MYOFASCIAL PAIN ·
AN UNDERRECOGNIZED SOURCE OF CHRONIC PAIN
By Seth D. Torregiani, D.O.
Many people who suffer from chronic, sciatic-type low back pain are often mistakenly diagnosed as having “disc disease” – a displaced intervertebral disk in the low back that is thought to be compressing the spinal cord, or an adjoining nerve root, and causing a variety of uncomfortable sensations, including burning pain, numbness, weakness, and a “pins and needles” feeling that radiates down the leg.
Similarly, people who suffer from chronic neck pain, with or without a pattern of pain that extends down the arm, may be diagnosed with cervical (neck) disk disease.
Such patients often undergo a battery of tests, from x-rays to MRIs to EMGs, and try an array of treatments, from physical therapy to massage to narcotic pain medication, in an attempt find relief from their pain. Some may even undergo surgery. Yet their pain remains.
While disc compression is a real entity, it does not account for all forms of musculoskeletal or nerve-type pain. One form of chronic pain that is often underdiagnosed – and often mistaken for a slipped disc or other type of neurologic pain – is myofascial pain.
Myofascial pain is a form (often chronic) of muscular pain that is characterized by the presence of trigger points in the affected muscles. Trigger points are basically small, contracted knots that form within the body of a muscle. They are hypersensitive to stimuli and exquisitely tender. Furthermore, they can cause referred pain – a pattern of pain that extends beyond the trigger point to affect other areas of the body. It is the referred pain patterns that result from trigger points that often cause patients to be mistakenly diagnosed with disc problems.
For example, a trigger point located in the muscles around the shoulder can radiate up the side of the neck or down the arm, mimicking cervical disk disease. A trigger point in the Piriformis muscle, one of the muscles of the hip, can mimic sciatic-type pain. In fact, trigger points can be responsible for mimicking many types of pain, including cardiac-type chest pain and temporomandibular joint pain.
Dr. Janet Travell, a personal physician to President John F. Kennedy and a specialist in physical medicine, coined the term “trigger point” in the 1950s. Dr. Travell was the first to describe the trigger point phenomenon and map out the referred pain patterns of trigger points throughout the body.
Myofascial pain, and its accompanying trigger points, often develops after a person has sustained a traumatic injury (such as whiplash from a motor vehicle accident or a fall). Additional contributing factors include prior injury, emotional or psychological stress, poor posture, and poor workplace ergonomics.
Frequently, a patient experiences a traumatic event (such as a motor vehicle accident) that causes an acute muscle spasm as part of the injury. Then, the patient may experience psychological stress, or re-injury, or fatigue, or some other type of physical insult. This sets up a cycle of chronic muscle spasm and the development of trigger points. The result is often a protracted, chronic course of myofascial pain with its accompanying pattern of referred pain.
If the source of the pain is not recognized by the patient’s physician as myofascial, the patient may undergo a prolonged course of testing and therapy in an attempt to arrive at a diagnosis. Often, many patients undergo prolonged suffering needlessly because the correct diagnosis isn’t arrived at until much later.
There are several modalities available for the treatment of trigger points and myofascial pain. One of the most common methods involves directly injecting the trigger point with anesthetic, saline, or “dry needling” the point. This often breaks the cycle of muscle spasm and relieves the pain. Additional techniques include the “sprayand-stretch” technique, where the trigger point is sprayed with a cold substance then stretched to the point of release. Additional techniques include manual therapy, particularly acupressure and myofascial release. Acupuncture is also often effective in treating chronic myofascial pain.
For more information, WebMD, www.webmd.com, contains a very good review of this topic. If you suspect you may be suffering from chronic myofascial pain, mention this possibility to your physician and ask to be evaluated for trigger points in your painful muscles.
Dr. Seth Torregiani completed his residency in Internal Medicine and Pediatrics at Christiana Care Health System in Newark, DE. He recently opened his integrative medicine practice, focusing on osteopathic manipulative medicine and acupuncture, treating both children and adults, at the Omega Professional Center in Newark, DE. He can be reached at 302-266-9010 or www.dr-seth.com.