Myofascial pain syndrome can be a real pain in the butt! Well, it can be – but it usually causes pain in other parts of the body too. Contrary to how it sounds, myofascial pain syndrome has nothing to do with the face – ‘fascial’ is the medical word for the whitish tissue that is attached to all muscles. Myofascial pain syndrome typically causes aching pains that just don’t go away, and no one really knows what causes it or how many people live with it. Researchers, however, believe that myofascial pain syndrome is more common than you might expect.
If you were to poke someone suffering from myofascial pain syndrome on one of the trigger points, even quite lightly, (please don’t) they may react as if you punched them hard. Sometimes the person will also experience pain in another part of the body. This is called referred pain and doctors look for this when trying to diagnose the condition. In other words, it can be a trigger point in your back giving you that pain in the butt.
As anyone who suffers myofascial pain syndrome will testify, it is certainly no laughing matter. It is estimated that the majority of us – 85% – will develop at least one sensitive trigger point at some point in our lives. The pain may start after an injury (such as whiplash or joint sprain) but for a minority of people experiencing muscle pain, it becomes a long-term, troublesome pain syndrome. Some people are at a higher risk for this long-term syndrome: those who have suffered previous injury or trauma, suffer from anxiety or depression, or who have a bad posture (I bet you just straightened your back).
Probing inside myofascial trigger points
Scientists don’t know why trigger points develop but they aren’t completely clueless either. Many scientists believe that trigger points are caused by ‘leaky’ nerves – a fault called ‘endplate noise’. Nerves connect to muscles at ‘endplates’, where the nerve releases a signalling molecule (called a neurotransmitter), causing the muscle to contract whenever we want to move it. Sometimes the neurotransmitter ‘leaks’ from the nerve, producing a constant ‘contract now!’ signal. Researchers think that continuously contracting muscles become deprived of oxygen, resulting in pain and long-lasting changes in the tissue and nerves. Such changes occur on a microscopic and molecular level and alter the sensitivity of the nerves, eventually causing the person to react with pain to soft prods and pokes (a state called allodynia).
Making sense of the noise: the myofascial pain syndrome controversy
The popular theory that trigger points cause this condition has been questioned by some researchers, who say that there isn’t enough evidence to prove it is true. Having taken the time to read through the published research, it is clear to me that hard facts are in short supply. Many of today’s theories about myofascial pain syndrome originally came from observations made by individual doctors (often dating quite a while back in time), rather than from controlled scientific studies involving lots of patients. Critics argue that other explanations for this pain phenomenon should be investigated – such as inflammation of the nerves supplying the aching muscles. Many academics also point out that there is a lack of diagnostic consistency for myofascial pain syndrome – that is, two different doctors are not very likely to identify the same trigger points, making a diagnosis a bit arbitrary.
‘Curing’ the pain the won’t go away
So even if we don’t fully understand it, what are the treatment options? Painkillers and muscle relaxant drugs may be used, alongside muscle stretches. Injecting saline, local anaesthetic or botulinum toxin (‘Botox’) into the trigger point are other techniques. Meanwhile simply inserting a needle into the trigger point without injecting anything (so called ‘dry needling’) is becoming quite popular, as is acupuncture. Counselling-based approaches to reduce stress and anxiety are also usually encouraged.
Experts in the field usually recommend a combination of the above-mentioned methods for the best result. That said. many of these treatments have never been properly tested in controlled scientific trials, and for some (i.e. botox), large studies have found no beneficial effect of the treatment. Nevertheless, some people do get relief through treatment; the pain disappears, and never comes back. Others are not as lucky, and even a combination of different treatments doesn’t help.
Improved understanding of what causes this horrible condition can lead the way for researchers to develop better myofascial pain syndrome treatments. Until it happens, we need to keep poking scientists to find a lasting solution.
Answer by Magdalena Kegel
Selected references & further information
Borg-Stein, J., & Iaccarino, M. A. (2014). Myofascial pain syndrome treatments. Physical Medicine and Rehabilitation Clinics of North America, 25(2), 357–374. doi:10.1016/j.pmr.2014.01.012
Giamberardino, M. A., Affaitati, G., Fabrizio, A., & Costantini, R. (2011). Myofascial pain syndromes and their evaluation. Best Practice & Research Clinical Rheumatology, 25(2), 185–198. doi:10.1016/j.berh.2011.01.002
Quintner, J. L., Bove, G. M., & Cohen, M. L. (2014). A critical evaluation of the trigger point phenomenon. Rheumatology, 1–8. doi:10.1093/rheumatology/keu471
Soares, A., Rb, A., Án, A., & Emk, S. (2012). Botulinum Toxin for Myofascial Pain Syndromes in Adults. Journal of Pain and Palliative Care Pharmacotherapy, 26(3), 283–283. doi:10.3109/15360288.2012.712806
Srbely, J. Z. (2010). New trends in the treatment and management of myofascial pain syndrome. Current Pain and Headache Reports, 14(5), 346–352. doi:10.1007/s11916-010-0128-4