Myofascial Pain

It’s a pain syndrome characterized by regional pain arising from hypermobile spots located within taut bands of skeletal muscle, known as myofascial trigger points. It reduces overall feeling of wellbeing.
Causes are varied
            Direct or indirect trauma
            Repetitive strain, postural dysfunction, spine pathologies

Many hypothesis exist each with merits and demerits. They have suggested its complex integration of cellular signalling, excitation-contraction coupling, neuromuscular inputs, local circulation and energy metabolism. One popular theory explains that pain is due to myofascial trigger points in skeletal muscle.
Trigger points can be active or latent. Active trigger points induce spontaneous pain as well as referred pain on palpation of muscle. Latent trigger points induce pain on palpation of muscle.
Treatment
A.Non pharmacologic treatment
Manual therapy- deep-pressure massage
Stretch therapy with spray (where a taut band is stretched immediately after cold spray),
Superficial heat

Ultrasound -       electrical energy to sound waves in order to provide heat energy to muscles 

Dry needling –            Inactivates the myofascial trigger points.
Needle is placed into trigger points using an in-and-out technique in multiple directions

B. Pharmacologic treatment
A.    Analgecis

1.      NSAIDs ( T. Aceclofenac )

2. Lidocaine Patch

3. Weak Opioids


B.Muscle Relaxants
1.      Tizanidine
2.      Benzodiazepines
3.      Cyclobenzaprine 
4.      Thiocolchicoside (TCC) 

C. Anticonvulsants

1. Tricyclic antidepressants (TCAs)
2. Duloxetine,
3. Sumatriptan 

D. Other Treatments

Botulinum type A toxin (BoNT-A)
Decreases production of substance P and glutamate 

Sources
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4107879/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4285362/

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