Myofascial pain syndrome is a disease that affects the muscles.1 This is a life long disease that cannot be cured. The exact cause of this disease is still unknown but there is a theory called myofascial trigger point theory. According to this theory, there is presence of trigger points in the muscles that are palpable as taut bands of muscle. These are hypersensitive areas that can elicit pain when pressed. The pain can either be local or referred. When it is referred, the pain is felt at some other area where the same nerve or muscle supplies. Along with pain other symptoms like muscle weakness is also present.
Is Myofascial Pain Syndrome Real?
Yes, myofascial pain syndrome is real. It is a chronic disease. It is the disease of muscles. There is no specific area where the pain is seen. There are muscles all over the body and hence it can be seen in any part of the body. The main symptoms of this disease are muscle tenderness, muscle pain and maybe muscle spasms. The pain in muscles is localized. Due to the pain the patient also experiences sleeplessness at nights, weakness, fatigue and stiffness of the muscles. There is no specific test to diagnose this disease; it is diagnosed on the basis of complaints of the patient and examination of the areas of pain.
The cause of this disease is not yet discovered. The factors that can lead to exacerbation of pain in myofascial pain syndrome are previous history of trauma or injury, stress and depression. The affected muscles lead to pain in that area like neck pain, back pain, etc. and the pain is either present on one side or it may be more severe on one side than the other. On touching, there is tenderness in that area. Due to this severe pain, the patient may suffer with insomnia and fatigue. The muscles become stiff after overuse or over-activity.
The treatment of myofascial pain syndrome includes stretching, relaxation, stress reduction, medications and physical therapy.1 Medications include analgesic drugs, muscle relaxants, anticonvulsants and anti-depressants. Other treatment option is using botulinum toxin type A. This toxin prevents contraction of the muscle. Ketamine can also be used. It is an analgesic, anesthetic and sedative altogether. It works as receptor antagonist of N-methyl-D-aspartic acid (NMDA). But studies have shown that it is not very helpful. Injections into the muscle trigger points are also helpful up to a certain extent. Any anesthetic medication or steroid is injected into the myofascial trigger point for quick pain relief.
About The Drugs Used In Treating Myofascial Pain Syndrome
Analgesic Drugs- The most commonly used analgesic drugs are NSAIDs (Non-steroidal anti-inflammatory drugs). The reason why these are widely used it because they have relatively less side effects and they are available easily.2 NSAIDs are both analgesic as well as anti-inflammatory.
Muscle Relaxants– A centrally acting muscle relaxant that acts as alpha-2-adrenergic agonist named tizanidine is helpful in reducing spasticity of the muscle.2 Sometimes tizanidine can be considered as the first line of treatment. Benzodiazepines can also be used to relax muscles. Benzodiazepines act on the GABA (Gamma-aminobutyric acid) receptors and it also depresses the release of serotonin at presynaptic end. Clonazepam has been used and found effective.
Anticonvulsants- Pregabalin and gabapentin have anticonvulsant, analgesic and anxiolytic activities. These drugs reduce release of chemicals like noradrenaline and glutamate, which are excitatory in nature. These drugs are useful for chronic pain and not for acute pain.
Antidepressants– For chronic pains like in myofascial pain syndrome and fibromyalgia, tricyclic antidepressants are used. It has been found that use of amitriptyline is very helpful in reducing the tenderness at trigger points and also decreases in the intensity of the headaches. At present, there is no use of these medications in treating myofascial pain syndrome. It has been suggested that serotonin plays an important role in production of myofascial pain.
Yes, myofascial pain syndrome is real. This disease affects the muscles of the body. There is tenderness over the involved part of body. The muscle becomes stiff and taut and these are known as myofascial trigger points. On applying pressure to these points there is elicitation of pain that may either me local or maybe referred.
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