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Semin Neurol 2016; 36(05): 469-473
DOI: 10.1055/s-0036-1586262
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Myofascial Trigger Point Pain Syndromes

Robert D. Gerwin
1   Department of Neurology, Johns Hopkins University School of Medicine, Bethesda, Maryland
› Author Affiliations
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Publication History

Publication Date:
23 September 2016 (online)

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Abstract

Myofascial pain syndromes caused by trigger points (TrPs) in muscle are a common cause of local and generalized pain. Trigger points are hyperirritable zones in contracted bands of muscle, thought to be caused by muscle overload or stress. Stress TrPs have characteristic electromyographic features, and can be visualized with ultrasound and magnetic resonance elastography. Trigger point needling or injection can be effective in inactivating TrP, but correcting triggers is also critical.

Keywords

myofascial pain - trigger points - referred pain - low back pain - trigger point needling
 

  • References

  • 1 Mansfield KE, Sim J, Jordan JL, Jordan KP. A systematic review and meta-analysis of the prevalence of chronic widespread pain in the general population. Pain 2016; 157 (1) 55-64
    CrossrefPubMedGoogle Scholar
  • 2 Fishbain DA, Goldberg M, Meagher BR, Steele R, Rosomoff H. Male and female chronic pain patients categorized by DSM-III psychiatric diagnostic criteria. Pain 1986; 26 (2) 181-197
    CrossrefPubMedGoogle Scholar
  • 3 Fleckenstein J, Zaps D, Rüger LJ , et al. Discrepancy between prevalence and perceived effectiveness of treatment methods in myofascial pain syndrome: results of a cross-sectional, nationwide survey. BMC Musculoskelet Disord 2010; 11: 32
    CrossrefPubMedGoogle Scholar
  • 4 Travel JG, Simons DG. Myofascial Pain and Dysfunction: The Trigger Point Manual. Baltimore, MD: Williams & Wilkins; 1983
    Google Scholar
  • 5 Quintner JL, Bove GM, Cohen ML. A critical evaluation of the trigger point phenomenon. Rheumatology (Oxford) 2015; 54 (3) 392-399
    CrossrefPubMedGoogle Scholar
  • 6 Mense S, Gerwin RD , Eds. Muscle Pain: Understanding the Mechanisms. Heidelberg, Germany: Springer; 2010. chapters 3–5
    CrossrefGoogle Scholar
  • 7 Turo D, Otto P, Shah JP , et al. Ultrasonic tissue characterization of the upper trapezius muscle in patients with myofascial pain syndrome. Conf Proc IEEE Eng Med Biol Soc 2012; 2012: 4386-4389
    PubMedGoogle Scholar
  • 8 Sikdar S, Shah JP, Gebreab T , et al. Novel applications of ultrasound technology to visualize and characterize myofascial trigger points and surrounding soft tissue. Arch Phys Med Rehabil 2009; 90 (11) 1829-1838
    CrossrefPubMedGoogle Scholar
  • 9 Simons DG, Hong CZ, Simons LS. Endplate potentials are common to midfiber myofacial trigger points. Am J Phys Med Rehabil 2002; 81 (3) 212-222
    CrossrefPubMedGoogle Scholar
  • 10 Shah JP, Phillips TM, Danoff JV, Gerber LH. An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. J Appl Physiol (1985) 2005; 99 (5) 1977-1984
    CrossrefPubMedGoogle Scholar
  • 11 Ge HY, Fernández-de-las-Peñas C, Arendt-Nielsen L. Sympathetic facilitation of hyperalgesia evoked from myofascial tender and trigger points in patients with unilateral shoulder pain. Clin Neurophysiol 2006; 117 (7) 1545-1550
    CrossrefPubMedGoogle Scholar
  • 12 Lucas KR, Rich PA, Polus BI. Muscle activation patterns in the scapular positioning muscles during loaded scapular plane elevation: the effects of latent myofascial trigger points. Clin Biomech (Bristol, Avon) 2010; 25 (8) 765-770
    CrossrefPubMedGoogle Scholar
  • 13 Ge HY, Zhang Y, Boudreau S, Yue SW, Arendt-Nielsen L. Induction of muscle cramps by nociceptive stimulation of latent myofascial trigger points. Exp Brain Res 2008; 187 (4) 623-629
    CrossrefPubMedGoogle Scholar
  • 14 Fernández-Carnero J, Ge HY, Kimura Y, Fernández-de-Las-Peñas C, Arendt-Nielsen L. Increased spontaneous electrical activity at a latent myofascial trigger point after nociceptive stimulation of another latent trigger point. Clin J Pain 2010; 26 (2) 138-143
    CrossrefPubMedGoogle Scholar
  • 15 Fernández-Carnero J, Ge HY, Kimura Y, Fernández-de-Las-Peñas C, Arendt-Nielsen L. Increased spontaneous electrical activity at a latent myofascial trigger point after nociceptive stimulation of another latent trigger point. Clin J Pain 2010; 26 (2) 138-143
    CrossrefPubMedGoogle Scholar
  • 16 Calvo-Lobo C, Pacheco-da-Costa S, Hita-Herranz E. Efficacy of deep dry needling on latent myofascial trigger points in older adults with nonspecific shoulder pain: a randomized, controlled clinical trial pilot study. J Geriatr Phys Ther 2015; (Epub ahead of print). doi: 10.1519/JPT.0000000000000048
