Treatment of Myofascial Pain Syndromes

The treatment of persons with myofascial pain syndrome (MPS) follows the general principles that apply to all medical disorders. The nature of the pain problem first must be understood through developing an appropriate differential diagnosis and evaluating the contributions of coexisting disorders, until a single working diagnosis emerges. Following the initial assessment and formulation of diagnostic hypotheses, new data are collected. A regular review at each encounter and modification of the hypotheses facilitate a more efficient and effective management of patients with MPS and dictate the actual program components ( Higgs & Jones, 1995 ; Jones, 1994 ). After addressing the issue of diagnosis, the practitioner must determine the structural or biomechanical functioning of the patient and the contribution that any dysfunction may have to the individual’s pain. Medical and psychological disorders that may alter the presentation of MPS or that may predispose to its becoming chronic are assessed. Treatment of persons with MPS addresses each of these issues specifically ( Figure 34.1 ). There must be relief of pain by the direct inactivation of the myofascial trigger point (MTrP) itself. The mechanical and structural factors that affect or overload the muscle and aggravate the pain must be resolved or alleviated. The medical and psychological problems that affect muscle function, including those that alter and impair intracellular metabolism, must be identified and corrected where possible. Inactivation of the MTrP may occur with direct intervention at the MTrP itself, through correction of the mechanical factors that produced it or through improvement in the underlying medical disorders that predispose to the development or maintenance of the MTrP. Figure 34.1 Treatment program example. https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429123801/252747c7-fca5-426b-ae09-f21807d4cf67/content/fig34_1.tif"/>