Myofascial Pain Syndrome

Hi,

I am Dr. Sidharth Verma, Pain Management Specialist and today I will talk about myofascial pain syndrome. Although this is a very uncommon term to the most patient. But this is the most common pain which we see in our OPD. So, this is so common that around 60% of the patients who come with the musculoskeletal pain are suffering from myofascial pain syndrome. So, my means muscles and fascial means facias. So, this is the soft tissue pain. Typically this presents when a patient suddenly complaints of pain in some muscle belly, some portion of his body. It persists for a long duration of time. The patient takes some painkillers, some tablets, get some massage and all done but he is not relieved typically. And the characteristic point for this myofascial pain is the presence of active and passive trigger points. There is a difference between trigger and tender points. In trigger points, the pain spread to the muscles.

And on the tender point, the pain is localized to the portion where you have applied the pressure. These trigger points are nothing but they are the areas of dysfunctional muscles because of various factors. The exact cause is not known. But some theories say that there is some dysfunctional blood flow to those areas and this results in ischemia, later on, the nerves fiber becomes hypersensitize. And this is how the pathogenesis occurs. And when there are multiple tender or trigger points throughout this belly of muscles then this results in a lot of pain and discomfort for the patient. This is usually not relieved by medications, massage, stretching, exercises. And then the patient goes for some investigation like MRI and that is also even normal. The patient is more confused as well as Dr. However if this syndrome is kept in mind then a lot of patients can get the benefit. It is also known as soft tissue pain.

Coming to the clinical features. This can vary from pain on touching, pain on activity, psychological symptoms like depression, loss of interest, this all can happen due to this syndrome. Because beyond the point when this persists the area or regional involvement starts recurring more and more and because of this muscles fibers are affected. This results in a lot of discomfort for the patient and the amplification of the symptoms. How to diagnose and treat it? When the patient comes to us with soft tissue pain, we immediately diagnose. It is a clinical diagnosis. However, the newer modality is the infra-red cameras pick up the areas with lesser temperature nowadays. And this is a clinical diagnosis. So, many of the good physiotherapists also pick-up this syndrome very well. They try to treat it with dry-needling, exercises, other physical activities. However, in many cases, the pain is still persistent. The syndrome still exists. That is when the patient comes to us. If patient early walk-in, we identify this and immediately give the treatment. So, the treatment here is very straight-forward. Almost gives the 100% result. However, the treatment needs to be repeated at frequent intervals.

It has to be clubbed to rule out the possible causes and eliminating them. Let's say that the patient comes with neck pain, if I examine, I find that they have a lot of tender points, the patient is having neck pain due to which he is not able to move. Then possibly I will try to find out what are his activities like long hour sitting, travels a lot or what are other activities which can possibly lead to this problem. Once I start treating the patient, simultaneously, we also try to take away this bad habit and inculcate good habits in the patient. We try to educate them about their symptoms in addition to the pharmacological treatment, interventional treatment. We add exercises so that the patient can have good strength. We add stretching. We may take the help of physiotherapists. This may result in complete resolution very fast. So, what are the interventions that we do in this syndrome? We do trigger points injection. Ultrasound-guided trigger points needling. In this, we locate the most tender points. Then we infiltrate with small anesthetic as well as sometimes we add a low dose of local anti-inflammatory agents.

What does this drug do? Helps in eliminating local inflammation and needling portion increases the blood flow which results in active healing. The patient develops the muscles strength and results in resolution to the symptom. Dry-needling is another symptom which is commonly used. It has a very specific indication. We can typically see the twitches which are present once the needle touches the tender points or the trigger zone. Once the needling is done, the resolution is very good and the results are very nice. This procedure is common in post-surgical patients like cancer and other patients who are suffering from other illnesses. Results are excellent. It is also helpful if we do the blood investigation also of these patients. Many of these patients have found deficient in vitamin-B & B12. This can be replenished. Bioenergiser also found to be helpful in these patients. So, if you are suffering from chronic muscle pain, you have a lot of massages, you went to a trusted physiotherapist but not able to help you fully. Earlier you used to get well but now you are not getting well. Again the pain is persisting. So, please don't suffer. Come to a pain relief centre. We will try our best to help you. And the earlier you, the better the results are. Don't ignore myofascial pain syndrome. It can magnify and often become very difficult to treat in the later stages. To know more you can visit my Lybrate website.

Thank You!