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Condition/Disorder Synonym

  • Chronic myofascial pain (CMP)

ICD-9-CM Code

  • 729.1 Myalgia and myositis unspecified

ICD-10-CM Codes

  • M60.9 Myositis, unspecified

  • M79.1 Myalgia

Preferred Practice Pattern1

Key Features

Description

  • 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

Essentials of Diagnosis

  • 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

  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.

  • Minor criteria include:

  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.

General Considerations

  • 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

Demographics

  • 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

Clinical Findings

Signs and Symptoms

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