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Condition/Disorder Synonym

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  • Chronic myofascial pain (CMP)

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ICD-9-CM Code

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  • 729.1 Myalgia and myositis unspecified

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ICD-10-CM Codes

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  • M60.9 Myositis, unspecified

  • M79.1 Myalgia

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Preferred Practice Pattern1

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Key Features

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Description

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  • Chronic, persistent, deep aching pains in muscle; non-articular in origin

  • Characterized by well-defined, highly sensitive tender spots (trigger points)

  • Usually caused by sudden overload, overstretching and/or repetitive/sustained muscle activities

  • Pain associated with activities, and generally relieved with rest

  • Fascial restrictions

  • Can be in localized areas affecting any muscle or fascia

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Essentials of Diagnosis

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  • Presence of myofascial trigger points (MTrPs).

  • Diagnosis is made by clinical assessment (generally palpation) with no diagnostic tests available.

  • Differentiates from fibromyalgia as it can occur in a single area, whereas fibromyalgia occurs in multiple locations and has tender points

  • According to Simons2 the diagnosis of MPS can be made if five major criteria and at least one out of three minor criteria are met.

  • The major criteria are

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  1. Localized spontaneous pain.

  2. Spontaneous pain or altered sensations in the expected referred pain area for a given trigger point.

  3. Presence of a taut palpable band in an accessible muscle.

  4. Exquisite localized tenderness in a precise point along the taut band.

  5. Some degree of reduced range of movement when measurable.

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  • Minor criteria include:

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  1. Reproduction of spontaneously perceived pain and altered sensations by pressure on the trigger point.

  2. Elicitation of a local twitch response of muscular fibers by "transverse" snapping palpation, or by needle insertion into the trigger point.

  3. Pain relieved by muscle stretching or injection of the trigger point.

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General Considerations

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  • Very common; affects most people during their lifetime

  • Trigger points: active trigger points are tender to palpation and have a characteristic referral pattern of pain when provoked

  • Latent trigger points are palpable taut bands that are not tender to palpation, but can be converted into an active trigger point

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Demographics

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  • In the US, 14.4% of the general population suffers from chronic musculoskeletal pain2

  • 21-93% of patients with regional pain complaints have myofascial pain1

  • 25-54% of asymptomatic individuals have latent trigger points3

  • No racial differences in the incidence of myofascial pain have been described in the literature

  • Myofascial pain is distributed equally between men and women

  • Myofascial trigger points can be found in persons/children of all ages

  • The likelihood of developing active trigger points increases with age and activity level

  • Sedentary individuals are more prone to develop active trigger points than are individuals who exercise vigorously on a daily basis

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Clinical Findings

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Signs and Symptoms

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