Q: What Drugs Are Useful In Mfps
A: Useful drugs in MFPS are:
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 has been shown in some studies to be effect for the treatment of MFPS. Tizanidine has side effects of drowsiness, and dry mouth.
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.
Trigger Points: Stepping Stones To Myofascial Pain Syndrome
Myofascial pain is unique in that its associated with trigger pointsareas of tenderness and stiffness within the muscle tissue that reduce your range of motion. Myofascial pain syndrome can occur when you have several areas of active trigger points.2
People often refer to trigger points as knots, as they feel tight and bundled to the touch compared to the suppler surrounding muscle. As the muscle becomes tight, it can cut off its own blood supply, which can trigger muscle tenderness, pain, and further spasm or tightness in the muscle.
Trigger points can form in muscles all over your bodyincluding those in your neck, mid-back, and low back.
One of the common characteristics of trigger points is that they cause referred pain, or pain that travels or spreads to a nearby location . They may also twitch when prodded.
Almost everyone has trigger points, but not every trigger point causes symptoms. Latenttrigger points may reduce your range of motion but will only cause pain when directly palpated or compressed, whereas active trigger points can be painful at any timeeven when youre resting. Lifestyle factors, such as stress and poor posture, can cause a latent trigger point to turn active.
Lower Back Pain Causes
Lower back pain or lumbar pain may have similar symptoms from person to person, but the cause of those symptoms might be completely different. Low back pain can be caused by pelvis misalignments, muscle and soft tissue tightness, and or nerve irritation. Lower back pain can start in one area and extend to other muscles and tissues causing a vicious cycle of continuous pain. The important part here is that the main common cause in ALL cases is myofascial restrictions in the local lumbar area or in a distant body part.
These fascial restrictions can pull the soft tissue from the lumbar area directly or indirectly. When the pelvis is misaligned, it can result in lower extremities postural length discrepancy. This happens because the lumbar muscles to work in a non-normal position to function. Thereby, overloading the soft tissue and the nerves.
Its these types of misalignments that cause lower back pain. Through daily activities such as walking, additional stress affects all the tissues until the pain becomes unbearable.
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What Is Myofascial Therapy
Myofascial Therapy is a type of safe, low load stretch that releases tightness and pain throughout the body caused by myofascial pain syndrome, which describes chronic muscle pain that is worse in certain areas known as trigger points. This article provides an overview of the treatment technique, including:
- What the myofascial system consists of
- Conditions and symptoms myofascial therapy can treat
- A description of the treatment and who typically provides it
- Results and outcomes of a course of myofascial therapy
Fascia is a three-dimensional web that permeates the whole body. The best way to envision the expanse of the fascial system is to think of it as a layer of connective tissue that starts with the top layer directly below the skin, and extends to two deeper layers.
When the fascia is in its normal healthy state it is a relaxed and supple web – like the weave in a loose-knit sweater. When it is restricted, it is more rigid and less pliable, and can create pulls, tensions, and pressure as great as 2,000 pounds per square inch. The fascia is a continuous system, running from the bottom of the feet through the top of the head and has three layers:
Fascia restrictions can occur within any or all of the layers.
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Myofascial Pain Syndrome Facts & Information
Over 40 million Americans estimated to have this condition. This is usually found in head, neck, shoulders, extremities and back.
Pain is present locally and often referred to other parts of the body that arises from trigger points which are localized sensitive areas in the muscle that contain palpable, taut bands.
Most often it presents following an initial insult or trauma to deeper structures of the spine. The muscles respond by contracting around the injured area and in the low back is typically referred to as a low back strain. Initially, it is a subconscious protective reaction to decrease any activities that could potentially aggravate the pain. After some time, if the deeper injury does not improve and/or is not treated appropriately soon after the insult, the muscle spasms can serve to contribute to your overall pain.
Pain can be localized or widespread, often in conjunction with vague symptoms like numbness, fatigue, or sleep disturbance.
Our board-certified pain management doctor can accurately diagnose if MPS is the source of your pain and help you gain relief with highly effective non-surgical treatment.
Possible Basis Of Soft Tissue Pain
The pain in question has the features of deep somatic pain. By the 1930s, the experiments of Sir Thomas Lewis and Kellgren convincingly demonstrated distant referral of somatic pain, such as originates in muscles, tendons and bone. Kellgren noted:The diffuse pain from a given muscle is always distributed within certain regions, though the distribution within these limits varies from individual to individual, and according to the part of the muscle stimulated and pain from muscle may be confused with pain arising from other deep structures such as joints and testis.
