Myofascial Pain Syndrome (MPS)

          Myofascial pain syndrome (MPS) is a chronic pain condition that affects the musculoskeletal system. Most people experience muscle soreness, which usually resolves on its own after a few weeks. But for some people, muscle pain persists. In people with myofascial pain syndrome (MPS), tender points are known as trigger points. These areas occur in tight bands (fascia) of muscles. When pressure is applied to these trigger points, pain occurs in a different part of the body.

                      Common symptoms of MPS include:

• Deep pain in localized areas of the muscles

• Pain that gets worse when the affected muscle is stretched

• Muscle pain that worsens or does not improve over time

• Presence of painful nodes that produce intense localized or directed pain when the muscles are pressed

• Muscles that are weak, stiff, inflexible, or have a reduced range of motion

• Sleep and mood disorders

            Most people with skeletal muscle pain and fatigue have fibromyalgia or MPS. Fibromyalgia is a common muscle pain disorder. It can be felt throughout the entire body. However, people with MPS experience localized pain in regional muscle groups such as the back, neck, or jaw.

         MPS is characterized by several localized trigger points in tense bands of muscles. These trigger points are sensitive and can cause localized pain. But their defining characteristic is that they trigger the specified pain. Fibromyalgia is associated with multiple, more common tender points. These are different from trigger points because they do not cause referred pain.

           Trigger points occur due to muscle overuse, muscle trauma (injury), or psychological stress. Trigger points are also often caused by repetitive activities at work, such as lifting heavy objects or working at a computer all day. No single factor is responsible for the development of myofascial trigger points. A combination of contributing factors may include:

• Poor posture

• Sitting in awkward positions for a long time

• Nutritional deficiencies

• Serious lack of exercise or movement

• Any injury to the musculoskeletal system or intervertebral discs

• Generalized fatigue

• Insomnia

• Hormonal changes (menopause)

• Rapid and intense cooling of the muscles (for example, while sleeping in front of an air conditioner)

• Emotional problems (depression, anxiety)

• Obesity

• To smoke

         A physical examination is first performed for myofascial trigger points. Your doctor will look for tender nodules in the tight bands of your muscles and press on them to find a pain response. When you press a trigger point, your doctor will feel a twitch in the muscle (also called a “jump cue”).

      There are no other tests that can show the presence of MPS. It is very important to tell your doctor about all your current symptoms and past injuries or surgeries.

       There are several different myofascial triggers points your doctor may find, including:

• Active trigger points: Trigger points are nodules within a taut muscle band. It is often the source of muscle pain. They are very sensitive, causing pain and twitching when touched.

• Hidden trigger points: These nodules do not cause pain when touched. They can remain dormant for years and become active when stress or trauma occurs.

• Secondary trigger point: This is a sore spot in the muscle that becomes active when another muscle is stressed.

• Satellite myofascial point: This is a painful spot that becomes active because it is located near another trigger point.

                                                   Treatments

Myofascial pain syndrome requires a versatile treatment plan. Many people combine medications with other treatments that relieve muscle stiffness and pain. Several medications can relieve the symptoms of MPS, including:

• NSAID (Non-steroidal anti-inflammatory): Over-the-counter medications such as acetaminophen and ibuprofen can relieve pain and swelling.

• Analgesics: Pain relievers such as lidocaine patch, tramadol, and COX-2 can be considered.

• Muscle relaxants: Benzodiazepines and tizanidine can reduce muscle spasms.

• Anticonvulsants: Gabapentin and pregabalin can relieve pain and reduce muscle spasms.

• Tricyclic antidepressants: Indicated to treat chronic pain, fibromyalgia and nerve pain, which are conditions similar to MPS.

• Botox injections: Botulinum type A is a potent neurotoxin that inhibits muscle contractions and can have pain-relieving effects.

                              dry needling

          Dry needling is one of the fastest ways to neutralize myofascial trigger points. Your doctor will insert the special needle directly into the trigger point, move it in a circle, and insert it in and out. It can be painful, but it is one of the most effective ways to neutralize the trigger point and reduce pain.

                          trigger point injections

       Trigger point injections are like dry needling, but only a solution is injected into the tissue. Typically, doctors inject a local anaesthetic such as saline or lidocaine. Its effects are comparable to dry needling, but the procedure may cause less discomfort. Trigger-point injections with steroids are also an option.

                                      ultrasound therapy

    Ultrasound machines transmit sound waves to tissue through a sound-conducting gel applied to the skin. Sound waves can warm and relax muscles, improve blood flow and relieve spasms. Pain-relieving effects may be minimal. However, this treatment can reduce stiffness and increase mobility if done before stretching.

                                         massage therapy

       There are a variety of massage treatments that can relieve myofascial trigger points. Massage therapy increases blood flow and warms the muscles. This can help reduce stiffness and relieve pain. The massage therapist may use their thumb to put pressure on your trigger points, which exacerbates the pain and then releases muscle tension.

                                                      Spray and stretch

    Stretching helps many people with MPS. Some physical therapists apply a cold spray to the muscle area before stretching someone. There are also some gentle exercises and stretches you can try at home to reduce pain.

                                   What You Can Do Yourself

          There are several steps you can take at home to reduce pain and improve your quality of life.

• Choose a better chair at work and improve your posture.

• Try adjusting your computer’s height so that it falls within your natural eye line.

• Try a new mattress or adjust your sleeping position.

• Practice yoga, Pilates or another stretching technique. For people with fibromyalgia symptoms, these pilates exercises can also help your MPS symptoms.

• Wear back support when doing the heavy lifting.

• Use a personal massager or vibrating device.

• Start an exercise program and move your muscles every day.

• Consult a mental health professional and reduce your stress level.

• Use an ice pack immediately after any muscle injury.

• Use heat to treat muscle inflammation.

• Take a warm bath.

• Use a traction device.

• Be mindful to manage pain.

                            Complications

          Myofascial pain syndrome can affect your quality of life. You may not be able to participate in physical activities done for pleasure. This can lead to depression and isolation. MPS can also affect your mobility. Seeking treatment, finding a support group, and talking to friends and family can help when symptoms first develop.