Discrepancy between prevalence and perceived effectiveness of treatment methods in myofascial pain syndrome: Results of a cross-sectional, nationwide survey

Abstract

BackgroundMyofascial pain is a common dysfunction with a lifetime prevalence affecting up to 85% of the general population. Current guidelines for the management of myofascial pain are not available. In this study we investigated how physicians on the basis of prescription behaviour evaluate the effectiveness of treatment options in their management of myofascial pain.MethodsWe conducted a cross-sectional, nationwide survey with a standardized questionnaire among 332 physicians (79.8% male, 25.6% female, 47.5 ± 9.6 years) experienced in treating patients with myofascial pain. Recruitment of physicians took place at three German meetings of pain therapists, rheumatologists and orthopaedists, respectively. Physicians estimated the prevalence of myofascial pain amongst patients in their practices, stated what treatments they used routinely and then rated the perceived treatment effectiveness on a six-point scale (with 1 being excellent). Data are expressed as mean ± standard deviation.ResultsThe estimated overall prevalence of active myofascial trigger points is 46.1 ± 27.4%. Frequently prescribed treatments are analgesics, mainly metamizol/paracetamol (91.6%), non-steroidal anti-inflammatory drugs/coxibs (87.0%) or weak opioids (81.8%), and physical therapies, mainly manual therapy (81.1%), TENS (72.9%) or acupuncture (60.2%). Overall effectiveness ratings for analgesics (2.9 ± 0.7) and physical therapies were moderate (2.5 ± 0.8). Effectiveness ratings of the various treatment options between specialities were widely variant. 54.3% of all physicians characterized the available treatment options as insufficient.ConclusionsMyofascial pain was estimated a prevalent condition. Despite a variety of commonly prescribed treatments, the moderate effectiveness ratings and the frequent characterizations of the available treatments as insufficient suggest an urgent need for clinical research to establish evidence-based guidelines for the treatment of myofascial pain syndrome.

Dry needling — peripheral and central considerations

“…56 Considering the relevancy of myofascial trigger points from a pain science perspective, it is not surprising that pain management specialists consider myofascial pain and trigger points to be clinically important. 134,135 Trigger points are peripheral sources of persistent nociceptive input, which can excite muscle nociceptors. 4,57,63,65,[136][137][138][139] Nociceptive input from muscle is particularly effective in inducing neuroplastic changes in the spinal dorsal horn and likely in the brainstem.…”

Shock Wave Therapy Versus Progressive Pressure Release on Myofascial Trigger Points

“…19,20 Myofascial pain syndrome is collection of the sensory, motor, and autonomic symptoms that include local and referred pain, decreased range of motion, and weakness. The health impact of myofascial pain can be quite severe as patients with the disorder not only suffer from decreased functional status associated with musculoskeletal pain and loss of function, but also suffer from impaired mood as well as decreased quality of life.…”

Chronic Prostatitis/Chronic Pelvic Pain Syndrome and Pelvic Floor Spasm: Can We Diagnose and Treat?

“…Importantly, the location of the trigger point may be different from the location of the pain that it triggers [11]. Common treatments for myofascial pain and trigger points include analgesics, anti-inflammatories, physical therapy, biofeedback, muscle relaxants, direct anesthetic injection, and acupuncture [12].…”