic or laboratory test for identifying trigger points. Therefore, much of the pathophysiologic research on trigger points has been directed toward verifying common theories of their formation. Fig. 1 provides an example of the theory behind the formation of myofascial trigger points.
The local twitch response (LTR) has been described as a characteristic response of myofascial trigger points. LTR is a brisk contraction of the muscle fibers in and around the taut band elicited
Diagnosis
The diagnosis of myofascial pain is best made through a careful analysis of the history of pain along with a consistent physical examination [11]. The diagnosis of myofascial pain syndrome, as defined by Simons and colleagues [12], relies on eight clinical characteristics (Box 1). Identification of the pain distribution is one of the most critical elements in identifying and treating myofascial pain. The physician should ask the patient to identify the most intense area of pain using a single
Spray (freeze) and stretch
Travell and Simons [1] advocated passive stretching of the affected muscle after application of sprayed vapocoolant to be the âsingle most effective treatmentâ for trigger point pain. The proper technique depends on patient education, cooperation, compliance, and preparation. The patient should be positioned comfortably, ensuring that the trigger point area is well supported and under minimal tension. Position should place one end of the muscle with the trigger point zone securely anchored. The
Invasive techniques for management
Trigger point injection remains the treatment with the most scientific evidence and investigation for support. Typically, it is advocated for trigger points that have failed noninvasive means for treatment. Injections are highly dependent of the clinician's skill to localize the active trigger point with a small needle.
Various injected substances have been investigated. These include local anesthetics, botulism toxin, sterile water, sterile saline, and dry needling. One common finding with
The universal technique for injection
The patient should be positioned in a recumbent position for the prevention of syncope, assistance in patient relaxation, and decreased muscle tension. The trigger point must then be identified correctly. The palpable band is considered critical in the identification of the trigger point. This can be done with any of the three methods described above. The trigger point should be marked clearly. Then, the skin is prepared in a sterile fashion. Various physicians use different skin preparations
Local anesthetics
Local anesthetics are the substances that have been investigated most frequently for the treatment of myofascial trigger points. Local anesthetic injections were shown to improve measures on a pain scale, range of motion, and algometry pressure thresholds. The volume of local anesthetic injected also has been investigated, and small volumes are considered the most effective. Typically, less than 1 mL of local agent should be injected in a highly controlled manner. The primary use for a local
Summary
Myofascial pain syndromes are a widely recognized phenomenon among physicians and represent a common pain disorder in the American population. A myofascial trigger point is âa hyperirritable spot, usually within a taut band of skeletal muscle or in the muscle fascia. The spot is painful on compression and can give rise to characteristic referred pain, motor dysfunction, and autonomic phenomenaâ [1]. Many treatment strategies, both invasive and noninvasive, have been recognized for myofascial
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Lidocaine intensifies the anti-osteogenic effect on inflammation-induced human dental pulp stem cells via mitogen-activated protein kinase inhibition
2023, Journal of Dental SciencesCitation Excerpt :The survival rate and regeneration capacity of transplanted MSCs are influenced by various factors, including bone defect size, tissue damage, bacterial infection, inflammation, and co-injectable drugs.11,12 Local anesthetics (LAs) are commonly used for pain treatment in various clinical fields such as regional anesthesia, local infiltration, and nerve blocking.13,14 During cartilage repair operations in orthopedic surgery, intra-articular administration of human MSCs is often performed in the regions surrounding the damaged ligament or tendon, accompanied by intra-articular injection of LAs.15,16
Orofacial pain: Time to see beyond the teeth
2021, Journal of the American Dental AssociationCitation Excerpt :Myofascial pain is 1 of the many conditions included in this category. Traditionally, in the literature, the presence of myofascial trigger points has been proposed as a cause of sensory, motor, and autonomic symptoms of myofascial pain.24,25 A myofascial trigger point is defined as âa hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band.â26
Quality and readability of online information on myofascial pain syndrome
2021, Journal of Bodywork and Movement TherapiesCitation Excerpt :Myofascial pain syndrome (MPS) is a syndrome that manifests itself with muscle spasm accompanied by pain and pain caused by trigger points in the tense bands formed in the muscles and/or fascia, with restriction in joint range of motion, stiffness, fatigue, and sometimes autonomic dysfunctions (abnormal sweating, lacrimation increase, dermal flushing, vasomotor symptoms, and temperature change) (Lavelle et al., 2007).
Use of pressure dynamometer in the assessment of the pressure pain threshold in trigger points in the craniocervical muscles in women with unilateral migraine and tension-type headache: An observational study
2017, International Journal of Osteopathic MedicineCitation Excerpt :In contrast, latent TPs are painful only on palpation with similar characteristics to active TPs present in asymptomatic areas. When submitted to stress, these points might become active and, thus, generate pain syndromes and disability [19,20]. Although TPs are regarded an important source of muscle pain, their diagnosis is still done by physical examination, both for clinical and research purposes [18].
An overview of myofascial pain syndrome with a focus on trigger point injection
2023, Nurse Practitioner