Hyperalgesia in muscles that are structurally and electrically normal suggests that the hyperalgesia is referred owing to peripheral antidromic activation or sensitization of nociceptive afferents or results from central sensitization of nociceptive dorsal horn neurons . Radiation of pain and tenderness may depend on altered central processing held responsible for secondary hyperalgesia maintained by nociception arising in peripheral nerves. But these factors still leave us without any good explanation of a mechanism to account for the persistence of aches and pains after a self-limited or unknown primary illness or injury.
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What Questions Should I Ask My Healthcare Provider
- Do I have myofascial pain syndrome or fibromyalgia?
- What medications will help with my myofascial pain syndrome?
- How did I get myofascial pain syndrome?
- Am I at risk for other pain conditions?
- Whats my treatment plan?
- Should I see a pain management specialist?
- What can I do to make myself feel better?
- How soon should I return to see you?
A note from Cleveland Clinic
Everyone experiences pain during their lifetime. But when that pain is unbearable or long-lasting, thats when you need to consult your healthcare provider. Fortunately, most pain including myofascial pain can be reduced or eliminated with the right treatment! See your healthcare provider as soon as possible for evaluation and treatment.
Last reviewed by a Cleveland Clinic medical professional on 07/06/2020.
Myofascial Pain Syndrome Vs Fibromyalgia
Most people with pain and fatigue in their skeletal muscles have either fibromyalgia or MPS. Fibromyalgia is a disorder of widespread muscular pain. It can be felt throughout the entire body. But, people with MPS feel localized pain in regional groups of muscles, like the lower back, neck, or jaw.
MPS is characterized by a few localized trigger points in the taut ropey bands of the muscles. These trigger points are tender and can produce localized pain. But their defining characteristic is that they trigger referred pain. Fibromyalgia is associated with multiple, more widespread tender points. These differ from trigger points because they dont produce referred pain.
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Questions Your Healthcare Provider May Ask To Diagnose Myofascial Pain Syndrome:
Your healthcare provider may order a few tests to rule out other conditions and ask you questions about your pain, including:
- Where do you feel the pain?
- How would you describe your pain?
- How often do you experience pain?
- What makes your pain better?
- What makes your pain worse?
- Have you had any recent injuries?
- Do your symptoms get better at certain times during the day?
- What does your work day look like ?
Your healthcare provider may check your gait and your posture to see if there is a balance of muscle use and look for signs of muscle weakness. You may also be asked about other health problems that can contribute to myofascial pain syndrome including how much and how well you sleep and if you feel stressed, anxious or depressed.
Different Types Of Pain
We all experience pain differently, but in general, people describe muscle pain as an aching or stiffness. The pain is typically localized in the muscle itself, and it usually hurts when you use the muscle. You feel fatigued and may have trouble sleeping.
Nerve pain is described as crushing, burning, tingling or numbness. It is sharp and you may feel pain on the skin above the nerves as well.
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How Myofascial Release Helps Relieve Low Back Pain
When patients receive the news of its part of life, Im grateful they dont give up. Instead, they seek a more natural or holistic treatment for back pain. Thats how they find us. Through Myofascial Release, it is possible to realign the fascia, which, in many cases, ends up being the cause of lumbar or lower back pain.
Research shows that the fascia is not only the support system of the body. It is also the communication network in between all and every single cell in the human body. Fascia forms a tridimensional web that expands through the entire body. In fact, all body tissues including organs, bones, muscles, etc. are fascia specializing in different functions. For example, bones are solidified fascia.
Fascial restrictions are unique for every person suffering from lumbar pain.
- In some cases, fascial restrictions may be caused by old or recent scar tissue, close or further away from the lumbar area.
- In other cases, the fascial restrictions are caused by postural issues, or maybe overuse of a body part during daily activities.
- Weve also seen if a patient suffers from fascial restrictions in one part of their body, they might overcompensate in the lumbar area to perform certain activities. Thereby creating unnecessary lumbar pain.
Wholistic PT offers a unique approach to treating lower back pain. We believe in treating the cause instead of merely the symptoms.
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Chronic Facial Muscle Pain Or Aching
Severe, constant and dull facial muscle pain is often the first pain-related symptom of Myofascial Pain Syndrome. The patient feels a constant pain in the affected area. Eventually, the pain might turn chronic after 2-3 months. Such chronic pain will not respond to normal medication. In addition, chronic pain caused by the Myofascial Pain Syndrome soon begins to affect the normal life of the patient.
This pain is often located in the jaw area, though it can spread to any of the body parts.
