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  Muscle pain

Myofascial pain syndrome (MPS), more commonly known as muscle pain, is a generalized term that refers to pain and inflammation in the soft tissues of the body. This is a chronic condition that affects the fascia (connective tissue that covers the muscles), a single muscle or a group of muscles. Sometimes, the area where a person experiences the pain is not the exact location of the pain. This situation is known as referred pain. The explanation for this by some experts is that the actual injured site or the strained site prompts the development of trigger points that in turn, causes pain in other areas.

Muscle pain
Muscle pain


A muscle injury, due to excessive strain on a particular muscle of muscle group, ligament or tendon, causes myofascial pain or muscle pain. Other possible causes include the following: intervertebral disc injury (herniated disc or herniated nucleus pulposus), general fatigue, repetitive motions, lack of activity (e.g. broken arm in a sling) and other medical conditions (including heart attack or myocardial infarction and stomach irritation).

Differential diagnosis for generalized muscle pain include : connective tissue/collagen disorders (autoimmune disorders), endocrine diseases (thyroid and parathyroid problems), fibromyalgia syndrome, polymyalgia syndrome, infections (e.g. necrotizing fasciitis, myositis), malignancy, drug or alcohol abuse, neuromuscular disorders/polyneuropathies (e.g. Guillain-Barre syndrome (GBS), Amyotrophic Lateral Sclerosis (ALS), muscular dystrophy, vascular diseases (e.g. thrombophlebitis, Buerger disease); sleep disorders and psychiatric diseases (chronic fatigue syndrome). A complete physical examination focusing on the neurologic (including motor strength, sensation, muscle tone, deep tendon reflexes (DTRs) etc.) can give additional finding or clue which maybe contributory to the patient’s presenting complain or symptom. This enables the examiner to rule in or rule out a differential diagnosis and also helps in formulating the primary impression. In some instances, the patient needs to undergo further diagnostic work-up to confirm or clarify the nature of the disease process.

Myofascial pain syndrome can be diagnosed clinically by determining the trigger points. A trigger point can be objectively measured when the examiner elicits pain once pressure is applied to a particular area of the person’s body. There are four types of trigger points that can be distinguished:

a. Active trigger point – an area of extreme tenderness that usually lies within the skeletal muscle, associated with a local or regional pain.
b. Latent trigger point – an inactive (dormant) area that has a potential to act like a trigger point at a later time.
c. Secondary trigger point – a highly irritable area in a muscle that can become active due to a trigger point and muscular overload in another muscle.
d. Satellite myofascial point – a highly irritable area in a muscle that becomes inactive because the muscle is in the region of another trigger point.

The mainstay of treatment in myofascial pain syndrome is mostly supportive. Physical therapy, “stretch and spray” technique which involves spraying the muscle and the trigger point with a coolant and slowly stretching the muscle, massage therapy and trigger point injection. However, muscle relaxants and analgesic class of drugs (e.g. NSAIDs, COX-2 inhibitors) may also play a role in alleviating the pain. In cases where the cause of the pain is due to excessive use or strain due to repetitive motions, it is advisable that the patient should stop using the muscle temporarily. Immobilization for a certain period of time will promote faster healing and reducing the inflammation of the strained muscle and connective tissues. Treatment of chronic myofascial syndrome requires combination of the different supportive treatment as mentioned above. Other conditions such as insomnia and depression may accompany the muscle pain which necessitates treatment with other medications such as antidepressants and anti-insomniacs.

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