Pain and Disability Clinical, Behavioral, and Public Policy Perspectives (1987) / Chapter Skim
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Appendix: Myofascial Pain Syndromes Due to Trigger Points
Appendix: Myofascial Pain Syndromes Due to Trigger Points
Pages 285-292
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From page 285... ...
MYOFASCIAL PAIN SYNDROMES: HOW COMMON ARE THEY? Recent reports indicate that myofascial pain syndromes are likely to be the major cause of pain that brings patients to chronic pain treatment centers.
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From page 286... ...
Acute myofascial pain syndromes are also common in general medical practice. Among 61 consecutive consultation or follow-up patients in an internal medicine group practice, 10 percent of all patients and 31 percent of those presenting with a pain complaint had myofascial trigger points that were primarily responsible for their symptoms (Skootsky, 1986~.
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From page 287... ...
In the absence of perpetuating factors, and in the presence of normal daily activities that stretch the muscle, active trigger points tend to revert to being latent trigger points. Examples of trigger point activation by acute gross trauma are activation of longissimus trigger points in the paraspinal muscles during a fall, or activation or sternocleidomastoid trigger points in the neck during a rear-end collision (one type of whiplash.
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From page 288... ...
This damage apparently acts as an endogenous perpetuating factor susceptible to augmentation by severe pain, additional trauma, vibration, loud noises, prolonged physical activity, and emotional stress. From the date of the trauma, coping with pain typically becomes the focus of life for these patients who previously paid little attention to pain.
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From page 289... ...
In the presence of sufficiently severe perpetuating factors and if left untreated, an acute myofascial pain syndrome characteristically becomes chronic. Mechanical or systemic perpetuating factors increase the susceptibility of muscles to trigger points; the severity of pain gradually increases, and less muscular activity is required to produce pain.
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From page 290... ...
The resultant myofascial low back pain often persists, regardless of appropriate therapy, until the chronic excess strain on the muscle is relieved by correcting the leg length disparity (Simons and Travell, 19831. Similarly, systemic perpetuating factors may cause minimal symptoms, including increased irritability of the muscles, that by themselves escape attention.
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From page 291... ...
Other treatments, such as muscle energy techniques, deep massage ultrasound, and specific relaxation techniques followed by stretch, are used with variable effectiveness depending on the practitioner's training and skill. Effective local injection of trigger points depends on physical disruption of the trigger point mechanism by penetration with the needle and flushing the region with either a short-acting local anesthetic or saline.
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From page 292... ...
Muscle pain syndromes Parts I and II. American Journal of Physical Medicine 54:289 311, 1975; 55:1~42, 1976.
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