Muscle Pain (Myalgia, Myofascial Pain Syndrome)

Optimal treatment of muscle pain (myofascial pain syndrome) can be a multifaceted approach.

Myofascial pain syndrome is characterized by muscle pain, tenderness, and spasm. Myofascial pain syndrome usually involves muscles in body areas that are asymmetric or focal, whereas fibromyalgia is typically a diffuse and symmetric muscle pain syndrome that involves both sides of the body.

Myofascial pain syndrome causes localized muscle pain. Affected muscles cause the following:

• neck pain,
• upper back pain, and
• lower back pain, generally affecting one side of the body or one side of the body much more than the other.
• there is commonly tenderness and spasms in the painful areas and there may be tenderness in areas that are not feeling chronic pain.

It is also common for patients with myofascial pain syndrome to have poor sleep patterns with decreased recovery sleep (non-rapid-eye movement sleep). This is associated with awakening feeling unrested and daytime fatigue. Stiffness after inactivity is common.

What causes myofascial pain syndrome?

The cause of myofascial pain syndrome is unknown. Nevertheless, prior injury, poor sleep patterns, stressful life situations, and depression are common underlying conditions that may play a role in inciting and exacerbating myofascial pain syndrome. It is currently felt that risk factors such as these may lead to a change in the ability of the brain to properly process pain perception (referred to as central pain processing).

Myofascial pain may develop from a muscle injury or excessive strain on a particular muscle or muscle group, ligament, or tendon.

Other causes of myofascial pain syndrome include:

• Injury to intervertebral disc
• General fatigue
• Repetitive motions
• Medical conditions (including heart attack, stomach irritation)
• Lack of activity (such as a broken arm in a sling)

Myofascial pain syndrome is commonly treated by primary-care physicians, including family medicine doctors, general practitioners, and internists. Other physicians who treat myofascial pain syndrome include physiatrists, orthopedists, and rheumatologists.

Physicians diagnose myofascial pain syndrome based on the areas of complaints of muscle pain and associated tenderness during a physical examination. Extensive laboratory testing is usually unnecessary. There are no apparent changes (redness, warmth, swelling, etc.) in areas of involvement. The appearance is the same as similar areas on the other side of the body. The widespread, diffuse body involvement that is typical of fibromyalgia is not present.

Is a muscle strain the same as a muscle tear?

A muscle strain is not the same thing as a muscle tear. A muscle strain is an injury that occurs when a muscle or a tendon is overstretched. A muscle tear is when a muscle or a tendon is overstretched and it tears.

Although a muscle strain is different from a muscle tear, many people get these injuries confused. A strain is an injury that involves a muscle or tendon being overstretched. Your doctor may also call the injury a pulled tendon or muscle pull. (A tendon is the cord of tissue that attaches a muscle to a bone.)

Sometimes the injury is more severe, and one, a few, or all of the muscle fibers get torn. In this case, you have a muscle tear.

Muscle strains and muscle tears can become chronic and can lead to myofascial pain syndrome.

How can you tell if you have muscle pain or nerve pain?

If the pain started after an injury and it is a dull ache, it's likely muscle pain. Muscle pain is commonly localized to only the area of the muscles involved. If your pain seemed to come out of nowhere or it's been ongoing, and it feels like your skin is on fire, you're likely experiencing nerve pain. Nerve pain can travel or “shoot” to areas of the body, can affect the skin and surrounding tissues, and is often a “burning” or sharp pain rather than the dull ache of muscle pain.

Optimal treatment of myofascial pain syndrome can be a multifaceted approach. This can include education of the patient and the following:

• stress reduction,
• stretching and exercise programs as well as physical therapy rehabilitation,
• sleep improvement, and
• medications all best organized by a single physician who tailors the therapies over time by customizing them for the individual patient.

Medications used to treat myofascial pain syndrome can be directed toward various features of the individual's condition and may be used temporarily or long-term. Often trials of medications are used to find the best treatment for a particular patient. For example, trazodone (Serzone) or amitriptyline (Elavil) may be used at bedtime to improve sleep as well as relieve pain; cyclobenzaprine (Flexeril) or orphenadrine (Norflex) can be used at bedtime to relax muscles and to aid sleep; and antidepressants such as sertraline (Zoloft), fluoxetine (Prozac), duloxetine (Cymbalta) can be used to help control pain as can gabapentin (Neurontin) and pregabalin (Lyrica).

Home remedies for myofascial pain syndrome include:

• exercise,
• massage,
• hot water soaks, and
• resting.

Ibuprofen (Motrin, Advil), acetaminophen (Tylenol), or naproxen (Aleve) can be beneficial in relieving symptoms of myofascial pain syndrome.

Myofascial pain syndrome can lead to several complications if left untreated, such as:

• Chronic pain
• Muscle weakness
• Anxiety and depression
• Sleep disorders
• Reduced quality of life

Because of the potentially life-altering consequences of myofascial pain syndrome, it is important to seek medical attention to manage symptoms and seek proper treatment.

Myofascial pain syndrome can resolve with ideal treatment regimens. However, many patients with myofascial pain syndrome have had symptoms for years. Outcomes are best when a multifaceted treatment approach is guided by a single physician who is monitoring the response to various therapies employed.

While myofascial pain syndrome cannot be prevented, it is certainly possible to avoid factors that make the condition worse. This includes avoiding reinjury, minimizing stress, maximizing optimal sleep, and treating any underlying depression.