ANKLE PAIN CARPAL TUNNEL SYNDROME CHRONIC PAIN ELBOW PAIN HIP PAIN IMPAIRMENT & DISABILITY KNEE PAIN MUSCLE WEAKNESS MYOFASCIAL PAIN NECK & LOW BACK PAIN NUMBNESS SHOULDER PAIN WRIST PAIN Spence Rehabilitation Center 9305 Calumet Ave. Suite C-1 Munster, IN 46321 Phone : (219) 513-2267 Fax      : (219) 836-1276         What is it?  Tight, hypersensitive muscle that is painful to touch. How is it different from Fibromyalgia? Myofascial pain commonly affects certain muscle groups while fibromyalgia is more widespread and typically accompanied by fatigue and sleep problems. What causes myofascial pain? Often the exact etiology is unclear and can be caused by a variety of factors. If the pain is persistant and not responsive to conservative treatments, further diagnostic workup may be indicated. Contributors to myofascial pain can include:   1. Joint disorders such as facet arthritis and osteoarthritis. 2. Inflammatory disorders such as rheumatoid arthritis, polymyalgia rheumatica, and lupus. 3. Radiculopathies which are pinched nerves at the spine level. 4. Degenerated disks in the spine can sometimes bulge out or herniated and touch the spinal cord or nerve roots nearby. 5. Common musculoskeletal disorders such as tendinitis and bursitis of the joints. 6. Mechanical issues such as unsafe bending, uneven leg length, and poor posture. 7. Nutritional deficiencies such as Vitamin B1, B12, folic acid, iron, magnesium. 8. Endocrine problems such as low thyroid hormone. 9. Psychologic disorders including depression and anxiety. 10. Infections such as hepatitis and viral syndromes. 11. Fibromyalgia.     What are some Nonpharmacologic Treatment options for Myofascial Pain?   1. Posture training: Typically reviewed by physical therapists. Also, an ergonomic assessment can be helpful which used to determine what your daily work activities are and whether job modification strategies can help. 2. Stress reduction: Meditation, biofeedback, and relaxation techniques can be taught by certain health clubs and pain centers. 3. Transcutaneous electric nerve stimulation (TENS): A device that provides a low level stimulation to block pain going to the brain. The etiology is unclear but is believed to be due to stimulation of certain receptors that then interfere with transmission of pain receptors. Another theory is that serotonin and dopamine levels are increased which help to decrease pain. 4. Massage: Has been found to decrease both neck and low back pain. Stretching exercises should also be included In the regimen. 5. Trigger point Injections: Can be used to break the pain cycle and help to reset the hypersensitive muscles. Injections typically include anesthetic agents such as lidocaine with or without a low dose of steroid. Some studies even demonstrated that dry needling (no medication) and Botox can be helpful. Because trigger point injections are often used to treat chronic pain, it is sometimes necessary to perform a series of injections to get optimal effect. The injections are typically performed in two to three week intervals. However, if the pain has not responded after three rounds, it should be considered that there may be some other factor that needs to be assessed further. 6. Acupuncture has been shown to be beneficial under certain conditions.     What pain medications have been found to be useful for Myofascial Pain? 1. Nonsteroid anti-inflammatory medications: When used with an antidepressant or muscle relaxant. 2. Tramadol: Also known as Ultram that prevents reuptake of Serotonin and Norepinephrine. It has some opiate like properties so it can be habit forming and should be used carefully. 3. Antidepressants: Such as tricyclics and SNRIs have been found to be helpful in decreasing myofascial pain. Commonly prescribed TCAs and SNRIs include Amitriptylene, Cymbalta, and Effexor. 4. Anticonvulsants: Such as Gabapentin and Lyrica are sometimes used for both myofascial pain and fibromyalgia. 5. Alpha adrenergic agonists: Such as Tizanidine also known as Zanaflex can be tried. This medication works at the level of the spinal cord to reduce the release of aspartate, glutamate, and substance P.

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