Myofascial Pain

While most people have joint or bone pain, there are also a fair number of individuals who have muscle pain. Today, Myofascial pain syndrome is recognized as a chronic pain disorder which requires treatment. The pain in this disorder is very localized and occurs at some sensitive points on the muscle known as trigger points. Whenever these trigger points are touched, there can be intense pain. In most cases when the trigger point is stimulated the pain can spread to the entire muscle.

Myofascial Pain Symptoms

All individuals experience muscle pain at some point in their lives but in most cases the pain resolves with time. However, individuals who develop myofascial pain usually have pain that is continuous and worsens with time. Myofascial pain can occur on any part of the body where there are muscles. This may be in the face, around the head, neck , back, pelvis, arms legs and low back. When treatment is sought early, myofascial pain can be effectively treated. There are several treatment options for myofascial pain which include trigger point injections, pain medications, physical therapy and TENS.

The pain of myofascial syndrome is deep and changes in intensity with time. Associated with pain, there is muscle soreness, joint stiffness near the affected muscle, tenderness to touch, feeling of a hard knot in the muscle and difficulty sleeping because of the pain.

Myofascial Pain Causes

The exact cause of myofascial pain is not known. Experts believe that some muscle tend to become hypersensitive to touch. These hypersensitive areas often form after muscle or nerve injury. Some people also develop myofascial pain after overuse of the extremity. These hypersensitive areas are known as trigger points. These trigger points when stimulated can rapidly cause severe burning pain.

Myofascial Pain Risk Factors

Myofascial pain is due to stimulation of trigger points in the muscles. Some of the risk factors for developing these trigger points include:

- Muscle injury of any type can induce Myofascial pain syndrome. The injury can be mild or severe. For example, some individuals may fall on their buttocks and develop severe low back pain and others may only bump their shoulder and have the same intensity of pain - Repetitive work or over use activities are also thought to induce formation of trigger points. Individuals who perform the same routine work everyday are more prone to Myofascial pain

- Inactivity or a sedentary life style can also lead to Myofascial pain

- Individuals who are bed ridden after a stroke or those who have had recent surgery often develop intense pain in the muscles for no apparent reason

- Emotional stress can also lead to develop of trigger points and lead to Myofascial pain. Individuals who are severely stressed and develop anxiety are more likely than others to develop this syndrome

Myofascial pain is a disorder of middle ages. Younger people are better able to cope with many stresses in life, are generally more active, and tend to have fewer incidence of myofascial pain. The peak incidence of myofascial pain is the 3rd decade of life. Women tend to develop myofascial pain more often than men. It is not clear why this is so and no direct link has been associated with the sex hormones.


Myofascial pain syndrome is not a benign disorder and if not appropriately treated can lead to a number of complications.

The complications include:

- Muscle weakness is common because the individual has intense pain and does not move around. The intense pain often makes the individual reluctant to use the muscles and over time, the muscles become thin and weak.

- Sleep problems are common in individuals with myofascial pain syndrome, the continuous pain makes it difficult to sleep, and moreover lying on certain parts of the body may also be difficult. At night if one inadvertently moves onto a trigger point, there can be excruciating pain. The sleep problem can be resolved with the use of anti depressants

- Fibromyalgia is the outcome of untreated myofascial pain syndrome. Fibromyalgia is a chronic pain condition and very similar to Myofascial pain syndrome. However, in fibromyalgia the pain is more widespread and much more difficult to treat

Fibromyalgia Diagnosis

The diagnosis of Myofascial pain syndrome can be difficult. The doctor will obtain a complete history and perform a physical exam. All the trigger points will be identified to determine if you really have Myofascial pain. The doctor will also stimulate the trigger points to make sure that you develop the same pain as before. In order to make sure that there is no other pathology; you may undergo a series of x rays and nerve conduction studies.

Since muscle pain has many possible causes, your doctor may recommend other tests and procedures to rule out other causes of muscle pain before diagnosing Myofascial pain syndrome.

Fibromyalgia Treatment

Treatment for myofascial pain syndrome typically includes physical therapy, trigger point injections, or medications. There is no definitive evidence supporting one therapy over another. The individual should discuss the options and treatment preferences with the physician. Some people may have to try out several different approaches before they discover one that works.

1) Physical therapy can help tremendously when one has myofascial pain. One can enter a physical therapy program and learn to do exercises that can relieve myofascial pain. Physical therapy may involve stretching, massage therapy or ultrasound guided acupressure treatments. Most trained physical therapists can help you identify your trigger points, help improve posture and offer exercises that will relieve the pain.

2) Trigger point injections are commonly performed by many physicians. This involves injecting a variety of medications into and around the trigger point. When the injections are done properly, they can rapidly ease pain and relieve tension. Prior to any injection, your physician will numb the area with ice or use a local anesthetic. Corticosteroids are often used to relieve pain around the trigger points

3) Medications are the mainstay of treatment. While NSAIDs are widely prescribed, they often do not work for more severe cases of trigger pain. Many individuals require prescription strength pain medications, but long-term use of these products is associated with side effects and physical dependence. Some people do respond to anti depressants and anti convulsants like neurontin.

Fibromyalgia Alternative Medicine

Many people are now trying alternative therapies to help relieve myofascial pain. However, one should discuss these options with a physician before trying out experimental therapies. Many doctors do understand the limitations of conventional medical therapies are quite aware of the alternative therapies available for the public. While many alternative treatments have been hyped as excellent options for managing pain, these claims are not always supported by clinical trials.

Acupuncture is widely used to treat a variety of pain disorder including myofascial pain. The therapist places fine needles in specific locations on the body. There is some evidence to support the use of acupuncture in the treatment of myofascial pain but small numbers of patients has limited the evaluation of these studies. Before you get acupuncture therapy, ensure that the practitioner uses sterile or new needles and get someone who has experience. Acupuncture should not be done if one is on blood thinning medications.

When to see a doctor

Most cases of myofascial pain are moderate to severe in intensity and are not responsive to over the counter pain medications. Many people go through several doctors because the diagnosis is missed and others search online for miracle cures. In order to get the condition treatment appropriately one needs to see a physician who specializes in pain disorder. The earlier the treatment is sought the better is the prognosis. Once myofascial pain has been established, it is very difficult to reverse. Whenever your pain fails to respond to ice, heat, massage or other home made remedies, it is wise to seek professional medical care.

San Francisco Myofascial and Fibromyalgia Pain Multi-Disciplinary Approach

The San Francisco Multi-Specialty Medical Group (SFMMG) provides Full Spectrum care for your symptoms. Our physicians and staff members represent a number of specialties including:

• Orthopedic Medicine Physiatry
• Chiropractic
• Podiatry
• Physical Therapy
• Acupuncture

Being able to offer appropriate, comprehensive and timely diagnosis and treatment in one location. Please call to schedule an appointment with our physicians at one of our locations.