How can someone prevent myofascial pain syndrome
Recognize & treat
Myofascial pain often occurs in the shoulder, neck or back area. What should be considered when diagnosing and treating these common pain syndromes, Dr. med. Olaf Günther, specialist in general medicine and physiology from Magdeburg, in conversation with the general practitioner.
The GP: How is myofascial pain defined?
Dr. Günther: Myofascial pain syndromes are pain in individual muscles or muscle groups that are characterized by tension disorders. It comes among other things. to functional and structural shortening, to the formation of trigger points and to radiation to other parts of the body (transmission pain).
Which muscle groups are particularly affected by myofascial pain?
Dr. Günther: In the shoulder and neck area, the trapezius, sternocleidomastoid and splenius cervicis muscles are particularly affected, the temporalis and masseter muscles in the head area and iliopsoas in back pain.
How should one imagine the development of muscle pain?
Dr. Günther: Tension disorders within the muscles occur on the one hand as a result of advanced age and on the other hand due to chronic or acute overload or improper stress, e.g. B. by monotonous uniform work, which is accompanied by holding functions. But mental illnesses such as anxiety and depression can also be involved.
Muscle pain or myalgia refers to a local nociceptively mediated pain in the area of the striated skeletal muscles. The muscle fiber itself is not supplied with pain fibers. In the case of myofascial pain syndrome, injuries and incorrect loads cause the muscle fascia to stick together, as well as the fasciae of the nerves, vessels and joints. This triggers an inflammatory cascade, which among other things. prevents relaxation of the muscle. There is an increase in tone with poor blood circulation, inflammatory reactions and pain.
How can diagnostic myofascial pain be distinguished from degenerative changes or root compression?
Dr. Günther: Radicular symptoms are subject to a very specific law, with abnormal sensations (pain, tingling, numbness) in the area of the affected nerve root up to typical sensory and motor failures. Myofascial pain syndromes, on the other hand, usually produce local or transmitted pain that does not correspond to the dermatomes. To differentiate this, the muscles must be palpated and examined for tenderness and stretch pain. It should be checked whether structural or functional shortenings have already occurred. In addition, the muscle strength must be checked for weakening.
However, one should also bear in mind that every degenerative change, every radical symptomatology and every joint change is generally accompanied by tension disorders in the corresponding characteristic and guiding muscles. The problem with this is that in the end only the joint or the radicular symptoms are treated, but not the accompanying muscular pain symptoms, which can also persist after an intervertebral disc operation, for example.
What therapy options are there for myofascial pain?
Dr. Günther: That depends on the initial stage. I divide the myofascial pain syndromes into three stages, which has proven itself well for daily practice.
Stage 1: Functional shortenings, i.e. adhesions in the fascia area, which can be loosened again by simple stretching (physiotherapy, heat supply, relaxation, stretching techniques).
Stage 2: Concomitant joint dysfunctions, which, however, still allow relaxation and stretching of the muscles.
Stage 3: Structural shortening of one or more joint-guiding muscles with permanent functional disorders of the joint that no longer allow relaxation or stretching of the muscle fascia.
In stage 2 manual therapeutic techniques, stretching, relaxation and - very importantly - instruction in self-stretching are indicated. In addition to this, neural therapy and physical therapy (detonating currents, moist and warm treatment) can have a decisive effect and drugs that are anti-inflammatory and pain-relieving, such as ibuprofen, flupirtine or methocarbamol, can also provide good support in this stage. In stage 3, in addition to drug therapy (antidepressants, botulinum toxin), psychotherapeutic procedures such as progressive muscle relaxation, autogenic training and pain management play a decisive role. But even at this stage, functional therapies such as medical training therapy are still urgently needed.
In what situations would you use medication?
Dr. Günther: For very severe pain that has either only recently existed or occurs as part of a chronic process as an acute exacerbation. I either administer local anesthetics as an injection into the affected muscles or oral medication such as flupirtine and methocarbamol, but also antidepressants. Antidepressants can also be used to lower the central muscle tone, especially if it has already become chronic, i.e. if the pain persists for days and weeks or even for years. Opiates, on the other hand, are not indicated for myofascial pain syndromes, although they are prescribed again and again, because the muscles' pain processing mechanism does not seem to go through opiate receptors. Again and again, patients with sometimes very high opiate doses report persistent pain.
What have you personally had good experiences with?
Dr. Günther: I have had very good experiences with the flupirt over the years. This drug has the advantage that it has an analgesic effect on the one hand, and a slight sleep-inducing or clearly relaxing effect on the muscles on the other. In addition, after a single dose in the evening, pain relief and tone decrease relatively quickly. Flupirtine inhibits the transmission of pain by stabilizing the resting membrane potential on the postsynaptic membrane of nerve cells. However, it may only be taken for two weeks at a time, and the liver values must be checked once a week. I prescribe flupirtine for five to six days for acute pain and up to 14 days for exacerbations of chronic pain. Known liver diseases are contraindications.
Very important: A pure drug therapy cannot work. It must always be combined with functional treatment (stretching, relaxation, balancing out the muscular imbalance, etc.). The patient has to relax and stretch the previously warmed-up muscle for a sufficiently long time. I recommend doing the stretching exercises at least 1 to 2 times a day, holding the stretching tension for 30 to 40 seconds and repeating the exercise up to 10 times in a row. Correct instructions are essential here.
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