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Treating Myofascial Pain Syndrome
If you have myofascial pain syndrome, your treatment will be increasingly more successful depending on how quickly you see your healthcare provider early in the development of your symptoms before trigger points establish themselves. There are a variety of treatment options your medical professional will consider to manage your pain and restore affected muscles.
One of the more effective treatments are trigger point injections. This procedure can be done in a medical office and does not require an outpatient surgical setting. Small amounts of anesthetic and steroid are injected into the trigger point to help alleviate pain.
In more persistent cases where trigger points are active frequently, botulism toxin is used in these injections to break the cycle often for up to 3 to 6 months. This medication inhibits muscle contraction at a cellular level.
The risk of complication from a trigger point injection is very low. Complications such as bleeding and infection at the injection site are uncommon. You may have temporary soreness or numbness at the injection site. After a trigger point injection, you can actively use your muscle. However, you should avoid strenuous activity for the first few days.
Disease Progression Including Natural History Disease Phases Or Stages Disease Trajectory
TrPs can be either active or latent . Latent TrPs can be regarded as a preclinical or subclinical phase of MPS.1,2,15,21 Examination often reveals tender taut bands in muscle and mild limitation in range of motion. Correction of biomechanical stressors and elimination of perpetuating factors may prevent the development of pain. Once TrPs become spontaneously painful, treatment intervention may be necessary to eliminate them. Acute myofascial pain due to TrPs caused by a clearly identifiable local muscle strain carries a favorable prognosis. As MPS spreads from local to regional and becomes more chronic, it becomes more difficult to eliminate.
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Specific Secondary Or Associated Conditions And Complications
MPS is a great imitator. It can present as shoulder pain in patients with impingement or capsulitis, hip or knee pain in patients with osteoarthritis, back or neck pain in patients with lumbar or cervical radiculopathy, periarticular muscle pain in a patient with underlying tendinosis, or headache.3 The pain pattern is dependent on the muscle involved. MPS can present as painful restricted range of motion, stiffness, referred pain, and autonomic dysfunction.2
Treatment Options For Myofascial Pain
The best treatment for myofascial pain is ordinarily physical therapy and massage therapy. Another treatment doctors may try is a stretch and spray technique, which involved spraying a coolant along the muscles length and then slowly stretching it. There is also trigger point injection, which involved injecting anesthesia directly into the trigger point of the patient. In certain cases of myofascial pain, a combination of all the above treatments if needed to effectively manage the condition. Medications for co-occurring health conditions, such as insomnia or antidepressants, may be used to help quell side effects.
Medications are also normally used to help address myofascial pain. These include:
- Nonsteroidal anti-inflammatory drugs, which are over-the-counter drugs like acetaminophen and ibuprofen that can relieve pain and swelling.
- Analgesics, which are pain relievers.
- Muscle relaxants, which can reduce muscle spasms.
- Anticonvulsants, which can relieve pain and reduce muscle spasms.
- Tricyclic antidepressants, which can treat chronic pain, fibromyalgia, and nerve pain similar conditions to myofascial pain.
- Botox injections, which help prevent muscle contractions and may have pain-relieving effects.
Can Myofascial Pain Syndrome Be Prevented
There are certain factors that can put you more at risk for developing myofascial pain syndrome. Managing these risk factors may not prevent you from developing the syndrome, but could help reduce the severity of the condition.
Many of the prevention suggestions to follow are also pain management strategies:
- Sugary foods and beverages such as soft drinks.
- Red meat .
- Artificial sweeteners and general additives .
- Processed meat .
Check your cupboards and your fridge. Empty it of any foods that will increase your myofascial pain syndrome symptoms.
Muscle Pain: It May Actually Be Your Fascia
You might attribute a painful neck or a backache to tired muscles or stiff joints. But these symptoms can also be caused by a part of your body you probably havent heard of: the fascia. Until recently, this network of tissue throughout the body received very little attention despite its major role in every move you make.
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Now Why Would Myofascial Pain Cause Dizziness
But, perhaps a more important question worth beginning with here is if myofascial pain causes dizziness, can both the pain and the dizziness be treated, or better still, can patients be cured of myofascial pain.
The answer to the first part of this question is yes, myofascial pain can be treated, controlled, remedied and even substantially reduced. Whether directly related to myofascial pain or not, dizzy spells can be remedied as well.
But can patients ultimately be cured of this chronic condition? There are cases where patients report a complete disappearance of all typical symptoms but ultimately and strictly speaking, there is no known medical cure.