Myofascial pain syndrome

Myofascial trigger points (MFTPs) are a common cause of chronic neck and back pain. They are localized segments of muscle that are thought to be subjected to trauma by acute injury or microtrauma from repetitive stress. MFTPs can occur in any skeletal muscle.

Diagnosis is clinical and includes the identification of small knots (2-5 mm in diameter) and tight bands within affected muscles that are painful when palpated. Diagnostic imaging is not helpful and should only be considered to rule out other causes of muscle pain.

The treatment of MFTPs should start with a manual technique that involves applying pressure to a trigger point to release the pathologic contraction of the muscle segment and to stretch the segment to restore normal muscle fiber length. This can be accompanied by acupuncture, stress management and relaxation techniques. Pharmacologic treatment is unspecific and may comprise muscle relaxants, nonsteroidal anti-inflammatory drugs (NSAIDs), anticonvulsants, or topical application of local anesthetics or botulinum toxin.

Radial shock wave therapy (RSWT) is very effective