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November 2021

Myofascial Pain Syndrome and Trigger Point Injections

An Extremely Common Condition That Is Often Underdiagnosed, Misdiagnosed, or Overlooked

 

You may suffer with ongoing or long-lasting muscle pain, in areas such as your low back, neck, shoulders, and chest. The culprit could be myofascial pain syndrome.

“Myo” is another medical term denoting a relationship to muscle. With this condition, pressure on sensitive points in your muscles causes pain – as well as can refer pain to other parts of your body.

What is fascia? It is thin, white connective tissue that is wrapped around every one of your muscles. Your fascia holds your muscles together, which allows them to contract and stretch. It is a complex substance that contains nerve endings. It also provides a slick surface that enables individual muscle fibers, single muscles, and muscle groups to slide against each other without causing damage.

Myofascial Pain Can Be Severe

Myofascial pain can strike anyone at anytime in their life. For some, the pain can be unbearable and debilitating.

Myofascial Pain

Myofascial Pain Can Be Debilitating

For example, one Main Line Spine patient we’ll call “Ed” goes about his daily life normally without any physical issues. However periodically, about once a year, Ed suffers myofascial low back pain that is so severe that he used to be bedridden for a week before recovering. Fortunately for Ed, his Main Line Spine physician now uses trigger point injections to get him more quickly on the road to recovery when Ed’s myofascial pain flairs up.

Did you know that John F. Kennedy, our 35th President, suffered from myofascial pain syndrome? Almost 60 years ago, Dr. Hans Kraus’s trigger point injections, along with Physiatry-focused therapy, nearly cured Kennedy of his lifelong back pain by the time we tragically lost the President.

When this condition persists or recurs frequently, it is known as chronic myofascial pain. It can involve a single muscle or group of muscles. It can be severe like “Ed” suffers or President Kennedy suffered – or evidence itself as persistent muscle pain that you live with that just won’t go away.

Is It Myofascial Pain? Or Something Else?

Myofascial pain is common and is estimated to occur in about 85% of people sometime during their life. It is often underdiagnosed, misdiagnosed, or overlooked because it can be hidden by other musculoskeletal pain issues.

Although chronic myofascial pain may resemble fibromyalgia syndrome, these two disorders are different. Both of these disorders relate to tender points in muscles. But chronic myofascial pain is a disorder in the muscle itself while fibromyalgia syndrome is believed to be a disorder in the way the brain processes pain signals.

Trigger Points

Shoulder Area Trigger Points

One of the major symptoms of myofascial pain is the presence of trigger points. These trigger points are tender and are highly sensitive areas within the muscle that are painful to touch. They may be evidenced as a tender knot. Trigger points can also be deceiving as when they are lightly pressed, they can cause pain in nearby areas – this is called “referred pain.”

Diagnosing myofascial pain syndrome is challenging and requires the experience of a medical specialist. There are no tests that can easily reveal it. The best method to detect this syndrome is for your healthcare provider to physically examine your muscles – to feel for the taut bands of muscles and then find the exact spots, or trigger points, where there is tenderness.

Trigger points might be “active” or “latent.” An active trigger point typically lies within a muscle and pressure to it will result in local or regional pain. Active trigger points can restrict the full use of a muscle, leading to weakness and decreased range of motion. Latent trigger points have the potential to be active but are dormant. Latent trigger points are still tender when touched but can become active when a muscle is strained, fatigued, or injured.

What Causes Myofascial Pain Syndrome?

A primary cause of myofascial pain syndrome can be a muscle’s reaction to an injury that you’ve sustained. It can also be caused by what is known as the pain-spasm-pain cycle – which is a self-perpetuating cycle in which skeletal muscle spasms cause pain, and the pain exacerbates a new cycle of spasms, leading to pain again in turn.

Secondary causes can include underlying sources such as disc disease or a pinched nerve.

Treating Myofascial Pain Syndrome

If you have myofascial pain syndrome, your treatment will be increasingly more successful depending on how quickly you see your healthcare provider early in the development of your symptoms – before trigger points establish themselves. There are a variety of treatment options your medical professional will consider to manage your pain and restore affected muscles.

One of the more effective treatments are trigger point injections. This procedure can be done in a medical office and does not require an outpatient surgical setting. Small amounts of anesthetic and steroid are injected into the trigger point to help alleviate pain.

In more persistent cases where trigger points are active frequently, botulism toxin is used in these injections to break the cycle – often for up to 3 to 6 months. This medication inhibits muscle contraction at a cellular level.

The risk of complication from a trigger point injection is very low. Complications such as bleeding and infection at the injection site are uncommon. You may have temporary soreness or numbness at the injection site. After a trigger point injection, you can actively use your muscle. However, you should avoid strenuous activity for the first few days.

Is a Trigger Point Injection Right for You?

A trigger point injection may be right for you if your muscle pain has not improved with other treatments, including pain medication and physical therapy.

Talk to your physician about it. To schedule an evaluation at Main Line Spine, call (610) 337-3111.

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