Symptoms You Should Never Ignore - Pain, Shortness of Breath

Myofascial Pain Syndrome (Chronic Soft Tissue Pain) - WebMD

Myofascial pain syndrome (MPS) is a chronic pain disorder that affects the fascia (the connective tissue that covers the muscles) and causes inflammation. MPS may affect a single muscle or a muscle group. In some cases, the area where a person has the pain may not be where the myofascial pain generator is located. Experts believe that the actual site of the injury or the strain prompts the development of a trigger point that, in turn, causes pain in other areas. This is known as referred pain.

Myofascial pain syndrome vs. Fibromyalgia

Both myofascial pain syndrome and fibromyalgia are chronic pain disorders. But there are distinctions between the two. A correct diagnosis is vital for you to receive the best treatment. 

Neither myofascial pain syndrome nor fibromyalgia has specific tests for diagnosis. Instead, your doctor can give a clinical diagnosis based on symptoms, a physical examination, and ruling out other possible diagnoses. 

Localized pain that is tender to the touch may be a symptom of myofascial pain. (Photo Credit: E+/Getty Images)

Myofascial pain (MFP) may come from a muscle injury or from heavy strain on a particular muscle or muscle group, ligament, or tendon. Other causes include:

Injury to muscle fibers

Repetitive motions

Lack of activity (such as having a broken arm in a sling)

Symptoms of myofascial pain syndrome include:

Localized point of pain that is tender to the touch

Muscle pain from pressure on a trigger point

Referred pain

Pain that feels like burning, aching, stinging, or stabbing

Pain that worsens with activity or stress

Reduced mobility or weakness in the area of pain

Symptoms caused by chronic pain from MPS include depression, sleep disturbances, headaches, and fatigue.

Types of myofascial trigger points

Trigger points are localized, very tender areas of pain within the fascia band of a skeletal muscle. The following are types of trigger points:

Active trigger point

Active trigger points are painful at rest. The referred area of pain from an active trigger point may be tender to touch. Pain between the trigger point and the referred area may feel like it's radiating out along the same muscle.

Latent trigger point

Latent trigger points are not painful at rest. Instead, they restrict movement and cause weakness. Latent trigger points only feel tender when pressure is put on the area. 

Satellite trigger point

Satellite trigger points are the domino effect of myofascial pain. Originating from an active trigger point, the satellite trigger point causes pain within the referred area. 

Trigger points can be identified by pain that results when pressure is applied to a specific area of a person's body. In the diagnosis of myofascial pain syndrome, two types of trigger points can be distinguished:

An active trigger point is an area of extreme tenderness that usually lies within the skeletal muscle and which is linked to local or regional pain.

A latent trigger point is a dormant (inactive) area that has the potential to act like a trigger point. It may restrict movement or cause muscle weakness.

Myofascial pain can stem from various things. Common risk factors are repetitive overuse of the muscles, an acute injury that didn't heal, structural issues, and stress. 

Chronic issues such as scoliosis, spondylosis, osteoarthritis, and osteoporosis can negatively affect your posture. An imbalanced posture can create muscular knots and trigger points. Over time, if unaddressed, you can get MFP. 

Other factors and nutritional imbalances can also increase your risk of MFP. Have your doctor check for hypothyroidism – a condition when your thyroid doesn't make enough hormones for your body – or a vitamin D or iron deficiency. Treating these imbalances may reduce your risk of getting MFP. 

Stress and anxiety may also increase your risk of MFP. Stress can cause some people to clench their muscles subconsciously. Repetitive muscle tension is often localized to the same area, leading to trigger points. 

If myofascial pain isn't treated, more complications can arise, such as:

Sleep disturbance

Chronic pain can make you less able to sleep well at night. Long-term sleep disturbances can set off a cascade of other problems, like fatigue, memory loss, and mood disorders. 

Fibromyalgia

Fibromyalgia causes chronic pain affecting the muscles and joints throughout the body. Some doctors believe it can come from localized MFP, then later become widespread fibromyalgia. 

Mental health issues

On average, 35% to 45% of people who struggle with chronic pain get mental health conditions. Disruptions in daily tasks and lifestyle from pain can lead to depression, anxiety, and substance abuse. 

Migraine and tension headaches

Active trigger points can create headaches and migraines in referred pain areas. 

