What is myofascial pain and why haven't I heard of it?
After I had neck surgery, saw multiple doctors and physical therapists, and lived with debilitating daily pain for nine horrible months, I was finally diagnosed with chronic myofascial pain syndrome (“CMP” or “MPS”), a largely unknown or undiagnosed, but widely experienced, health condition. [See My Journey.]
Studies indicate that myofascial pain affects up to 85% of the general population (Fleckenstein et al., 2010), and that myofascial pain syndrome is a far more common cause of chronic and acute musculoskeletal pain than is generally recognized (Argoff, Smith and Evans, 2012).
I had never heard of MPS, so as a patient desperately seeking pain relief, I looked to the internet to learn more about this condition. Now, after years of first-hand experience, I can say that the Mayo Clinic, Cleveland Clinic, WebMD, and Verywell.com websites fairly accurately describe the condition, as I've summarized below.
Myofascial pain syndrome (MPS), also known as chronic myofascial pain (CMP), is a chronic disorder. This painful condition affects the muscles and the sheath of tissue (called fascia) surrounding the muscles (Mayo Clinic; Cleveland Clinic).
“Pain originating in the muscles and fascia is very common. Nearly everyone at some point suffers from this type of pain.” MPS/CMP, however, “involves chronic, or long lasting, pain and is associated with specific trigger points” (Cleveland Clinic).
A trigger point (TrP) is a small, hard knot that you can sometimes feel under your skin. It develops in the muscle and fascia (WebMD; Verywell.com). The knot itself can be painful, especially when touched. Note, these are not the same as tender points found in fibromyalgia, although fibromyalgia patients may also have TrPs.
While nearly everyone has experienced occasional muscle-tension pain, the discomfort associated with myofascial pain syndrome persists or worsens over time (Mayo Clinic).
Myofascial pain may develop from a muscle injury or from excessive strain on a particular muscle or muscle group, ligament, or tendon. Other potential causes include injury to muscle fibers, repetitive motions involved in jobs or hobbies, stress-related muscle tension, or lack of activity (such as having a broken arm in a sling). Once incurred, pain can worsen with activity or stress (WebMD).
In some cases, a person experiences pain in a different location from the TrP, with or without pressure on the sensitive TrP. This is known as referred pain (Mayo Clinic; Cleveland Clinic; Verywell.com).
According to the Cleveland Clinic, possible causes of myofascial pain include “mechanical factors (such as having one leg longer than the other), poor posture, stress, and overuse of muscles. Exercising or performing work activities using improper 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 may be activated by overwork, fatigue, direct trauma, and cold.” CMP most often occurs in people between thirty and sixty years of age and affects men and women equally (Cleveland Clinic).
As stated on the Verywell.com website: “Experts don't know why damage that heals normally in most people causes TrPs in others. However, studies suggest that muscle trauma in some people leads to malformations where the nerve cells connect to muscle cells. This suggests MPS is a neuromuscular disease.” The website also explains, “Some researchers use the name ‘chronic myofascial pain’ (CMP) instead of myofascial pain syndrome [MPS] because of evidence it's a disease, not a syndrome. (A ‘syndrome’ is a set of symptoms without a known cause)” (Verywell.com).
Stats & Quotes from the Scientific Literature:
"Myofascial pain is a common dysfunction with a lifetime prevalence affecting up to 85% of the general population" (Fleckenstein et al., 2010).
"Myofascial pain (MP) is not a fatal condition, but it can cause significant reduction in quality of life (QOL) and is a major cause of time lost from work. [And] [c]osts associated with MP sap millions, perhaps billions, of dollars from the economy" (Findley, 2017).
"...myofascial pain syndromes constitute the largest group of unrecognized and undertreated acute and chronic medical problems in clinical practice today, and these are among the most commonly overlooked causes of chronic pain and disability in medicine" (Simons, 1988 in Argoff, Smith, and Evans, 2012).
"[Myofascial pain] is responsible for many cases of chronic musculoskeletal pain and the diagnosis is commonly missed. In the US, 14.4% of the general population suffers from chronicmusculoskeletal pain. Approximately 21-93% of patients with regional pain complaints have [myofascial pain]" (Findley, 2017).
"A skilled examiner can provide accurate diagnosis of myofascial pain (MP). Unfortunately, most medical school and residency training programs do not adequately cover this common condition" (Graff-Radford, 2004 in Findley, 2017).
"Myofascial pain is poorly understood, which results too often in underdiagnosis and poor management" (Graff-Radford, 2004).
"...A trigger point is a region of increased energy consumption with an inadequate oxygen supply" (Simons, 1988).
"[C]hronic MPS ... is associated with higher trait-anxiety concurrent with higher [disability related to pain]." (Vidor et al., 2014).
“Signs and symptoms of myofascial pain syndrome may include: deep, aching pain in a muscle; pain that persists or worsens; a tender knot in a muscle; difficulty sleeping due to pain” (Mayo Clinic). In addition to the local or regional pain associated with myofascial pain syndrome, people with the disorder can also suffer from depression, fatigue, and behavioral disturbances (WebMD).
Click here for a list of books and articles about the physical symptoms and treatment of myofascial pain.
Click here for a list of books about mind-body explanations of chronic pain.
Initially, my myofascial pain presented itself as daily burning, jabbing, searing, and highly debilitating pain, which began as TrPs in my neck and upper back and then moved up into my head. As I have progressed in my healing, my pain is far less severe than it was, but is still daily and limiting. It fluctuates between mild pressure pain and discomfort, to occasional burning and jabbing, to mind-thwarting pressure pain around my head (causing difficulty concentrating) and sometimes disorienting pain (causing cognitive deficit and severe disorientation).
Over the years—and after being rear-ended in my car three and a half years after I initially ruptured the disc in my neck and had neck surgery— my active TrP pain has moved from my neck and upper back to being concentrated in my upper neck and head.
Keep in mind that this describes my experience and where my CMP/MPS affects me. Myofascial pain can affect any of the muscles in the body.
Myofasical pain is also ...
The websites mentioned above adequately describe the physical nature of MPS/CMP and some everyday activities that affect MPS/CMP. However, only a few websites touch on how emotions can lead to, trigger, or exacerbate myofascial pain. For example, the Cleveland Clinic website notes that stress and anxiety can also cause myofascial pain. From my experience and research, emotions can play a critical role in myofascial pain as well as in many other chronic pain conditions (and possibly many other chronic illnesses).
While some websites indicate that “trauma to muscle” may contribute to MPS/CMP, they do not discuss the effects of emotional trauma on MPS. This oversight is despite the fact that many scholarly articles and several books discuss the connection between physical pain and emotional trauma. For more information, click on the Trauma & Chronic Pain tab and see Trauma and pain resources within the Resources page).
For some people, simply addressing the emotional component of chronic pain is all they need to heal. For others, healing requires addressing the emotional component in combination with using other modalities, some of which may or may not be the placebo effect in play. But I'm all for the placebo effect if it works to eliminate pain! For more in-depth coverage of treatment approaches, click on the Treatments tab.