Treatment and management of myofascial pain syndrome

Urits, Ivan; Charipova, Karina; Gress, Kyle; Schaaf, Amanda L.; Gupta, Soham; Kiernan, Hayley; Choi, Paula E.; Jung, Jai Won; Cornett, Elyse M.; Kaye, Alan D.; Viswanath, Omar

doi:10.1016/j.bpa.2020.08.003

Cited by 69 publications

(55 citation statements)

References 88 publications

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“…Stiffness and lack of mobility of fascia has implications beyond a patient being unable to move adequately, it can affect the behavior of all cells interacting with the connective tissue matrix [ 16 ]. If indeed nature designed a way to relax fascia during movements and reverse these changes it might happen through (i) dissipation of fascial energy as mentioned above; (ii) mechanical effect of movement that ruptures fascial fibers or shakes off fibers, which might explain why studies find extra-corporeal shock wave therapy to be effective for MPS (e.g., Uritis et al [ 54 ]); (iii) friction between sliding layers of fascia elevating the local tissue temperature, or “warming up” myofascial tissue. Literature suggests the three-dimensional supramolecular assembly of HA breaks down progressively at 35–40 degrees Celsius [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Scoping review and interpretation of myofascial pain/fibromyalgia syndrome: An attempt to assemble a medical puzzle

Plaut

2022

PLoS ONE

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Background Myofascial Pain Syndrome (MPS) is a common, overlooked, and underdiagnosed condition and has significant burden. MPS is often dismissed by clinicians while patients remain in pain for years. MPS can evolve into fibromyalgia, however, effective treatments for both are lacking due to absence of a clear mechanism. Many studies focus on central sensitization. Therefore, the purpose of this scoping review is to systematically search cross-disciplinary empirical studies of MPS, focusing on mechanical aspects, and suggest an organic mechanism explaining how it might evolve into fibromyalgia. Hopefully, it will advance our understanding of this disease. Methods Systematically searched multiple phrases in MEDLINE, EMBASE, COCHRANE, PEDro, and medRxiv, majority with no time limit. Inclusion/exclusion based on title and abstract, then full text inspection. Additional literature added on relevant side topics. Review follows PRISMA-ScR guidelines. PROSPERO yet to adapt registration for scoping reviews. Findings 799 records included. Fascia can adapt to various states by reversibly changing biomechanical and physical properties. Trigger points, tension, and pain are a hallmark of MPS. Myofibroblasts play a role in sustained myofascial tension. Tension can propagate in fascia, possibly supporting a tensegrity framework. Movement and mechanical interventions treat and prevent MPS, while living sedentarily predisposes to MPS and recurrence. Conclusions MPS can be seen as a pathological state of imbalance in a natural process; manifesting from the inherent properties of the fascia, triggered by a disrupted biomechanical interplay. MPS might evolve into fibromyalgia through deranged myofibroblasts in connective tissue (“fascial armoring”). Movement is an underemployed requisite in modern lifestyle. Lifestyle is linked to pain and suffering. The mechanism of needling is suggested to be more mechanical than currently thought. A “global percutaneous needle fasciotomy” that respects tensegrity principles may treat MPS/fibromyalgia more effectively. “Functional-somatic syndromes” can be seen as one entity (myofibroblast-generated-tensegrity-tension), sharing a common rheuma-psycho-neurological mechanism.

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Section: Discussionmentioning

confidence: 99%

Scoping review and interpretation of myofascial pain/fibromyalgia syndrome: An attempt to assemble a medical puzzle

Plaut

2022

PLoS ONE

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“…Stiffness and lack of mobility of fascia has implications beyond a patient being unable to move adequately; it can affect the behavior of all cells interacting with the connective tissue matrix. 16 If indeed nature designed a way to relax fascia during movements and reverse these changes it might happen through (i) dissipation of fascial energy as mentioned above; (ii) mechanical effect of movement that ruptures fascial fibers or shakes off fibers, which might explain why studies find extra-corporeal shock wave therapy to be effective for MPS (eg, Uritis et al) 54 ; (iii) friction between sliding layers of fascia elevating the local tissue temperature, or “warming up” myofascial tissue. Literature suggests the three-dimensional supramolecular assembly of HA breaks down progressively at 35-40 degrees celcius.…”

Section: Discussionmentioning

confidence: 99%

“…Non-pharmacological [4,9,11,[54][55][56][57]: including manipulative therapy, vibration therapy, exercise, etc. Since it is shown that needle insertion reduces pain and SEA on EMG [58], this suggests a therapeutic role for mechanical needling.…”

Section: Treatments For Mpsmentioning

confidence: 99%

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Scoping review and interpretation of Myofascial Pain/Fibromyalgia syndrome: an attempt to assemble a medical puzzle

