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Myofascial Pain Syndrome

Myofascial Pain Syndrome is a common cause of chronic pelvic pain associated with trigger points in the skeletal muscles. When these trigger points are stimulated by touch or pressure, the body elicits a pain response. Estimated to be the cause of pelvic pain in nearly 30% of patients who report pain in the lower abdomen or pelvis to their gynecologist or family physician, Myofascial Pain Syndrome is poorly understood and hard to diagnose. It is defined as being a noncyclic pain of at least six months duration, occurring in the anterior abdominal wall, buttocks or lower back and can cause functional disability. The pain has been described as a recurring pain that originates in the skeletal muscles in hyper-irritable spots in the muscle and can produce referred pain and tenderness.

What are the causes of myofascial pain?
The causes of myofascial pain is difficult to demonstrate in most patients but have been associated with the following situations:

  • Trauma
  • Inflammation of the muscles or fascia (supporting tissue of the abdomen)
  • Generalized fatigue
  • Emotional stress
  • Extreme exercise
  • Lack of sleep
  • Hormonal changes
  • Nutritional deficiencies and/or obesity
  • Smoking
  • Extreme hypothermia

The exact mechanism of action that produces the pain has not been shown but recent studies and theories suggest that elevated chemicals in the muscles and nerves may lead to prolonged muscle contractions which decrease oxygen and nutrient flow to the tissues. The contractions of the muscles may lead to nodules that are palpable in the muscle tissues. The condition has been described as being active or latent with an active problem that seems to be always present causing constant pain and weakness, and the latent form being present only when pressed on.

What are the therapies for myofascial pain syndrome?
The current therapies are varied and no adequate studies can be found that compare pre- and post-treatment assessments of the therapies.

  • Non-medical and non-surgical therapies have been tried and include stretching, massage, wet heat, icing, transcutaneous electrical stimulation, biofeedback, topical analgesics and acupuncture. The results vary from study to study and probably reflect more the compliance of the patients to perform the therapies and the perception of results by the patient.
  • Medications have been tried and can include muscle relaxants, anti-inflammatory drugs, antidepressant medications and anticonvulsant medications with varied results. The medications work to improve the conditions but may not be consistent from one person to another.
  • Trigger point injections with saline, local anesthetics or botox can immediately decrease pain but may not be long lasting. In a recent study of 29 patients, local anesthetics gave a 50-60% relief for several days after injection. Botox has been also been used and studies have been revealing 63-77% improvement in two to four treatments that lasted up to two years. Injections may cause local bruising at the injection site.

If you have chronic pain talk to you physician as to whether Myofascial Pain Syndrome might be a possibility.

More about Dr. Aulds

Donald G. Aulds, MD is an Obstetrician and Gynecologist and currently serves as the Medical Director for both the Women's Center and the Best Start Program of North Alabama. He is a Diplomat of the American Board of Obstetrics and Gynecology and Fellow of the American College of Obstetricians and Gynecologists.

Dr. Aulds completed his medical education at Louisiana State University School of Medicine, New Orleans, LA and his Internship and Residency in Obstetrics and Gynecology at Ochsner Medical Foundation, New Orleans, LA.

Dr. Aulds has been an active member of the Huntsville Hospital Medical Staff since 1980.