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psychosocail pain syndrome

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medhareddyacademic
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Myofascial pain syndrome

Overview
Myofascial pain syndrome is a long-term pain condition. It involves some muscles
and the thin cover of tissue that holds muscles in place, called fascia. Pressure on
these areas, called trigger points, causes pain.

Sometimes, the pain is felt in other parts of the body. This is called referred pain.
The pain often is felt as shoulder pain, back pain, tension headaches and face pain.

This syndrome can happen after a muscle has been tensed over and over. Repeated
motions used in jobs or hobbies can be the cause. So can stress-related muscle
tension, poor posture and weak muscles. In some cases, the cause of myofascial
pain is unknown.

Almost everyone has felt muscle tension pain. But the pain of myofascial pain
syndrome doesn't go away. Treatment options include exercise, massage, physical
therapy and shots in the trigger points. Pain medicines and finding ways to relax also
can help.

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Symptoms
Symptoms of myofascial pain syndrome may include:

 Deep, aching pain in a muscle.


 Pain that doesn't go away or gets worse.
 A tender knot in a muscle.
 Trouble sleeping due to pain.
 A general feeling of being not well, called malaise.
 Tiredness.

When to see a doctor


Most people have muscle pain at times. But if your muscle pain doesn't go away with
rest, massage and other self-care measures, make an appointment with your
healthcare professional.

Causes
The exact cause of myofascial pain syndrome is not known. Areas of tight muscle
fibers, called trigger points, form in muscles. Too much use of the muscles, most
often with poor form, injury to the muscle and mental stress likely help cause trigger
points.

Risk factors
In myofascial pain syndrome, something such as muscle tightness sets off trigger
points in the muscles. Factors that may increase the risk of muscle trigger points
include:

 Muscle injury. A muscle injury or ongoing muscle stress may lead to the
forming of trigger points. For instance, a spot in or near a strained
muscle may become a trigger point. Repeat motions and poor posture
also can increase the risk.
 Stress and anxiety. People who often feel stressed and anxious may be
more likely to get trigger points in their muscles. One theory is that these
people may be more likely to clench their muscles. Clenching is a form of
repeated strain that leaves muscles open to trigger points.

Complications
Complications linked to myofascial pain syndrome include:

 Sleep problems. Symptoms of myofascial pain syndrome may make it


hard to sleep. It might be hard to find a good sleep position. And if you
move while sleeping, you might hit a trigger point and awaken.
 Fibromyalgia. Some research suggests that myofascial pain syndrome
may lead to fibromyalgia in some people. Fibromyalgia is a long-term
condition of widespread pain.
It's believed that the brains of people with fibromyalgia respond more to
pain signals over time. Some experts believe myofascial pain syndrome
might help start this process.

Diagnosis
During a physical exam, your healthcare professional may put gentle finger pressure
on the affected muscle, feeling for painful areas. Certain ways of pressing on the
trigger point can cause certain responses. For instance, you might have a muscle
twitch.

Muscle pain has many possible causes. Your healthcare professional uses other
tests and procedures to rule out other causes of muscle pain.

Treatment
Treatment for myofascial pain syndrome typically includes medicines, shots into the
trigger points and physical therapy. Exercise is a big part of any treatment plan.

Discuss treatment options and what you prefer with your healthcare professional.
You may need to try more than one approach to find pain relief.

Medications

Medicines used for myofascial pain syndrome include:

 Pain relievers. Pain relievers you can get without a prescription, such as
ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), may
help. Some come in the form of creams or patches that you put on the
skin. Or your healthcare professional may prescribe stronger pain
relievers.
 Antidepressants. Many types of antidepressants can help relieve pain.
For some people with myofascial pain syndrome, amitriptyline seems to
reduce pain and improve sleep.
 Muscle relaxers. Clonazepam (Klonopin) and other medicines called
benzodiazepines help treat the anxiety and poor sleep that sometimes
come with myofascial pain syndrome. These medicines can cause
sleepiness and can be habit-forming.

Therapy

A physical therapist can help relieve your pain based on your symptoms. Treatment
might involve:
 Stretching. A physical therapist may lead you through gentle stretches
to help ease the pain in your sore muscle. If you feel trigger point pain
when stretching, the therapist may put a numbing spray on your skin.
 Massage. A physical therapist may massage your affected muscle to
help relieve your pain. The therapist may use long hand strokes along
your muscle or place pressure on areas of your muscle to release
tension.

Procedures

 Shots, also called injections, into trigger points. A shot of a numbing


medicine or a steroid into a trigger point can help relieve pain.
OnabotulinumtoxinA (Botox) also might be used.
 Dry needling. In some people, just putting the needle into the trigger
point helps break up the muscle tension. This is called dry needling.
Acupuncture also appears to help some people who have myofascial
pain syndrome.
 Transcutaneous electronic nerve stimulation (TENS). This sends a
tiny electrical current to painful areas. The current is sent using
electrodes taped to the skin. It's not known how TENS relieves the pain.
More study is needed.
 Ultrasound. This type of therapy uses sound waves to increase blood
flow and warmth. This may reduce pain in the muscles affected by
myofascial pain syndrome.
 Extracorporeal shock wave therapy. Sound waves are directed at the
area of pain. Some studies have shown it to ease pain in myofascial pain
syndrome

Cortisone shots are injections that can help relieve pain, swelling and
irritation in a specific area of your body. They're most often injected into joints —
such as the ankle, elbow, hip, knee, shoulder, spine or wrist. Even the small joints in
the hands or feet might benefit from cortisone shots.

A cortisone shot usually contains a corticosteroid medicine for pain relief over time
and a local anesthetic for pain relief right away. Often, you can receive one at your
doctor's office. Because of potential side effects, the number of shots given in a year
generally is limited.

Products & Services


 A Book: Mayo Clinic Family Health Book, 5th Edition
Show more products from Mayo Clinic

Why it's done


Cortisone shots might be most effective in treating inflammatory arthritis, such as
rheumatoid arthritis. They also can be part of treatment for other conditions,
including:

 Back pain.
 Bursitis.
 Gout.
 Osteoarthritis.
 Psoriatic arthritis.
 Rheumatoid arthritis.
 Tendinitis.

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