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  • Chronic myofascial pain (CMP)

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  • 729.1 Myalgia and myositis unspecified

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  • M60.9 Myositis, unspecified
  • M79.1 Myalgia

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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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Signs and Symptoms

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  • Muscle stiffness
  • Headaches
  • Vertigo
  • Paresthesias
  • Referred pain
  • Joint stiffness
  • Limited range of motion
  • Deep aching pain that is constant
  • Pain upon palpation of the trigger point
  • Upon palpation ...

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