From the Guidelines
Myofascial pain is a chronic pain condition characterized by discomfort and tenderness in the muscles and surrounding connective tissues called fascia, which can be effectively managed with manual physical therapy techniques, such as resolving pelvic, abdominal, and/or hip muscular trigger points, as recommended by the AUA guideline amendment 1. This condition typically involves specific trigger points, which are hypersensitive spots in taut bands of muscle that cause pain when pressed and can refer pain to other areas of the body.
- Key characteristics of myofascial pain include:
- Discomfort and tenderness in the muscles and surrounding fascia
- Presence of trigger points, which are hypersensitive spots in taut bands of muscle
- Pain referral to other areas of the body when trigger points are pressed
- The etiology of myofascial pain is not fully understood, but it is thought to involve sustained muscle contraction leading to reduced blood flow, causing the accumulation of inflammatory substances and sensitization of nerve endings, creating a cycle of pain and muscle tension 1.
- Treatment of myofascial pain usually involves a multimodal approach, including:
- Manual physical therapy techniques, such as myofascial physical therapy, which has been shown to provide symptom relief in patients with interstitial cystitis/bladder pain syndrome 1
- Stretching exercises and massage therapy to release tension in the affected muscles and connective tissues
- Trigger point release techniques, such as dry needling or lidocaine injections, to break the cycle of pain and muscle tension
- Medications, such as muscle relaxants and non-steroidal anti-inflammatory drugs, may also be used to help manage myofascial pain, but the primary focus should be on addressing the underlying muscle and connective tissue abnormalities through manual physical therapy techniques, as recommended by the AUA guideline amendment 1.
From the Research
Definition and Characteristics of Myofascial Pain
- Myofascial pain syndrome (MPS) is a musculoskeletal pain condition that stems from localized, taut regions of skeletal muscle and fascia, termed trigger points 2.
- It is a regional musculoskeletal pain disorder characterized by trigger points within the muscle or fascia 3.
- MPS is a chronic regional pain condition characterized by trigger points-hyperirritable spots within taut bands of muscle fibers that cause both localized and referred pain 4.
Prevalence and Impact
- MPS can present acutely, but it frequently presents as a chronic condition, affecting up to 85% of adults during their lifetime 2.
- The prevalence of MPS is generally increased among patients with other chronic pain disorders and has been associated with various other conditions such as bladder pain syndrome, endometriosis, and anxiety 2.
- Myofascial pain syndromes arise from acute and chronic musculoskeletal pain and often have a referred neuropathic component, affecting more than three quarters of the world's population 5.
Diagnosis and Treatment
- Diagnosis is made by clinical examination for the presence of myofascial trigger points, though some ancillary tests may provide supportive evidence 5.
- The mainstay of treatment is regular physical therapy with the goal of restoration of normal muscle laxity and range of motion 5.
- A multimodal approach is recommended, involving patient education, exercise, behavior modification, pharmacotherapy, and procedural interventions 3.
- Commonly used treatments include trigger point injections, dry needling, acupuncture, kinesiology tape, transcutaneous electrical nerve stimulation, extracorporeal shockwave therapy, and low-level laser therapy 3, 4.