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Significant developments and changes in the use of interventions and treatments for the management of myofascial pain syndrome have occurred in the past 10 years. These emerging concepts have changed the approach for clinicians who manage these pain disorders. However, wide variations in practice patterns prevail, and no clear consensus exists regarding when and how to use these interventions; in addition, awareness of the evidence basis behind their use is limited. This review examines the most recent advances in the treatment of myofascial pain syndromes. Specifically, the evidence basis of various emerging interventions is reviewed and recommendations for routine clinical practice and their rationale are provided. The purpose of this review is to provide the clinician with a better understanding of emerging concepts in the interventions used for myofascial pain syndromes.

Objectives: To review the literature on topical pain management in fibromyalgia [FMS] and to report on effective treatment with topical O24 essential oils.Methods: Following a literature review of MEDLINE and EMBASE for published randomized controlled trials on topical therapies for FMS pain treatment, a double-blinded placebo controlled trial was carried out in outpatient clinics on 153 subjects meeting the American College of Rheumatology criteria for FMS using topical O24 essential oils for a treatment period of one month. Main outcome measures were pain visual analog scale ratings, a diary, the Fibromyalgia Impact Questionnaire, Jamar grip strength, pressure algometry measurements of tender point [TeP] pain threshold, and seven-point Lanier scale rating of treatment. Results: In the 133 participants with complete data, improvements were noted in the visual analog scale night pain rating [P = 0.018], Jamar grip strength [P < 0.001], number of TePs [P < 0.001] and average TeP pain threshold [P < 0.001], and the Lanier scale [P = 0.001] with topical O24 over the placebo.Conclusion: This pilot randomized controlled trial suggests that FMS patients may be effectively managed for pain with topical O24. This would need to be confirmed with larger and longer randomized controlled trials. The topical O24 essential oils appear to have a clinically important effect in FMS. ]. Dr. Ko would like to thank the following for helping with this review paper: Ms. Iris Weverman, BSc[PT] and the Iris Weverman Physiotherapy Clinic for allowing the clinic to be used as a testing center, and for her patients who participated in the clinical trial. Michael Jokic, HBSc [University of Toronto] for assistance in data collection and in the CAM survey of FMS participants. Fibromyalgia treatment clinic team including physiotherapist