Myofascial pain syndrome and trigger-point management

Myofascial pain syndrome (MPS) is a common condition often resulting in referral to a pain clinic. The epidemiology, pathogenesis, and various diagnostic tools are reviewed, and a variety of treatment methods are discussed.

Extensive periodical literature and textbooks are reviewed, and selected manuscripts are critically analyzed.

The incidence of MPS with associated trigger points appears to vary between 30 and 85% of people presenting to pain clinics, and the condition is more prevalent in women than in men. Patients complain of regional persistent pain, ranging in intensity and most frequently found in the head, neck, shoulders, extremities, and low back. Muscle histologic abnormalities have been described in some studies. Similarly, electromyographic, thermographic, and pressure algometric studies have inconsistently identified abnormalities. A multidisciplinary approach to treatment appears to be most beneficial and may include such modalities as trigger-point injections, dry needling, stretch and spray, and transcutaneous electrical nerve stimulation.

The definitive pathogenesis of MPS is currently unknown, and no single diagnostic method is consistently positive. While trigger-point injection is the most widely employed method of treatment, other modes of therapy have also proved to be effective.