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Understanding ...
your pain can help you treat it

Understanding Pain Myofascial pain (MFP) is a very common problem that may affect each of us to some degree at certain times. How it starts, and why it can continue indefinitely is not understood. However, a comprehensive rehabilitation program seems to be the key for success in treating this often-misunderstood condition.

MFP is a Latin-derived term that stands for pain that comes from muscles. More specifically, from muscles and the connective tissues associated with muscle (myo = muscle, fascial = connective or fibrous tissue). Connective tissue is the glue that holds our individual cells and tissues together. For example, have you ever eaten steak that was very tough to chew? Have you ever eaten steak that was very easy to chew? The major difference in the two is the amount of and toughness of the connective tissue. Muscles have lots of connective tissue; in fact, muscles are made up of two primary components; muscle cells and connective tissue. MFP describes discomfort that comes from these two components of muscle.

MFP has been known by several other terms. Fibrositis has been the most frequently used but is inaccurate, implying that the condition is primarily an inflammation of connective tissue Fibro = connective tissue, sitis = inflammation). This is not so, even though inflammation plays a role. Today, MFP and Fibromyalgia (fibro = connective tissue, my = muscle, algia = pain) share in the description of this malady. I prefer to use the term myofascial pain, because there are significant differences between MFP and fibromyalgia.

There are many signs and symptoms that are common in MFP. Most common are muscular pain, tenderness, and periodic stiffness. The level of the discomfort varies and tends to wax and wane. There are good days and bad days, but in some cases they all seem to be bad. There are usually tender points found upon physical examination. These areas are very pressure sensitive causing localized pain, and sometimes pressure on these areas causes pain to be felt in some other area or areas. The latter is called trigger points, and the phenomenon of feeling discomfort at a site different from where the pressure is applied is called referred pain.

These muscular problems are usually aggravated by activity, but interestingly enough, both over activity and under activity aggravate them. An important concept in treatment is that exercise must be maintained at activity levels between upper and lower limits of tolerance (moderation). These muscular problems, instead of healing, often progress gradually. People who have been struggling with this condition for some time have a tendency toward it and once it gets started, it seems to continue and worsen. But take heart; there is hope.

There are common patterns of muscular involvement such as the back of the neck, around the shoulder blades, and the lower back and buttocks; but any muscle or group of muscles can be involved. The pattern in any given case may be related to the reason for the development of this problem in the first place. Often strain, injury, or overuse is the cause of the onset of the problem, but in some cases, the problem seems to gradually arise for no apparent reason.

With upper back and neck involvement, headaches are a frequent problem. These usually radiate from the neck to the back of the head and sometimes to the sides or front of the head. These headaches are usually dull and aching and are associated with muscle tension. They may occur daily and even affect the sleep pattern.

Almost everyone with MFP can recognize that certain situations, activities, or environmental changes cause increases in the level of discomfort. Oncoming cold weather will often cause increases in symptoms. Prolonged, repetitive, or vigorous activities or prolonged positioning will aggravate this condition. A sedentary lifestyle and poor physical fitness probably cause predisposition for MFP and can help to keep it from healing and resolving.

A sedentary lifestyle and poor physical fitness probably cause predisposition for MFP Certain factors or activities cause symptom reduction or relief. Warm, dry weather generally makes people feel a bit better. A hot shower or bath can be very relaxing, reducing discomfort at the time and for some time afterward. Moderate activity and short bouts of rest and relaxation help to reduce discomfort and stiffness, but rest and inactivity can be a two-edged sword, and like activity and exercise must be taken in moderation, not excess. Massage can make a person with MFP feel better, but a massage done incorrectly might aggravate the condition. General massage is temporarily soothing and typically tolerated well, but deeper more vigorous massage should be done only by trained therapists and after adequate cold pack or ice massage treatment.

The local application of heat is a standard in many treatment protocols. Heat can be helpful, but only if used prudently. The use of moist heating pads, hot water bottles, and electric heating pads (at low heat settings) are soothing and decrease discomfort temporarily. In general, heat may have a very limited ability to help resolve these problems; however, while the heat is in place, the pain is masked. Heat should be used with some reservations because using heat may be both beneficial and harmful. The involved muscles are in a deteriorative state (not completely healthy) in MFP. There may be some swelling (edema) and inflammation in these muscles, and the application of heat may cause an increase in the swelling and inflammation. Therefore, the use of heat must be monitored closely. If discomfort is worse 15 to 30 minutes after the heat is removed than prior to the application of the heat, then heat is probably not the right treatment at this time. Heat may be more appropriate later, after the muscles are healthier. Cold pack treatment is usually much more affective and tends to help in muscle healing. Cold penetrates better than heat, and it reduces swelling and inflammation.

MFP is a cyclical process, and it is a complex intermingling of mind and body functions. It is also a soft tissue process, involving muscles (not bones). There can be underlying bone or joint problems, such as arthritis, that can affect MFP, but MFP can exist and continue without any other underlying bodily problems. It is important to get a doctorís examination to assess whether bones, intervertebral discs, joints, ligaments (any structure other than muscles), are involved because treatment of these problems will require different methods from those described here.

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"Understanding ...
your pain can help you treat it"

   authored by:
Dr. Livingstone is the medical director of rehabilitation at Havasu Regional Medical Center in Lake Havasu City, Arizona. He is board certified in physiatry (P.M.&R.) having developed an interest in this field because of personal experience after a m...

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