Myofacial trigger points in advanced cancer patients

Abstract

Myofascial pain syndrome is started to be recognized as one of important factors of pain in cancer patients. However, no reports on features of myofascial trigger points were found in terminally-ill cancer populations. This time, we encountered 5 patients with myofascial pain syndrome and terminal cancer in whom delirium developed due to increased doses of opioid without a diagnosis of myofascial pain syndrome on initial presentation. The delirium subsided with dose reductions of opioid and treatment of myofascial pain syndrome. The common reason for a delayed diagnosis among the patients included an incomplete palpation of the painful sites, which led to unsuccessful myofascial trigger points identification. The features of myofascial trigger points included single onset in the cancer pain management site with opioid and the contralateral abdominal side muscles of the non-common sites. Withdrawal reflexes associated with cancer pain in the supine position, which are increasingly seen in the terminal cancer patients, were considered to have contributed to this siuation. We consider that careful palpation of the painful site is important, in order to obtain greater knowledge and understanding of the features of myofascial trigger points.

Frequency of Psychosomatic-Prone Myofascial Pain Syndrome in Patients with Incurable Cancer and its Association with the Armchair Sign: A Secondary Analysis of A Prospective, Multicenter, Observational Clinical Study

“…The ndings of this study may be useful to raise awareness of psychosomatic-prone MPS in patients with incurable cancer. MPS in patients with incurable cancer is often overlooked and is a common cause of opioid-induced delirium (16). Furthermore, medical professionals may consider pain that is exacerbated by stress as psychogenic pain.…”

The Effect of Trigger Point Injections on Pain in Patients with Advanced Cancer

“…It is usually managed with conservative treatment such as physical therapy and medication. In severe cases, the pain needs to be alleviated by inactivating the trigger point and restoring muscle function.1,7,9) Various studies have reported that pain due to cancer can create trigger points, that trigger points can coexist with cancer pain, and that pain may be exacerbated by cancer [5,10]. Especially in advanced cancer patients, opioids alone may not adequately control pain or the side effects of the opioids may prevent a satisfactory dosage from being attained [11-13].…”

Quadratus Lumborum Block for Back Pain Related to Pancreatic Cancer – A Report of Two Cases

“…Myofascial pain syndrome may develop abruptly or gradually, and may not respond to treatments that are effective for other sources of pain. As an example, opioids, which are highly effective for treating most types of cancer-related pain, are often ineffective in relieving myofascial pain (3). Furthermore, myofascial pain may persist even after successful neurolytic blocks, targeting the visceral component of pancreatic cancer.…”

“…MPS is frequently diagnosed in patients with cancer pain (3,4), in whom it is thought to be triggered by several mechanisms, including direct muscle invasion by the tumor, muscle irritation by metabolites secreted into the milieu of the tumor, sarcopenia accompanying deconditioning in advanced disease, prolonged bed rest, and by some anticancer treatments such as irradiation and surgery.…”