myofascial pain syndrome (MPS)

Last edited 04/2021 and last reviewed 05/2021

Myofascial pain syndrome (MPS) is characterized by acute or chronic regional muscle pain associated with single or multiple restricted painful regions (trigger points) within muscle taut bands

• also associated with stiffness and local twitch response when stimulated by digital pressure or during located needling generating local or referred pain
  
  
• individuals who have regional pain present with a high prevalence of MPS
  • studies carried out in pain management centers and clinics of different specialities have shown prevalence ranging from 30% to 93% in patients complaining of regionalized pain
  • high prevalence of MPS in people in their mature years of maximum activity, and in women
  • the trapezius, levator scapula, infra-spinatus, and scalenes are the most frequently affected areas by MPS
    
    
• a number of causal factors associated with MPS have been suggested such as:
  • acute physical overload,
  • deep pain impulse,
  • emotional tension,
  • postural habits,
  • fatigue,
  • hypovitaminosis,
  • infections,
  • physical inactivity,
  • poor physical conditioning,
  • repetitive musculoskeletal microtraumas and trauma
    
    
• diagnosis of MPS is based on
  • exclusion of other causes of regional muscle pain
  • identification of trigger points in the taut band through palpation of sensible nodules, local twitch response and specific patterns of pain referral associated with each trigger point
    
    
• treatment
  • MPS treatment consists of trigger points inactivation, and breaks the vicious cycle of pain-spasm-pain
  • also includes reassurance (patient education, self care and behaviour therapy), physiotherapy (ultrasound, megapulse, low-level laser therapy, heat exercises, biofeedback, spray and stretch technique), acupuncture, dry needling, injections of anaesthetic, drug therapy and combined treatments
  • medicine used to treat MPS includes analgesics, non-steroidal anti-inflammatory drugs (NSAIDS), muscle relaxants and tricyclic antidepressants

For NICE guidance regarding management of chronic pain (pain that lasts for more than 3 months) then see linked item.

Reference:

• Ernberg M. The physiopathological mechanisms behind chronic myofacial pain. Lakartidningen 2002;99(32-33):3206-10.
• Esenyel M, Caglar N, Aldemir T. Treatment of Myofascial Pain. Lippincott Williams & Wilkins 2000;79(1):48-52
• Bron C, Wensing M, Franssen JL, Oostendorp RA. Treatment of myofascial trigger points in common shoulder disorders by physical therapy: a randomized controlled trial . BMC Musculoskeletal Disorders 2007;5(8):107