Abstract
Myofascial pain syndromes arise from acute and chronic musculoskeletal pain and often
have a referred neuropathic component. It affects more than three quarters of the
world's population and is one of the most important and overlooked causes of disability.
The origins of pain are thought to reside anywhere between the motor end plate and
the fibrous outer covering of the muscle, with involvement of microvasculature and
neurotransmitters at the cellular level. Diagnosis is made by clinical examination
for the presence of myofascial trigger points, though some ancillary tests may provide
supportive evidence. The mainstay of treatment is regular physical therapy with the
goal of restoration of normal muscle laxity and range of motion. Adjunct therapies
including pharmacologic and nonpharmacologic interventions provide varying degrees
of benefit in refractory cases, and onabotulinum toxin A injection has the most evidence
of efficacy for these patients. Here, we discuss the epidemiology, pathophysiology,
and diagnostic and therapeutic options for the evaluation and treatment of myofascial
pain syndrome.
Keywords
myofascial - trigger points - onabotulinum toxin