Myofascial pain medication

Nonsteroidal anti-inflammatories are often used to reduce pain and inflammation caused by myofascial pain. Mild opioids also have been used. But they should be used with caution, as research shows they can set back recovery. Muscle relaxants are sometimes used, as well as medications for sleep or depression.

Nonsteroidal anti-inflammatory medications:

Diclofenac

Ibuprofen

Naproxen

Acetaminophen

Antidepressants:

Muscle relaxants:

Tizanidine

Benzodiazepines (also antidepressant)

Cyclobenzaprine

Thiocolchicoside (also anti-inflammatory)

Myofascial pain therapy

Nondrug treatments can ease myofascial pain and are often necessary to correct structural imbalances causing myofascial pain. They include:

Physical therapy

Myofascial release therapy

"Stretch and spray" technique, which involves spraying the muscle and trigger point with a coolant and then slowly stretching the muscle

Massage therapy

Trigger point injection

Ultrasound therapy

In some chronic cases of myofascial pain, combinations of medication, physical therapy, myofascial release therapy, trigger point injections, or massage are needed.

Myofascial pain home remedies

Reduce and manage stress levels

Develop healthy sleep habits

Eat a healthy diet

Reduce alcohol, which can increase inflammation in the body

Gentle exercise and stretching

Myofascial pain syndrome can be prevented by addressing any ongoing pain right away. Your doctor should examine any pain lasting more than a few days. They may prescribe physical therapy if there is an injury or chronic condition.

If your daily tasks or work requires repetitive motions, taking precautions can help prevent MFP. Regular breaks to rest, walk, stretch, or move in an opposing direction help. 

Consistent daily habits, including good sleep hygiene, a healthy diet, regular exercise, stress reduction and hydration, can all help cut your chances of getting myofascial pain syndrome.

The outcome of your myofascial pain syndrome depends on whether the pain is acute or chronic, how quickly the pain is addressed, and if treatment is given.

Acute myofascial pain syndrome gets better faster than chronic myofascial pain syndrome when addressed with treatment right away. Chronic myofascial pain syndrome may return if there are other health issues that have not been addressed. 

The average length of symptoms can range from 6 months to 7.5 years. Follow up with your health care provider if the pain returns or is not going away. They may be able to help reduce your time with myofascial pain syndrome.

Myofascial pain syndrome is preventable and treatable. If you're living with chronic pain, speak with your doctor. They can help you create a plan to address your pain and lower your risk of more complications from MFP. 

What aggravates myofascial pain?

Myofascial pain syndrome can get worse when it's not treated. Stress on the trigger points linked to the MFP can increase pain or develop additional trigger points, causing more pain.

Will myofascial pain ever go away?

Left untreated, it's not likely MFP will go away on its own. But with the right treatment plan from your doctor, you have a better chance of living pain-free or with less pain.

Is myofascial pain an autoimmune condition?

Myofascial pain caused by trigger points is not an autoimmune condition. But it can sometimes overlap with autoimmune conditions such as fibromyalgia.

Myofascial Pain: Treatment, Symptoms, Causes, And More - Healthline

Myofascial pain syndrome (MPS) involves localized pain in one or more groups of muscles, like the lower back or neck. It may also lead to mood and sleep changes. MPS is different from fibromyalgia.

Most people experience muscle pain at some time that typically resolves on its own after a few weeks. But for some people, muscle pain persists.

In people with myofascial pain syndrome (MPS), sensitive spots are known as trigger points. These areas develop in the taut, ropey bands of the muscles (the fascia). When pressure is applied to these trigger points there is pain (called referred pain) in a different part of the body.

Common symptoms of MPS include:

deep pain in localized areas of muscles

pain that gets worse when the affected muscle is stretched or strained

muscle pain that gets worse or fails to improve with time

presence of painful knots in muscles that when pressed produce intense localized or referred pain

muscles that are weak, stiff, inflexible, or have reduced range of motion

mood or sleep disturbances

Most people with pain and fatigue in their skeletal muscles have either fibromyalgia or MPS.

Fibromyalgia is a disorder of widespread muscular pain. It can be felt throughout the entire body. But, people with MPS feel localized pain in regional groups of muscles, like the lower back, neck, or jaw.

MPS is characterized by a few localized trigger points in the taut ropey bands of the muscles. These trigger points are tender and can produce localized pain. But their defining characteristic is that they trigger referred pain.

Fibromyalgia is also associated with multiple, more widespread tender points. These occur in joints as well as muscles.

