Treatment of Myofascial Pain Syndrome
Myofascial Pain Syndrome (MPS) is a painful musculoskeletal condition, characterized by the development of Myofascial trigger points (TrPs), that are locally tender when active and refer pain through specific patterns to other areas of the body.
Goal of Treatment
The key goal of treatment of the Myofascial Pain Syndrome is targeted at the trigger points. A trigger point is a knot or a tight, ropy band of muscle that forms when muscles fails to relax as normal muscle should.
The trigger point can trap or irritate surrounding nerves and cause referred pain, which is felt in another part of the body. Scar tissue, loss of range of motion and weakness may also develop over time.
The main goals of treatment modalities followed for MPS are to:
Inactivate trigger points Stretch tight soft tissues to enable them to return to their normal resting length Strengthen weak muscles Eliminate perpetuating factors such as environmental, mechanical, occupational and nutritional factors
Symptoms of Myofascial Pain Syndrome often respond well to the conservative and traditional forms of medicine. However, in some cases there is also a need to resort alternative form of medicine, wherein non-pharmacologic and other forms of medicine are resorted to.
Here we list the main treatment options available for the cure of Myofascial Pain Syndrome.
A) Trigger Point Injections
Trigger point injections (TPI) are injections of local anesthetic (numbing) medication, saline, and/or cortisone into the trigger point(s). The aim of a trigger point injection is to relax the area of intense muscle spasm. There are two broad types of TPIs, namely injection by manual palpation and needle EMG-guided injection.
These TPIs have been shown to be one of the most effective treatment modalities to inactivate trigger points and provide prompt relief from symptoms.
The trigger point injections should ideally be administered to patients who have not responded in the first four to six weeks to a properly planned treatment program and suitable pharmacologic intervention.
A vast series of prescription drugs are generally advised for the treatment of the Myofascial Pain Syndrome. These medicines are basically prescribed for relief from the symptoms of the disorder and might not cure the underlying condition completely.
The most common categories of drugs include:
Anti-depressants Tranquilizers Muscle relaxers Pain relievers
Each of these drug groups are prescribed either individually or in combination in accordance with the individual condition. The most common drugs prescribed include:
Amitriptyline (Elavil) Trazadone (Desyrel) Cyclobenzaprine(Flexeril) Carisprodol (Soma) Diphenhydremine (Benadryl) Alpramazolam (Xanax) Hydrocodone (Vicodin)
C) Physical Therapy
Through physical therapy, there is a focus on correction of muscle shortening by a targeted stretching and strengthening of the affected muscles. Physical therapy is also targeted towards correction of the aggravating factors, which mainly include improper posture and ergonomics.
Main modalities include:
Diathermy Ultrasound therapy
The spray and stretch technique is another important technique of physical therapy. This technique involves spraying a muscle with a topical anesthetic to numb the area and then stretch out the painful, contracted muscle to reduce pain and stiffness.
D) Manipulation therapy
The myofascial release therapy involves working on tight, contracted muscle and trigger points to release or stretch out the problem areas. Massage therapists generally work lightly and progress slowly in doing deep muscle work.
E) Dry Needling
In this procedure, a needle is inserted into the painful muscle and is then removed. No medicines are injected into the muscle during this procedure. Thin needles are inserted into the target points to ease pain and improve sleep patterns.
F) Occupational therapy
This form of therapy helps in assessing and setting up ergonomically correct workstations to prevent exacerbation and recurrence of symptoms. Properly set-up workstations can often help to decrease aggravating factors such as poor posture.
Biofeedback is a form of alternative medicine that involves measuring a subject’s bodily processes such as blood pressure, heart rate, skin temperature galvanic skin response. This information is conveyed to the patients in order to raise his or her awareness and conscious control of the related physiological activities.
Other treatment options available for MPS include:
Cyrotherapy – This procedure freezes a nerve for three to four months. The nerve regenerates itself in a given time. TENS Unit: The Transcutaneous Electrical Nerve Stimulator (TENS) is a form of treatment in which electrodes are connected to a small batter-powered unit and placed along the painful muscle. A low level of electrical stimulation is then applied to relieve the muscle tension and pain. Ultrasound – This procedure is expected to destroy an active trigger point, thus helping with the condition.