A real disorder affecting all human – adults and children alike.

The above medical terms are used to describe a constellation of symptoms and signs affecting muscles, joints, ligaments, tendons and tendon sheaths which present as firm, taut band of hyperirritable and painful muscle and fascia (fibrous tissue sheath covering muscles).

Where are your trigger points?

Trigger points involved specific sites on the body and appear to be constant in all people like a map.

To recognize specific trigger points is to know the disorder leading to correct diagnosis and proper treatment.

Fact on myofascial pain

Myofascial/fibromyalgia – hyperirritability and pain of the soft tissues and muscles involve and perpetuate by the autonomic nervous system. Trigger point, fibrositis or myofascial pain can cause severe and disabling burning, throbbing, lancinating pain, weakness and abnormal sensations in the back and legs. Patient often cannot lie on the pain side of the body and sleep is disturbed. Weakness of the arm causes the dropping of object. Weakness of the leg causes the leg to give out leading to fall. Unpleasant sensations and other referred pain and discomforts such as inability to move the leg and gastrointestinal and pelvic disorders are common.

  • Female is affected more than male. All races are affected.
  • Symptoms – ache, pain – described as burning, lancinating, soreness, hurting, miserable, gnawing, throbbing.
  • Multiple pain sites – face, head, neck, shoulders, front and back chestwalls, arms, hands, fingers, low back, legs, hips, thighs and feet.
  • Stiffness of soft tissues such as muscles and joints.
  • Shortening and spasm of muscles and tendons.
  • Loss of motion of joints.
  • Swelling tissues – muscle, joint, tendon, fascia.
  • Fatigue – general, chronic, morning, overwhelming.
  • Weakness – arm, hand, finger, leg and foot.
  • Accident – dropping of object, falling
  • Sleep – poor, disrupted, disturbed, nonrestorative and nonrefreshed.
  • Abnormal sensations – paresthesia, numbness, tingling.
  • Psychological disturbances – anxiety, depression.
  • Referred pain to other parts of the body.
  • Tinnitus (ringing in the ear), dizziness.

There are also concomitant autonomic nerve phenomena and visceral disorders. Visceral and autonomic symptoms – headaches, dysmenorrhea, nausea and vomitting, irritable bowel, lacrimation (excessive tearing), coryza (acute rhinitis), sicca complex (dry eyes and mouth), pilomotor phenomenon (goose bumps), raynaud’s phenomenon, female urethral syndrome, hyperemia (redness) of the skin, reticular (mottled, blue or purple) discoloration of the skin in the arms, hands, fingers, legs, feet and toes.

Pathogenesis (mechanism) – it is reported to be poorly understood.

Several causes have been implicated such as tension, stress, fatigue, chill, connective tissue diseases such as osteoarthritis, rheumatoid arthritis, compression of nerve, nutritional deficiency, endocrine imbalance such as estrogen deficiency and hypothyroidism, acute and chronic trauma such as repetitive strain injury and overuse syndrome.

Aggrevating factors – cold or humid weather, disturbed sleep, physical and metal fatigue, strenous physical activity, anxiety and stress.

Cornerstone of management of myofascial pain

Physician, patient, physical therapist, massage therapist, occupational therapist, exercise physiologist and nutritionist are the forefront clinicians and active participant in the treatment of myofascial pain. These clinicians are endowed with different skills and varying and diverse abilities to treat and care for myofascial pain.

Treatment modalities

Myofascial/fribromyalgia injection is performed using sterile technique by physician. This common procedure involves using a small needle and syringe to safely introduce a small quantity of lidocaine solution or a few other types of medications into the painful muscle sites of the body. In the skilled hands of a physician, the procedure is very safe and almost always painless. The resolution of pain and associate symptoms is fast and remarkable.

Trigger point injection and acupuncture are synergistic. In other words, both procedures give relief to the body from pain and associate disorders.

Allergy to lidocaine is rare, allergy to the preservative of the lidocaine solution may uncommonly occur.

Toxic symptoms from overdose of lidocaine, inadvertent puncturing of the chest cavity, injection of toxic dose of lidocaine into the blood vessels and nerve injury are extremely rare when the injection is performed by a skilled physician using proper technique. Small and localized hematoma (bruise particularly in light-skin person) is not uncommon but can usually be prevented by the application of good pressure to the injection site immediately after the injection. Skin hematoma is benign and resolves spontaneously without ill effect. Patient on anticoagulant can be treated provided adequate pressure is applied to the injection site.

  • Dry needling of the trigger point by twirling a sterile needle in a trigger point like manual acupuncture.
  • Soft-tissue mobilization, trigger-point release and stretching of muscles and tendons.
  • Spray and stretch of the skin using coolant such as fluorimethane.
  • Strengthening exercise programs.
  • Relaxation and restful sleep.
  • Correct postures in activities of daily living and work.
  • Ergonomic equipment and furniture at home and work.
  • Transcutaneous electrical nerve stimulation (tens)

Oral medications have little or no effect on trigger point. The type of medications and examples are as follow:

  • Nonsteroidal anti-inflammatory drugs (nsaids)
  • ibuprofen,
  • steriods – prednisone,
  • anxiolytics – valium,
  • muscle relaxants – soma,
  • antidepressants – amitriptyline,
  • narcotic analgesics – codeine.