Myofascial Pain
Myofascial pain refers to pain coming from "trigger points,"
which are mainly in muscles or in the tendons and ligaments that
connect muscles to bones. Some trigger points are easy to feel
as
“knots” in muscles, that hurt when pressed. Others
are quite hard to detect, and even skilled observers differ in
their findings when they examine people for trigger points. Because
of this, there is considerable controversy over what trigger points
really are, and what pain problems they cause. Some people believe
they are unimportant. Others believe they are common and severe,
and that many patients labelled as having "fibromyalgia"
are actually just suffering from multiple trigger points.
Myofascial pain may be right at the trigger point, but it may
also be a considerable distance away. For instance, a trigger point
in the low back may cause pain that goes all the way down the leg.
In that case, an examination of the leg alone will miss the trigger
point. This happens quite often and leads to frequent mis-diagnoses.
In the example just given, a diagnosis of sciatica (irritation
of the sciatic nerve) might be made, if the trigger point is missed.
Trigger points may be caused by injuries such as falls or traffic
accidents. They may be localized to one small area, or widespread,
depending on the original injury. Sometimes they are due not to
specific injuries, but to more chronic mechanical stress due to
repetitive tasks at work or at home; these can sometimes be eliminated
simply by changing the way the offending task is done. Trigger
points can also be due to other medical conditions, for instance
arthritis, or spinal disc disease. And sometimes, they have no
obvious cause at all.
Treatment of trigger points depends on the cause. Obviously, if
another illness is causing them, that needs to be taken care of
if possible. Old injuries may need to be treated in their own right,
and adjustments to the work environment may be necessary. But after
addressing all these "perpetuating factors" it is often
also helpful to treat the trigger points directly. This can be
done with specific types of massage, with stretching and exercises
the patient can do at home, with acupuncture or with injections.
(Injections can be of local anesthetics like lidocaine, of steroids
in small doses, or occasionally of long-lasting but expensive medications
like Botox.) Each method works for some people, some of the time.
We are fortunate to have practitioners in the office who are skilled
in each of the above treatment methods for myofascial pain.
Alan Spanos, MD, MA
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