What’s Best Practices When it comes to Managing Myofascial Pain?

Myofascial pain syndrome is defined by the presence of trigger points throughout the body that are tender and cause pain. The pain that results from irritating a trigger point might even be referred to a different body part, making identifying trigger points a little complicated. Usually, the trigger points and subsequent discomfort are localized to a certain part of the body. And when myofascial pain syndrome becomes chronic, the symptoms it shares with fibromyalgia often cause doctors to confuse the two syndromes. There’s a laundry list of treatments available for managing myofascial pain, such as acupuncture, Botox, prolotherapy, and opioids. But not all treatments are created equally. Some cover symptoms, and others work to remedy the cause of the myofascial pain at the source.

Dry needling is the traditional method for treating myofascial pain. This is where a doctor needles around a trigger point to release the fascia, relieve the tenderness, and deactivate the trigger point. Some doctors partner dry needling with heat, and lifestyle adjustments like diet, exercise, posture, etc. Studies also suggest that dry needling partnered with active stretching is more effective than just stretching. Peer reviewed papers disagree on the effectiveness of dry needling, but study after study shows its efficacy in treating myofascial pain syndrome.

Myofascial Pain: Causes and Symptoms

So, what causes myofascial pain in the first place? Myofascial pain syndrome is basically just a formal name for pain that comes from a lifetime of injuries to the fascia that holds our bodies together. Then inflammation frominsomnia, food, environmental toxins, , and stress amplifies the pain signals and makes them much louder.  And people with spinal deformities or damage are very likely to suffer from myofascial pain as muscles as the fascia injuries may be more important than the vertebral issues.

As we mentioned earlier, symptoms of myofascial pain syndrome overlap with fibromyalgia. This is because most of the pain that is diagnosed as fibromyalgia is actually myofascial pain. People with myofascial pain and fibromyalgia almost always have:

• Active trigger points
• Latent trigger points
• Chronic pain
• Poor sleep
• Moodiness

However, there are distinct differences between how these symptoms present in each disorder. Myofascial pain in fibromyalgia is widespread, and so are the trigger points. There are also several other symptoms related to loss of resilience. With a localized myofascial pain syndrome there are fewer trigger points, and the trigger points and resulting pain occur in a specific part of the body. With fibromyalgia, referred pain is diffuse through the body, compounded by the inflammatory effect of toxic food and environmental poisons.

Common Interventions for Myofascial Pain Syndrome

Treatments for myofascial pain range from tweaking lifestyle habits to holistic treatments to pharmaceutical pain management. Common interventions include:

• Eliminating inflammatory foods
• Dry needling, wet needling, acupuncture
• Trigger point injections (prolotherapy)
• Prolozone
• PRP therapy, stem cell therapy
• Myofascial release, massage therapy
• Physical therapy, stretching
• Electrical stimulation (TENS)
• Medical marijuana
• Steroids
• Opioids
• Muscle relaxants
• NSAIDS (should almost never be taken)

You’ll notice these treatments are all over the map. And they are – regarding efficacy and also regarding safety. It’s always good to stay away from pharmaceutical options. Why? The long-term health risks are real, they rarely actually fix a problem, they just treat symptoms, and sometimes they cause other issues. Pharmaceuticals often create a vicious cycle of medications that leads to new problems that lead to additional medications, etc. One of the most effective treatments for myofascial pain, which is safe, holistic and healing, is prolotherapy.

Prolotherapy for Myofascial Pain: Research and Implications

Prolotherapy treatment is where a doctor injects an irritant at the site of fascia ligament and tendon injury, which spurs the body to increase blood supply to the area and repair the damaged tissue that’s causing the myofascial pain. It’s regenerative medicine at its best: the injected irritant is a neutral solution, usually dextrose, and the treatment is meant to result in long-term pain relief via actual healing. It’s an effective treatment with permanent results. One study showed almost 25% of patients treated with prolotherapy had complete symptom remission, and a whopping 80% had an improvement of more than 50% of their pain symptoms. Another study compared the efficacy of prolotherapy and steroidal treatment, and found the two treatments resulted in similar remission rates.

What does this imply? Simply, that the benefits of prolotherapy, coupled with the safety and long-term healing, are better than pharmaceutical treatments that are equally as effective, but not nearly as safe. Long-term steroid use tends to do the opposite of what it’s supposed to; in this case, repeatedly treating weakened or injured ligaments with steroids actually weakens the soft tissues more. Which means more steroids, more weakness, and now we’re back in that vicious cycle so typical of Western pharmaceutical pain interventions. Prolotherapy has promising implications for doctors that deal with fibromyalgia treatment, myofascial pain syndrome, repetitive use injuries like carpal tunnel and De Quervain’s, and countless other fascia-related chronic pain syndromes. If you’re suffering from chronic pain, prolotherapy is a safe and effective (not to mention cost-effective!) treatment to consider.