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Myofascial Pain Syndrome

What is causing your muscles aches and how to treat it.
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Written by
Petros Efthimiou, MD, FACR.
New York Rheumatology Care, PC
Last updated October 9, 2020

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What is myofascial pain syndrome?

Myofascial pain syndrome (MPS) is a chronic pain disorder that usually affects a specific group of muscles in your body. It’s caused by tight, contracted bands of fibers in your muscles called “myofascial trigger points.”

The pain feels like a deep constant ache. When trigger points are pressed, the pain can radiate to surrounding areas. You may also feel a burning or stinging sensation.

MPS is often confused with fibromyalgia, which causes pain throughout the body, not just in a specific area, and does not usually have trigger points.

Most common symptoms

You may feel a pain in one muscle group or part of your body, like the lower back, neck, or jaw.

Main symptoms

  • Pain
  • Muscle stiffness
  • Trigger points (they may feel like muscle knots)

Pro Tip

Myofascial pain syndrome is often confused with fibromyalgia, a more generalized condition. They share many common characteristics, such as the type of pain and the presence of tender points. However, MFS usually affects specific muscle groups/areas of the body. —Dr. Petros Efthimiou

What causes myofascial pain syndrome?

MPS seems to be set off by some type of event, such as a muscle spasm, a muscle injury, or continual muscle stress (overuse). These may lead to the development of the contracted muscle fibers, which become trigger points. It may also be caused by poor posture.

Pro Tip

Ask your doctor: Is there a particular posture, exercise, repetitive movement that causes pain and muscle spasm in the area of my body affected by MFS? Can non-pharmacologic approaches (change of posture, avoidance of a particular exercise/movement) help resolve it? —Dr. Efthimiou

What makes you more likely to have MPS?

Factors that may contribute to the development of MPS:

  • Poor posture
  • Sitting for a long time in awkward positions
  • Nutritional deficiencies (e.g. vitamin deficiencies, electrolyte abnormalities)
  • Any injury to the musculoskeletal system (muscles, bones, tendons) or disks in the spine
  • Fatigue and lack of sleep
  • Hormonal changes (menopause)
  • Intense cooling of muscles (such as when sleeping in front of an air conditioner)
  • Stress and mental health issues (depression, anxiety)
  • Underlying inflammation conditions
  • Obesity

What is the best treatment for myofascial pain?

Dr. Rx

In milder cases, topical injections of the trigger points with local anesthetics (e.g. lidocaine) can release the muscle spasm and relieve the pain, without the need for oral medicines. —Dr. Efthimiou

Treatment for MPS typically includes a combination of medications, trigger point injections, exercise, massage, and physical therapy.

  • Stretching. A physical therapist may lead you through gentle stretching exercises to help ease the muscle pain. If you have trigger point pain when stretching, the physical therapist may spray a numbing solution on your skin.
  • Massage. Massaging the tight muscles manually or by acupressure or use of a massage percussion device (massage gun) applied directly on trigger points may offer instant pain relief and release muscle tension.
  • Heat. Apply heat using a heat pack or warm towel to the painful area to help relieve muscle tension and reduce pain.
  • Therapeutic ultrasound. Use of sound waves may increase blood circulation and warm the area, which can bring relief and promote healing in muscles.
  • Dry/wet needling. Inserting a needle (dry needling) into the trigger point may break up the tension. Sometimes a numbing agent or steroid is used (wet needling).

Medication 

  • Muscle relaxants
  • NSAIDs
  • Trigger point injections
  • Analgesics (lidocaine patches) applied on affected muscle groups
  • Anticonvulsants (lidocaine, pregabalin)
  • Antidepressants (duloxetine)
  • Botox injections to affected areas

Prevention

  • Improving your posture can help treat, but also prevent myofascial pain, particularly in your neck (e.g., “tech neck”). You can improve posture by stretching and avoiding being in the same position for a long period of time.
  • Doing exercises that strengthen the muscles surrounding your trigger point will help avoid muscle overuse.
  • Try to reduce your stress and practice relaxation techniques.
  • Try to keep a regular sleep schedule to improve your sleep.
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New York Rheumatology Care, PC

Petros Efthimiou is a Board Certified Specialist in Rheumatology at the rank of Clinical Professor of Medicine & Rheumatology in New York City.

A summa cum laude graduate of the University of Ioannina Medical School in Greece, Dr. Efthimiou became a Research Scholar at Northwestern University College of Medicine in Chicago, Illinois. He then completed his Internal Medicine Residency at Brown University in Providence, Rhode Island, while his Rheumatology Fellowship took place at the Hospital for Special Surgery and New York Presbyterian/Cornell Campus.

Dr. Efthimiou has expertise in the treatment of autoimmune disorders including Rheumatoid Arthritis, Psoriatic arthritis, gout, osteoarthritis, myositis, SLE-lupus, Sjogren’s syndrome, Vasculitis, Pulmonary Hypertension, Scleroderma, Osteoporosis, Auto-inflammatory Syndromes and Adult Still’s Disease. Dr. Efthimiou has published extensively in peer-reviewed journals and medical textbooks and has served as Clinical Investigator in multiple, international, randomized controlled trials. He has served as an ad hoc reviewer and editorial board member in peer-reviewed rheumatology journals and is a frequently invited speaker in national and international medical conferences.

A 2011-20 “Castle Connolly” and “US News & World Report”, Top Doctor in Rheumatology, he was the recipient of the Patients’ Choice Award in 2012-20 and named a 2014-20 “Super Doctor” by the New York Times and “Best Doctor” by New York Magazine. He has published a medical textbook in the Auto-inflammatory Syndromes and a Rheumatology Review Textbook.

Dr Efthimiou is Board Certified in Rheumatology and Internal Medicine.

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