A critical evaluation of the trigger point phenomenon

Abstract

The theory of myofascial pain syndrome (MPS) caused by trigger points (TrPs) seeks to explain the phenomena of muscle pain and tenderness in the absence of evidence for local nociception. Although it lacks external validity, many practitioners have uncritically accepted the diagnosis of MPS and its system of treatment. Furthermore, rheumatologists have implicated TrPs in the pathogenesis of chronic widespread pain (FM syndrome). We have critically examined the evidence for the existence of myofascial TrPs as putative pathological entities and for the vicious cycles that are said to maintain them. We find that both are inventions that have no scientific basis, whether from experimental approaches that interrogate the suspect tissue or empirical approaches that assess the outcome of treatments predicated on presumed pathology. Therefore, the theory of MPS caused by TrPs has been refuted. This is not to deny the existence of the clinical phenomena themselves, for which scientifically sound and logically plausible explanations based on known neurophysiological phenomena can be advanced.

A Brief Overview of Myofascial Trigger Points.

“…One of their explanations is that the properties of myofascial pain based on myofascial trigger points are not discernible from those of neural pain. Therefore, these theories state that the main cause of MTrPs symptoms is due to disorders of the nervous system such as neuritis (inflammation of the nerve), allodynia (pain sensations from a non-painful stimulus) or hyperalgesia (exaggerated sensitivity to pain) (Quintner, 2014).…”

“…Furthermore, most of the evidence, which supports the idea that MPS is based on trigger points, relates to low-quality studies or ones conducted using only small groups, which may not allow us to 2838 generalize the results. Nevertheless, some recent studies have investigated other causes of MPS, such as central sensitization (Giamberardino et al, 2011;Quintner, 2014).…”

Response to Dommerholt and Gerwin: Did we miss the point?

“…Clearly, when we gaze upon the field of "myofascial pain due to trigger points", we (Quintner et al, 2014) see a landscape that is different from that appreciated by Dommerholt and Gerwin (2015). They conclude that "Quintner et al have not succeeded in providing sufficient evidence that the current TrP hypotheses (sic) should be rejected."…”

A critical evaluation of Quintner et al: Missing the point

“…Quintner, Bove and Cohen stated that the objective of their recent paper "A critical evaluation of the trigger point phenomenon" (Quintner et al 2014) (Dommerholt et al 2006, Gerwin et al 2004, Simons 1975, Simons 1976, since British physician Balfour in 1816 described muscle pain as "patients having a large number of nodular tumours and thickenings which were painful to the touch, and from which pains shot to neighboring parts" (Stockman 1904). We appreciate Quintner et al's efforts to critically review the current hypothetical constructs of myofascial pain and TrPs and to offer alternative perspectives and hypotheses, which eventually may lead to a better understanding of myofascial pain, although we disagree with many of their specific comments.…”