Myofascial Syndromes

Introduction

• Description: Myofascial syndrome is characterized by muscular and fascial pain and is associated with localized tenderness and pain referred to sites that are often remote. Myofascial pain syndromes and fibromyalgia frequently demonstrate trigger-point involvement. These syndromes may present as chronic lower abdominal or pelvic pain that is easily confused with gynecologic causes.

• Prevalence: 3% of the population. Approximately 15% of women with chronic pain syndromes.

• Predominant Age: Sedentary middle-aged women.

• Genetics: No genetic pattern. More common in women (80%–90%) than in men. Several studies indicate that women who have a family member with fibromyalgia are more likely to have fibromyalgia themselves.

Etiology and Pathogenesis

• Causes: Abnormal spasm of a small portion of a muscle resulting in an extremely taut, tender band of muscle (trigger point). Compression of this site elicits local tenderness and often reproduces the referred pain. Most trigger points are located at or near areas of moving or sliding muscle surfaces, although they are not limited to these locations. Genetics and physical and emotional stressors are possible contributory factors to the development of the illness. Central pain sensitization may also play a role.

• Risk Factors: Stress, sleep deprivation, trauma, depression, and weather changes.

Signs and Symptoms

• Chronic pain referred to remote sites.

• “Trigger points” (hypersensitive areas overlying muscles that induce spasm and pain) that induce or reproduce the patient’s symptoms. Trigger points may be found throughout the body but are most common in the abdominal wall, back, and pelvic floor when pelvic pain is the symptom. Most patients have 11 or more trigger points.

• Pain is worse in the morning, with stress or weather change, after nonrestorative sleep. Pain is better with activity, stress reduction, and rest.

• Urinary tract symptoms (frequency, urgency, incontinence, nocturia, dysuria, sensation of incomplete emptying, bladder pain)

• Vulvovaginal discomfort/dyspareunia

• Two criteria established by the American College of Rheumatology: a history of widespread pain lasting more than 3 months and the presence of tender points.

Diagnostic Approach