Chronic Myofascial Pain (CMP)

An interventional approach to treating chronic pain

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Chronic myofascial pain (CMP), also called myofascial pain syndrome, is a painful condition affecting the muscles and the sheath of the tissue - called the fascia - that surround the muscles. CMP can involve a single muscle or a group of muscles.

What are the symptoms of CMP?

The most notable feature of CMP is the presence of tender points that are tender to the touch and create a twitch response leading to pain. Trigger points are tender points that cause pain that can be felt in another area of the body, called referred pain.

CMP is often described along with fibromyalgia; however, they are different disorders. CMP is a neuromuscular disorder affecting the muscles and fascia directly. Fibromyalgia is believed to stem from a dysfunction of the chemical substances - such as neurotransmitters and hormones - that transmit information from tissue to tissue. Fibromyalgia can affect the body in many ways, often causing a general aching, while CMP is related to specific triggers points and is more localized.

Trigger points might be active or latent. An active trigger point is always sore and can prevent the full use of the muscle, leading to weakness and decreased range of motion. A latent trigger point does not cause pain during normal activities, but is tender when touched and can be activated when the muscle is strained, fatigued, or injured.

Other symptoms associated with CMP include a sensation of muscle weakness, tingling, and stiffness. The pain associated with CMP might also lead to problems sleeping.

What causes CMP?

No one is sure what causes CMP. Possible causes include mechanical factors ” such as having one leg longer then the other - poor posture, stress, and overuse of muscles. Exercising or performing work activities using poor techniques can also put excessive strain on muscles, leading to CMP. In addition, anxiety and depression can cause increased muscle tension, leading to significant myofascial pain. Trigger points might be activated by overwork, fatigue, direct trauma, and cold.

How common is CMP?

Pain originating in the muscles and fascia is very common. Nearly everyone at some point suffers from this type of pain, known as myalgia fascitis or myofascitis. CMP, however, involves pain that is chronic, or long lasting and is associated with specific trigger points.

CMP most often occurs in people between the ages of 30 and 60 years. It affects men and women equally.

How is CMP diagnosed?

Your health care provider usually begins with a thorough physical examination and medical history, including a review of symptoms. The provider will likely perform a detailed exam of the affected muscles, including strength and range of motion testing. He or she will rub the suspected trigger points to see if the muscles respond, or twitch, and cause pain in a predictable pattern or specific region.

Sometimes, blood tests will be performed to look for medical causes of muscle pain, such as vitamin D deficiency or hypothyroidism.

How is CMP treated?

Treatment options might include:

• Physical therapy: A therapy program includes stretching, postural and strengthening exercises.
• Medicine: Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, might be used to help reduce pain.
• Massage therapy: Therapeutic massage can loosen tight muscles and relieve cramping or spasms.
• Injections: This involves injecting a pain medicine (local anesthetic) directly into the trigger points.

It is also important to address any factors ” such as poor posture, workplace ergonomics, or mechanical problems ” that might be contributing to CMP pain.

What complications are associated with CMP?

In some cases, the pain of CMP can affect additional muscles. For example, a muscle can be stressed when another muscle is affected by CMP and is not functioning properly.

What is the outlook for people with CMP?

In general, the outlook is good. When properly diagnosed and treated, the pain associated with CMP often can be controlled.

Can CMP be prevented?

It might not be possible to prevent all episodes of CMP, but the following tips might help reduce their occurrence and hasten recovery:

• Improve your posture
• Reduce your body weight
• Exercise regularly
• Eat a healthy, well-balanced diet.
• Learn stress-management techniques
• Use proper techniques at work, and during exercise and sports