Differential diagnosis of trigger points

Research output: Contribution to journalArticle

Abstract

Objective: A number of medical and structural conditions produce muscular pain associated with myofascial trigger points [TrPs]. These conditions should be considered when evaluating a patient with muscle pain. Thesis: Myofascial pain syndrome is characterized by regional or widespread myalgia with muscle TrPs. Trigger points are also common in fibromyalgia. The TrP is a physical sign that occurs in a variety of myalgic conditions. Acute or chronic muscle stress creates an "energy crisis" that can result in a TrP. A muscle-related nociceptive stimulation of the peripheral and central nervous system results in hypersensitivity. Both mechanical and systemic medical disorders stress muscle. Mechanical problems can be structural or postural. Static [postural] or acute [trauma] muscle overload occurs in mechanical disorders which results in physical and biochemical changes including hypoxia and ischemia, and neuromuscular junction dysfunction. Delayed onset muscle pain is seen in unaccustomed eccentric exercise. Post-laminectomy and failed spinal fusions are causes of myofascial pain syndrome. Systemic medical disorders can result in diffuse TrP-related myalgia, though the mechanism may be unclear. Systemic medical disorders that cause TrP-related pain include connective tissue disorders [hypermobility syndrome and polymyalgia rheumatica], hypothyroidism, vitamin B12 insufficiency, and infectious diseases [Lyme disease and parasitic infection]. Drug induced myalgia ['statin' drugs, propoxyphene, and penicillamine] and myalgic encephalomyelitis/chronic fatigue syndrome, neurogenic myalgia in radiculopathy or nerve entrapment, and viscerosomatic pain syndromes are all important causes. Conclusion: Trigger points pain can have many different causes that must be identified and treated specifically.

Original languageEnglish (US)
Pages (from-to)23-28
Number of pages6
JournalJournal of Musculoskeletal Pain
Volume12
Issue number3-4
DOIs
StatePublished - Dec 1 2004

Fingerprint

Trigger Points
Myalgia
Differential Diagnosis
Myofascial Pain Syndromes
Pain
Muscles
Chronic Fatigue Syndrome
Dextropropoxyphene
Nerve Compression Syndromes
Polymyalgia Rheumatica
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Spinal Fusion
Parasitic Diseases
Radiculopathy
Penicillamine
Laminectomy
Fibromyalgia
Lyme Disease
Neuromuscular Junction
Peripheral Nervous System

Keywords

  • Myalgia
  • Myofascial pain syndrome
  • Trigger points

ASJC Scopus subject areas

  • Rheumatology
  • Health Professions(all)

Cite this

Differential diagnosis of trigger points. / Gerwin, Robert.

In: Journal of Musculoskeletal Pain, Vol. 12, No. 3-4, 01.12.2004, p. 23-28.

Research output: Contribution to journalArticle

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