Multidisciplinary Pain Clinic

Myofascial Pain Syndrome

Myofascial Pain Syndrome (MFPS) is a condition where you develop one or more trigger points. A trigger point is an area in your muscle where the muscle is tight or shortened. Pressing on the point usually produces pain both at the site and at areas away from the site (referred pain). MFPS can cause or be present in conditions such as:

  • TMJ pain
  • Neck pain
  • "Whiplash"
  • Shoulder pain
  • Low back pain

  • Q: Are there any tests for MFPS?

    A: There are no diagnostic tests for MFPS. This is a clinical diagnosis based on your symptoms or your doctor’s examination. Your doctor may wish to do tests to rule out other causes of your symptoms.

  • Q: How is MFPS related to fibromyalgia?

    A: While MFPS appears to be a different disease from fibromyalgia, observation of patients in our clinic over time suggests that in some cases the localized pain of MFPS may become the more generalized pain seen in fibromyalgia. Some scientific data supports the idea that similar processes may be at work in MFPS and fibromyalgia. Certainly many of the treatments, (exercise, stretching and antidepressants) are the same.

  • Q: What causes MFPS?

    A: The exact cause of MFPS is still not clear. It appears that in response to acute trauma or chronic movements or positions that anatomic or physiologic changes may occur in you muscles leading to formation of a trigger point. It is also possible that there may be changes in your central nervous system leading to or contributing to the trigger point.

  • Q: What drugs are useful in MFPS?

    A: Useful drugs in MFPS are:

    Cyclobenzaprine (Flexeril R)

    Cyclobenzaprine is chemically similar to the amitryptiline and other drugs and have a similar mechanism of action and effect in MFPS.

    Non steroidal anti-inflammatories

    Drugs such as ibuprofen, Naprosyn and similar drugs may be useful for exacerbations but should not be used daily for prolonged periods. Acetaminophen may be useful for acute flare-up but should not be used for prolonged periods. COX 2 Inhibitors such as Cellebrex or Bextra should probably be only used for acute flare-ups.

    Tizanidine (Zanaflex R)

    Tizanidine has been shown in some studies to be effect for the treatment of MFPS. Tizanidine has side effects of drowsiness, and dry mouth.

    Narcotics

    Our experience in the Pain Clinic suggests that narcotics can be a useful part of a treatment program for MFPS. We prefer to prescribe long preparations of medications. Methadone which is a narcotic may also be useful. In our experience addiction to narcotics when prescribed for chronic pain is rare.

  • Q: What is the treatment for MFPS?

    A: The primary treatments for MFPS are:

    Exercise and stretching

    Exercise remains the primary treatment for MFPS. Many patients have allowed themselves to become deconditioned due to their pain. When we teach people about pacing exercise at the Multidisciplinary Pain Clinic, we recommend that exercise should start at half the maximum amount of exercise that can be tolerated and then gradually increasing one’s activity level every few days. An intense exercise session that leaves you on the couch for several days is of no help. It may be worthwhile dividing your exercise into several brief sessions every day. Walking is the best exercise. Swimming or aquacize can be useful. Exercise should not be limited to the painful area of the body.

    Stretching can be done by itself or in conjunction with an exercise program. There are many good books on stretching available. We have a sheet of stretches available at the Multidisciplinary Pain Clinic and posted on our website. Stretching should be done several times a day for short periods of time.

    It is a good idea to stretch before your exercise session. Therapies such as yoga or Tai Chi may be appropriate. The GET SET program offered at the Edmonton General Hospital and the Gerald Zetter Centre is useful in MFPS.

    Proper sleep

    Many MFPS sufferers complain of problems sleeping, so it makes sense to try to improve your sleep. The Multidisciplinary Pain Clinic has a handout available on proper sleep hygiene which is also posted on our website.

    Psychology

    You can be taught relaxation and coping skills that you will be able to use on a daily basis You may benefit from a formal pain management group such as the Life Despite Pain program at the Multidisciplinary Pain Clinic or other similar programs.

    Trigger point injections

    Trigger point injections are can be useful in MFPS. In trigger point injections, dilute local anesthetic in injected into your trigger points. These should be combined with stretching or massage. Steroids are usually not injected. Many patients get 3-4 weeks relief with trigger point injection with some cumulative benefit. In certain circumstances injection of Botulinum toxin may produce prolonged relief.

    Trigger point injection is generally safe. There may be a temporary exacerbation of your pain. There is a small risk of a punctured lung.

    Acupuncture

    Despite little experimental evidence that acupuncture is effective in MFPS, many of our patients find it to be effective. Intramuscular stimulation (IMS) which uses acupuncture needles may also be effective.