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What is Myofascial Pain Syndrome?

Submitted by Corie Kovach, MD, FACOG, MBA

Myofascial pain syndrome is a deep chronic pain condition affecting the musculoskeletal
system. Most people experience temporary muscle pain from time to time that typically
resolves on its own after a few weeks. But for some people, soft tissue pain persists for
months without an obvious explanation. Individuals affected by myofascial pain
syndrome (MPS) have sensitive spots, known as trigger points. Most of these points
result from muscle trauma/injury, or overuse, often arising from sustained repetitive
activities, like lifting heavy objects at work or working on a computer all day.
Contributing factors may include:

 Tobacco use
 poor posture, prolonged sitting or travel
 obesity or nutritional deficiencies
 sedentary lifestyle/lack of exercise
 previous injury or underlying inflammatory condition
 increased emotional stressors
 generalized fatigue, lack of sleep
 menopause
 depression/anxiety

Common symptoms may include: deep pain in localized areas of muscles, muscle pain
that gets worse or fails to improve with time, presence of painful knots in muscles that
when pressed produce intense localized or referred pain; and muscles that are weak,
stiff, inflexible, or have reduced range of motion; as well as mood or sleep disturbances.

Dry needling and trigger point injections are excellent therapeutic options for
improvement of myofascial pain and providing prompt relief of trigger point pain. Not all
trigger points require injection or dry needling. Many active trigger points will respond to
massotherapy and physical therapy, especially in the early stages of trigger point
formation. However, for chronic trigger points, trigger point injection and needling are
more effective treatments

Dry needling is the use of solid filament needles inserted through the skin and into the
muscle to release painful trigger points. No solution or medication is injected as with a
hypodermic needle during a flu shot. With dry needling, the needle itself and the effects
it produces within the tissue is the treatment.
Dry needling works by causing a local twitch response which is both diagnostic and
therapeutic. In order to break the pain cycle, we must achieve decreased muscle
contraction, reduced chemical irritation, improved flexibility and decreased pain. When a
needle is inserted into muscle it will also produce a controlled lesion and will cut
between three to fifteen thousand individual muscle fibers. The body activates a positive
systemic immune response to the needle as a foreign invader and the cut muscle fibers
also produce a local reaction that your body will respond to reduce inflammation

A trigger point injection is just that—an injection of an allotted amount of long-acting
local anesthetic, sometimes combined with an injectable corticosteroid at the offending
trigger point area. It is usually accompanied by immediate relief of the immediate
localized pain. It may take a series of trigger point treatments to accomplish complete or
adequate relief of a chronic problematic area. Several mechanisms have been
suggested as possible explanations for the inactivation of trigger points by injection
including disruption of muscle fibers or nerve endings that create an abnormal feedback
loop and a local release of intracellular potassium, which may depolarize and thus
disrupt nerve conduction. Additionally, injected fluid may reduce nerve irritability,
increase circulation, and increase the removal of local waste metabolites. Furthermore,
a local anesthetic may interrupt erroneous pain feedback loops between the trigger
point and the central nervous system.

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