    PubMedGoogle Scholar
  • 17 Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain 2011; 152 (3, Suppl): S2-S15
    Google Scholar
  • 18 Shankar H, Reddy S. Two- and three-dimensional ultrasound imaging to facilitate detection and targeting of taut bands in myofascial pain syndrome. Pain Med 2012; 13 (7) 971-975
    CrossrefPubMedGoogle Scholar
  • 19 Chen Q, Bensamoun S, Basford JR, Thompson JM, An KN. Identification and quantification of myofascial taut bands with magnetic resonance elastography. Arch Phys Med Rehabil 2007; 88 (12) 1658-1661
    CrossrefPubMedGoogle Scholar
  • 20 Gerwin RD, Dommerholt J, Shah JP. An expansion of Simons' integrated hypothesis of trigger point formation. Curr Pain Headache Rep 2004; 8 (6) 468-475
    CrossrefPubMedGoogle Scholar
  • 21 Scott NA, Guo B, Barton PM, Gerwin RD. Trigger point injections for chronic non-malignant musculoskeletal pain: a systematic review. Pain Med 2009; 10 (1) 54-69
    CrossrefPubMedGoogle Scholar
  • 22 Cagnie B, Castelein B, Pollie F, Steelant L, Verhoeyen H, Cools A. Evidence for the use of ischemic compression and dry needling in the management of trigger points of the upper trapezius in patients with neck pain: a systematic review. Am J Phys Med Rehabil 2015; 94 (7) 573-583
    CrossrefPubMedGoogle Scholar
  • 23 Liu L, Huang QM, Liu QG , et al. Effectiveness of dry needling for myofascial trigger points associated with neck and shoulder pain: a systematic review and meta-analysis. Arch Phys Med Rehabil 2015; 96 (5) 944-955
    CrossrefPubMedGoogle Scholar
  • 24 Alonso-Blanco C, Fernández-de-las-Peñas C, Morales-Cabezas M, Zarco-Moreno P, Ge HY, Florez-García M. Multiple active myofascial trigger points reproduce the overall spontaneous pain pattern in women with fibromyalgia and are related to widespread mechanical hypersensitivity. Clin J Pain 2011; 27 (5) 405-413
    CrossrefPubMedGoogle Scholar
  • 25 Michel F, Decavel P, Toussirot E , et al. The piriformis muscle syndrome: an exploration of anatomical context, pathophysiological hypotheses and diagnostic criteria. Ann Phys Rehabil Med 2013; 56 (4) 300-311
    CrossrefPubMedGoogle Scholar
  • 26 Clauw DJ. Fibromyalgia: a clinical review. JAMA 2014; 311 (15) 1547-1555
    CrossrefPubMedGoogle Scholar
  • 27 Affaitati G, Costantini R, Fabrizio A, Lapenna D, Tafuri E, Giamberardino MA. Effects of treatment of peripheral pain generators in fibromyalgia patients. Eur J Pain 2011; 15 (1) 61-69
    CrossrefPubMedGoogle Scholar
  • 28 Ge HY, Wang Y, Danneskiold-Samsøe B, Graven-Nielsen T, Arendt-Nielsen L. The predetermined sites of examination for tender points in fibromyalgia syndrome are frequently associated with myofascial trigger points. J Pain 2010; 11 (7) 644-651
    CrossrefPubMedGoogle Scholar
  • 29 Tfelt-Hansen P, Lous I, Olesen J. Prevalence and significance of muscle tenderness during common migraine attacks. Headache 1981; 21 (2) 49-54
    CrossrefPubMedGoogle Scholar
  • 30 Giamberardino MA, Tafuri E, Savini A , et al. Contribution of myofascial trigger points to migraine symptoms. J Pain 2007; 8 (11) 869-878
    CrossrefPubMedGoogle Scholar
  • 31 Gerber LH, Shah J, Rosenberger W , et al. Dry needling alters trigger points in the upper trapezius muscle and reduces pain in subjects with chronic myofascial pain. PM R 2015; 7 (7) 711-718
    CrossrefPubMedGoogle Scholar
  • 32 Bron C, de Gast A, Dommerholt J, Stegenga B, Wensing M, Oostendorp RA. Treatment of myofascial trigger points in patients with chronic shoulder pain: a randomized, controlled trial. BMC Med 2011; 9: 8
    CrossrefPubMedGoogle Scholar
  • 33 Iglesias-González JJ, Muñoz-García MT, Rodrigues-de-Souza DP, Alburquerque-Sendín F, Fernández-de-Las-Peñas C. Myofascial trigger points, pain, disability, and sleep quality in patients with chronic nonspecific low back pain. Pain Med 2013; 14 (12) 1964-1970
    CrossrefPubMedGoogle Scholar
  • 34 Staal JB, de Bie RA, de Vet HC, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low back pain: an updated Cochrane review. Spine 2009; 34 (1) 49-59
    CrossrefPubMedGoogle Scholar
  • 35 Saeidian SR, Pipelzadeh MR, Rasras S, Zeinali M. Effect of trigger point injection on lumbosacral radiculopathy source. Anesth Pain Med 2014; 4 (4) e15500 . eCollection
    PubMedGoogle Scholar
  • 36 Mayoral O, Salvat I, Martín MT , et al. Efficacy of myofascial trigger point dry needling in the prevention of pain after total knee arthroplasty: a randomized, double-blinded, placebo-controlled trial. Evid Based Complement Alternat Med 2013; 2013: 694941
    PubMedGoogle Scholar