The most common causes of the neck and back pains are fibromyalgia and myofascial pain syndrome (MPS), which are categorized in the group of soft tissue rheumatisms. In MPS, there are trigger points affecting one or a few regional muscles. Palpation of these points initiates referred pains. MPS is a chronic pain syndrome.
MYOFASCIAL PAIN SYNDROME
What Causes MPS?
The etiology of MPS is not elucidated yet. The postural faults of the modern human, the increase of people working at a desk, using mobile phone, and laptop may be the risk factors increasing the incidence of the MPS.
In MPS, pain may suddenly emerge due to the excessive use and stretching of the muscles, trauma, cold, stressful working conditions, stress and abnormal posture. Besides these, the pain may develop gradually depending on chronic muscle fatigue and recurrent microtraumas. It is more common among females. Vitamin and mineral deficiencies, infections, endocrine diseases like goiter, depression, and anxiety may pave the way for MPS.
What are the Clinical Complaints?
In MPS patients, the compression of small nerve endings within the cramped muscle fibers together with the compression of the capillaries creates a pain generator. The pain is persistent and causes generally a burning sensation. Muscles stiffness, limitation in joint mobility and fatigue may accompany the pain. The onset may sudden or slow. Cold weather, stress, viral infections, and insomnia may aggravate the pain
The patients may complain from a headache, lumbar and neck pain, joint pain and pain caused by herniation like sciatica. In patients, who have trigger points at the nape of the neck, a pain spreading from the neck to the temporal area, which is often confused with migraine, may occur. Morning stiffness and limited movement may be observed. The patient complains from fatigue and weakness during the daily activities..
How is MPS Diagnosed?
A good anamnesis and physical examination are sufficient for the diagnosis. Palpation of the painful area enables the detection of the trigger points. The tenderness is very characteristic. The compression of the trigger points with fingers causes the projection of the pain to other regions and fasciculation can be observed in the muscle.
The goal of the treatment is to eliminate the trigger points, which cause pain and stiffness and thus to interrupt the pain-spasm cycle. The MPS treatment program should be determined according to the findings of the physical examination and the complaints of the patient.
The first-line treatment is physiotherapy. Local physiotherapy methods like medical massage, heat, electrotherapy, laser, ESWT are effective in the elimination of the trigger points. The exercise programs intended to correct the postural faults and to relax the cramped muscle constitute the base of the treatment.
Injection methods like dry needling, trigger point injections with local anesthetics, prolotherapy, neuraltherapy and PRP may provide recovery in suitable patients.
Muscle relaxants and analgesics may be used for the symptomatic treatment of pain and muscle spasms. In addition, antidepressants and drugs indicated in neuropathic pain may be useful.
Psychotherapy and training programs including behavioral methods can be used for the treatment of chronic pain.