Most points occur because of muscle overuse, muscle trauma (injury), or psychological stress. Trigger points often arise from sustained repetitive activities, like lifting heavy objects at work or working on 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 for a long time in awkward positions

nutritional deficiencies

serious lack of exercise or movement

any injury to the musculoskeletal system or intervertebral disks between the bones of the spine

generalized fatigue

lack of sleep

hormonal changes (menopause)

intense cooling of muscles (such as when sleeping in front of an air conditioner)

emotional problems (depression, anxiety)

other pain or inflammation conditions

obesity

smoking

Your doctor will perform a physical exam to look for myofascial trigger points. Your doctor will look for tender nodules in the taut bands of your muscles and press them to find a pain response. When pressing a trigger point, your doctor will feel for a twitch in the muscle (also called a "jump sign").

There are no other tests that can show the presence of MPS. Your doctor will rely on you to describe where and how you're experiencing pain. It's important to tell your doctor about all your current symptoms and any past injuries or surgeries.

There are several different types of myofascial trigger points that your doctor may find, including:

active trigger points: These trigger points are nodules within a taut band of muscle. They're typically the source of muscular pain. They're very tender, cause referred pain, and produce a twitch when touched.

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

secondary trigger point: This is a painful point in the muscle that becomes active when you stress another muscle.

satellite myofascial point: This is a painful spot that becomes active because it's located near another trigger point.

Myofascial pain syndrome requires a multipronged treatment plan. Many people combine medications with other therapies that relieve muscle stiffness and pain.

Medications

There are several medications that can ease the symptoms of MPS, including:

nonsteroidal anti-inflammatory drugs (NSAIDs): Over-the-counter drugs like naproxen (Aleve) or ibuprofen (Advil) can relieve pain and swelling.

analgesics: Pain relievers such a lidocaine patch, tramadol, and acetaminophen (Tylenol) may be considered.

muscle relaxants: Benzodiazepines and tizanidine (Zanaflex) can reduce muscle spasms.

anticonvulsants: Gabapentin (Neurontin) and pregabalin (Lyrica) may relieve pain and reduce muscle spasms.

tricyclic antidepressants: These are indicated to treat chronic pain, fibromyalgia, and nerve pain, which are conditions that resemble MPS.

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

Dry needling

Dry needling is one of the quickest ways to inactivate myofascial trigger points. Your doctor will insert a needle directly into your trigger point, move it around, and poke it in and out. It can be quite painful, but it's one of the most effective ways to inactivate a trigger point and reduce the pain.

Trigger point injections

Trigger point injections are like dry needling, but only a solution is injected into the tissue. Typically, doctors inject saline or a local anesthetic like lidocaine. The 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 into tissue through a sound-conducting gel applied to the skin. The sounds waves can heat up and relax muscles, improve blood flow, and remove scar tissue.

The pain-relieving effects may be minimal. But, this treatment may reduce stiffness and increase mobility if done before stretching. Ultrasound therapy has been successfully used for pain associated with rheumatoid arthritis, so it may be worth discussing with your doctor.

Massage therapy

There are several types of massage treatments that can relax myofascial trigger points. These include:

Massage therapy increases blood flow and warms up muscles. This can help reduce stiffness and ease pain. The massage therapist may use their thumb to put pressure on your trigger points, which will aggravate pain and then release the muscle tension.

Spray and stretch

Myofascial Pain Syndrome: Causes, Symptoms, And Treatment - Medical News Today

Myofascial pain syndrome is a chronic condition that affects the musculoskeletal system, including the bones, tendons, cartilage, ligaments, and connective tissue. The muscular and skeletal systems work together to move and support the body.

Musculoskeletal pain affects up to 80% of the population. Myofascial pain syndrome is one of the most common forms of chronic musculoskeletal pain, and 30–85% of people with musculoskeletal pain experience this condition.

This article looks at the symptoms, causes, treatments, and diagnosis of myofascial pain syndrome. We also discuss prevention and answer some frequently asked questions.

Myofascial pain syndrome typically causes pain and tenderness in a specific area, such as the neck and one shoulder.

The pain generally links to trigger points in the muscles, which radiate pain to the affected area when something applies pressure. However, pain may occur spontaneously with no pressure and may appear in areas of the body that seem unrelated to the trigger points.

Common symptoms of myofascial pain syndrome are localized pain in the muscles and trigger points in the muscles that activate pain.

