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Myofascial Pain

A muscle naturally reacts to pain by contracting, much the way we withdraw if we touch something sharp or hot.  When the pain is sustained (as it is in Fibromyalgia) a knot may develop.  These knots can be felt under the skin and are usually tender to touch.

If the knot persists, it may develop into a “triggerpoint” and radiate pain to another location.  (The term “triggerpoint” refers to a gun and its bullets. The “knot” is the “trigger” and pain radiates to wherever the “bullet” lands.)

A triggerpoint at the shoulder, for example can radiate pain, aching, sensations of hot or cold, and autonomic phenomena (goosebumps or sweating, for example) to the upper chest and breast, down the scapula, or right down the arm to the fingers. Triggerpoints in the neck generally radiate to the temples, eyes, or frontal area, where they are mistaken for headaches.  A triggerpoint in the piriformis muscle of the buttock can cause an aching pain to radiate down the leg just like sciatica. Myofascila triggerpoints, therefore, can be quite severe and they can mimic pinched nerves and headache.

Myofascial pain is quite different from fibropain, and is treated entirely differently. Myofascial pain is thought to be due to a vicious cycle involving a spinal reflex.  Fibropain causes muscle spasm, which causes more pain, which triggers more spasm, as illustrated below:

[Illustration]

 

The goal of treatment is to break this cycle.  This can be accomplished in 3 different ways:  (1) pain killers, (2)  muscle relaxers, (3) and direct physical therapy on the painful knotted muscle.

Pain Killers

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Topicals (Icy Hot, BenGay, Biofreeze …)

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Lidoderm  

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Elavil / amitriptyline

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Ultram / tramadol

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Opioids (codeine, hydrocodone, oxycodone, morphine …)

Muscle Relaxers

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Flexeril / cyclobenzaprine

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Soma / carisoprodol

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Skelaxin /

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Zanaflex / tizanidine

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Baclofen / liorisal

Direct Physical Therapies

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Cold-to-hot packs

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Massage, myofascial release, cranio-sacral therapy

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Acupressure (gentle pressure can break up a knot)

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          Intermittent thumb pressure

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          Tennis ball therapy

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          Theracane ( www.theracane.com ) or Backnobber

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Massager / vibrator

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Galvanic- or electro-stimulation (electrical current can fatigue a muscle)

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Physical Therapy (spray-and-stretch)

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Triggerpoint injections (dry, lidocaine, lidocaine:Sarapin, Botox)

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Chiropracty

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Acupuncture

For more information on MP:  http://www.emedicine.com/pmr/topic84.htm