Plaut

2021

Preprint

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Introduction: Myofascial Pain Syndrome (MPS) is a common overlooked and underdiagnosed condition, and with significant burden. MPS is often dismissed by clinicians while patients remain in pain for years. MPS can evolve into fibromyalgia, however, effective treatments for both are lacking due to absence of a clear mechanism. Many studies focus on central sensitization. Therefore, the purpose of this scoping review is to systematically search cross-disciplinary empirical studies of MPS, focusing on mechanical aspects, and suggest an organic mechanism explaining how it might evolve into fibromyalgia. Hopefully, it will advance our understanding of this disease. Methods: Systematically searched multiple phrases in MEDLINE, EMBASE, COCHRANE, PEDro and medrXiv, majority with no time limit. Inclusion/exclusion based on title and abstract, then full text inspection. Additional literature added on relevant side topics. Review follows PRISMA-ScR guidelines. PROSPERO yet to adapt registration for scoping reviews. Findings: 734 records included. Fascia can adapt to various states by reversibly changing biomechanical and physical properties. Trigger points, tension, and pain are a hallmark of MPS. Myofibroblasts play a role in sustained myofascial tension. Tension can propagate in fascia, possibly supporting a tensegrity framework. Movement and mechanical interventions treat and prevent MPS, while living sedentarily predisposes to MPS and recurrence. Interpretation: MPS can be seen as a pathological state of imbalance in a natural process; manifesting from the inherent properties of the fascia, triggered by a disrupted biomechanical interplay. MPS might evolve into fibromyalgia through deranged myofibroblasts in connective tissue, or "fascial armoring", which may explain pain, distribution of pain, decreased pressure/pain threshold, and other phenomena eg, occasional complete resolution after surgery. Movement is an underemployed requisite in modern lifestyle. Lifestyle is linked to pain and suffering. The mechanism of needling is suggested to be more mechanical than currently thought. MPS should no longer be overlooked but solidified in the domain of common modern medicine.

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“…MTrP is an important part of the diagnosis and treatment of MPS, as well as an important etiological mechanism of MPS [17,18]. e chronic pain caused by the trigger point starts from the nociceptors, and some chemical stimuli such as muscle metabolites and pain-causing substances can also activate the nociceptors [4,19] and ultimately lead to central sensitization.…”

Section: Discussionmentioning

confidence: 99%

Convolutional Neural Network Optimization Algorithm-Based Magnetic Resonance Imaging in Analysis of Chronic Pain Caused by the Myofascial Trigger Point

Jin

Fan

Yao

2021

Scientific Programming

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This study was to explore the value of magnetic resonance imaging (MRI) technology processed by convolutional neural network (CNN) optimization algorithms in the clinical research of patients with chronic pain caused by myofascial trigger points (MTrPs). Firstly, referring to the traditional iterative algorithm, this study iterated the convolution network and data consistency layer as a whole for several times, which increased the fitting ability of the data consistency layer and network. When it was applied to magnetic resonance examination, it could be concluded that the effect of its reconstruction method was better than the traditional convolution neural network without the data consistency layer. The image edge was clear, and the restoration effect of details was better. 100 patients with chronic neck pain caused by MTrP were collected and divided into an ultrasound treatment group and a local anesthetic drug injection group, with 50 cases in each group. In addition, 50 healthy volunteers were selected. After clinical treatment, the results showed that, after 3 weeks of treatment, the visual analog score (VAS) and the pain rating index (PRI) of the injection group were 3.16 ± 1.14 points and 4.92 ± 1.26 points, respectively; the present pain intensity (PPI) score was 2.06 ± 0.85 points, and the number of pain days per month was 7.73 ± 1.15. After 1 month of treatment, the VSA and PRI of the injection group were 1.24 ± 0.89 and 1.31 ± 0.97, respectively; the PPI score was 1.34 ± 0.65, and the number of pain days per month was 5.34 ± 0.98. In addition, there were 38 cases reaching the level of clinical cure, accounting for 76%. Therefore, all indicators in the injection group were better than those in the ultrasound treatment group, and the differences were statistically significant ( P < 0.05 ). The results of MRI examination showed that compared with the healthy control group, patients with chronic pain caused by the myofascial trigger point had reduced axial kurtosis (AK), mean kurtosis (MK), and radial kurtosis (RK) in multiple brain areas such as the right parahippocampal gyrus and the right medial prefrontal cortex. In short, chronic pain caused by the trigger point of the myofascial membrane would affect the microstructure of the gray matter of the patient’s brain. In clinical treatment, the efficacy of local anesthetic injection was better than ultrasound therapy.

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Treatment and management of myofascial pain syndrome

Cited by 69 publications

References 88 publications

Scoping review and interpretation of myofascial pain/fibromyalgia syndrome: An attempt to assemble a medical puzzle

Scoping review and interpretation of myofascial pain/fibromyalgia syndrome: An attempt to assemble a medical puzzle

Scoping review and interpretation of Myofascial Pain/Fibromyalgia syndrome: an attempt to assemble a medical puzzle

Convolutional Neural Network Optimization Algorithm-Based Magnetic Resonance Imaging in Analysis of Chronic Pain Caused by the Myofascial Trigger Point

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