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News in the
World of Myofascial Pain
by Devin J. Starlanyl
Life has been tough for those of
us with myofascial pain syndrome. We have too often been met
with doctors who "don't believe in" MPS. We have been hampered
by the lack of a scientifically credible and understandable
cause for this condition, and an officially recognized set of
diagnostic criteria. This resulted in a lack of training of
physicians and therapists. The insurance companies and the
Social Security Administration made our lives even more
difficult. This is about to change.
We now have facts that cannot be disputed. At last we have proof
that myofascial pain caused by trigger points is a true disease.
We know what creates a trigger point, what it is, and many of
the ways it can cause us pain and other symptoms. We know what
causes those taut bands that constrict our muscles, and we know
why our muscles become so tight that they hurt.
A myofascial trigger point is a localized area starving for
oxygen. It creates an increased local energy demand. This local
energy crisis releases neuroreactive biochemicals which
sensitize nearby nerves. The sensitized nerves initiate the
motor, sensory, and autonomic effects of myofascial trigger
points by acting on the central nervous system. Muscles with
trigger points are muscles in a constant state of energy crisis.
Myofascial trigger points can be identified and documented
electrophysiologically by characteristic spontaneous electrical
activity (SEA). They may also be identified histologically
(which means that the structure of the cells have changed) by
contraction knots – the lumps and bumps we know only too well.
Both of these phenomenon seem to result from excessive release
of the neurotransmitter acetylcholine (ACh) from the nerve
terminal of the motor endplate (the complex end formation of the
We now have objective confirmation of electromyographic imaging
of a myofascial trigger point. There are also ultrasound imaging
of local twitch responses of trigger points, and biopsies of
myofascial trigger points that show contraction knots and giant
rounded muscle fibers. To quote from this article, "The endplate
dysfunction characteristic of MTrPs involves both the nerve
terminal and the postjunctional muscle fiber. This relationship
identifies MTrPs as a neuromuscular disease."
Simons DG. 1999. Diagnostic
criteria of myofascial pain caused
by trigger points. J Musculoskeletal Pain 7(1-2):111-120.
A MTrP is always found in a taut
band which is histologically related to contraction knots caused
by excessive release of ACh in an abnormal endplate. The
pathogenesis of myofascial trigger points appears to involve
serious disturbance of the nerve ending and contractile
mechanism at multiple dysfunctional endplates. Doctor Hong has
even formed a theory concerning fibromyalgia tender points.
Hong, CZ. 1999. Current research
on myofascial trigger points –
pathophysiologicalstudies. J Musculoskeletal Pain
Please ask your librarian to
obtain these articles through Interlibrary loan, and give them
to your doctor. Don't forget to keep copies for yourselves. For
more information on this issue of the Journal of Musculoskeletal
Pain, go to Journal of Musculoskeletal Pain from Haworth Medical
Starlanyl, author of Fibromyalgia & Chronic Myofascial
Pain: A Survival Manual, The Fibromyalgia Advocate, and
Worlds of Power, Lines of Light.
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