Less common symptoms may include:

Ergonomic factors: One example is abnormal posture, which might be due to working at a desk all day. Another is mechanics, which may involve repetitive overhead activity, such as painting a ceiling.

Traumatic events: An event such as a car accident or sports injury may cause this condition.

Systemic factors and diseases: Deficiency in certain minerals or vitamins, such as iron or vitamin D, may increase a person's risk of myofascial pain syndrome. Some health conditions, such as hypothyroidism, may also be risk factors.

Structural factors: Conditions that affect the structure of the musculoskeletal system may lead to myofascial pain syndrome. Examples include:

Treatments for myofascial pain syndrome usually focus on the trigger points. The options can include:

nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants

red light therapy, also known as low-level light therapy or cold therapy, in which a doctor or technician exposes the person's trigger points to near-infrared light

electrical stimulation, in which a doctor or technician places electrodes onto the affected muscle to cause rapid contractions

transcutaneous electrical nerve stimulation, in which a technician or doctor attaches a small device to the painful area through pads that sit on the skin, sending low voltage electrical signals

physical therapy, which will likely involve stretching exercises and activities to modify posture

therapeutic ultrasound, which uses sound waves to penetrate soft tissues

dry needling, in which a practitioner inserts thin needles into and around the trigger point and sometimes also injects a steroid or numbing agent

acupuncture, which involves the insertion of very thin needles into different locations on the body at various depths

Kinesio taping to support muscles and joints

There is scientific evidence to support the use of many of these treatments. For instance, 2022 research has shown that red light therapy can significantly reduce pain for people with myofascial pain syndrome. Slightly older research found that TENS may offer short-term relief from pain for these individuals.

Questions about the pain, such as:

potential risk factors, such as repetitive movements or recent injuries

where the pain occurs

how often the person experiences the pain

when they experience the pain

A physical exam: A doctor will apply gentle pressure to feel for tight bands of muscle that may cause twitches or trigger pain.

A visual exam: The doctor will look for postural abnormalities, such as hunching of the shoulders or the head position being far forward and misaligned with the spine.

Diagnostic and imaging tests: X-rays and ultrasound scans can rule out other conditions.

As experts do not fully understand what causes myofascial pain syndrome, a person may be unable to avoid the condition. However, reducing potential risk factors associated with the condition, where possible, could help prevent it.

A person can take steps to counter certain risk factors, such as improper posture, repetitive motions, and underlying health conditions. These steps include:

exercising regularly to strengthen the muscles and improve range of motion and flexibility

stretching frequently throughout the day

changing positions regularly throughout the day to avoid the overuse of a particular muscle group

trying to improve the posture with exercises, stretches, or posture devices and aids

speaking with a doctor to diagnose and treat underlying conditions that may contribute to myofascial pain, such as:

hypothyroidism

osteoarthritis

spondylitis

scoliosis

Below, we answer some common questions about myofascial pain syndrome.

Can doctors cure myofascial pain syndrome?

Doctors cannot cure myofascial pain syndrome. Although the symptoms of the acute form of the condition may spontaneously disappear or fully recede following treatment, the chronic form may produce symptoms over long durations.

One study found that the average duration of symptoms was 63 months. The symptoms may also become more difficult to treat if a person does not address any underlying causes.

However, by managing the condition through treatment, a person can minimize the symptoms.

How do you release myofascial pain?

A person can see a physical therapist for myofascial pain release therapy. This type of therapy involves gentle manipulation and massage of the trigger points and stretching. A person may be able to perform this therapy at home, using foam rollers and other tools. More research is necessary to determine the effectiveness of this therapy, but researchers believe that it shows promise.

What muscles does myofascial pain syndrome affect?

Myofascial pain syndrome can cause multiple areas of musculoskeletal pain. However, the affected sites are usually in the back, shoulders, and neck.

Myofascial pain syndrome is a chronic musculoskeletal condition. Experts do not fully understand what causes it, but factors such as repetitive movement or injury can contribute to the condition.

In myofascial pain syndrome, trigger points radiate pain to other muscles. This pain tends to occur when trigger points are under pressure, but it can happen spontaneously.

There is no cure for the chronic condition, but it is possible to manage it with treatments. The options may include medications, stretches and exercises, electrical stimulation, red light therapy, dry needling, and acupuncture.

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Symptoms You Should Never Ignore - Pain, Shortness of Breath