The management of myofascial pain syndromes

Objective: To present an approach to the management of the Myofascial Pain Syndrome [MPS] based on clinical experience, addressing the problems posed by the specific nature of primary myofascial trigger point pain, and the problem of chronic myofascial pain. Results: Specific trigger point therapy is designed to inactivate the myofascial trigger point by means of manual techniques, intermittent cold and stretch, and invasive trigger point needling or injection with a local anesthetic. Management of recurrent MPS requires addressing the perpetuating factors of mechanical imbalances [structural, postural, compressive] and systemic abnormalities which interfere with the ability of muscle to recover or which continuously stress muscle reactivating the trigger point. The common systemic factors associated with MPS are hypothyroidism, folic acid insufficiency and iron insufficiency. The relationship of many of the perpetuating factors to MPS is clinically apparent, but has yet to be established firmly by statistically rigorous clinical studies. Corrective measures to prevent the reactivation of trigger points, physical reconditioning and psychological re-education help maintain improvement. Conclusion: MPS is a condition which is treatable by eliminating the specific trigger points that are the immediate cause of pain, and correcting those factors that predispose to recurrence.