Myofascial Pain Syndrome

Dr. TONG Ka Fai, Henry

Honorary Consultant in Anaesthesiology

Specialist in Pain Medicine

Dealing with nerve-related pain, also known as neuropathic pain, can be quite challenging as it is often harder to control compared to nociceptive or bodily pain from injuries. Recent studies indicate that mixed pain has a bigger impact on a person’s quality of life than neuropathic pain. Managing mixed pain is also more complex. Mixed pain often occurs in cancer patients, where it could be caused by tumours invading the spinal bones and putting pressure on the spinal nerves at the same time. People with fibromyalgia and joint pain can also experience mixed pain.

A common type of mixed pain, Myofascial Pain Syndrome (MPS) refers to a pain condition that involves muscle tissues and tendons. There are 640 muscles and about 4,000 tendons in the human body. Some muscles cross multiple joints, e.g. those in the neck and waist. These joints may bear excessive pressure if the muscles and tendons stay tensed for a long time, causing accelerated degeneration or herniated discs. Patients may also experience indescribable pain all over the body.

Referred Pain Affects Different Parts of the Body

Due to untreated acute muscle injuries or chronic muscle fatigue, some hyperirritable spots called “trigger points” may be formed in both the deep and superficial muscles as it tightens like a bunch of rubber bands.

One of the symptoms of MPS is “referred pain”, which occurs and radiates to other parts of the body when excessive pressure is applied on the trigger points. For example, people with MPS may feel pain like sciatica all the way from the back to the calves when the trigger points in the three muscle groups of the lower back and buttocks, i.e. gluteus minimus, piriformis and quadratus lumborum, are hit. Trigger points can also be found in the neck muscles in case of cervical spondylosis. An accurate diagnosis is only possible by an experienced specialist in pain medicine, who is adept at identifying different muscles and related clinical symptoms by hand.

Interventional Therapy for Complex Trigger Points

Many people wonder if massage is effective for treating trigger points. Sometimes massage can relieve trigger points, but if the underlying problem is not properly addressed, massage can only provide short-term relief, not a permanent solution for MPS. While stretching, massage and pain medications are prescribed for simple trigger points, thorough investigations and injections are required in complex cases.

Conventionally, needles are inserted into the trigger points to relax the muscles and alleviate pain, i.e. dry needling. While dry needling is a simple, non-pharmalogical procedure, one may feel pain in the insertion areas for days after treatment. Also its effect varies with the size of the needled area. Other solutions include radiofrequency treatment and injections. In the latter, a local anaesthetic is injected into the trigger points, mostly with a fine needle. The treatment is non-myotoxic and highly effective in pain relief. Under the guidance of a physiotherapist, intensive stretching is required immediately after injection to prevent recurrence of trigger points.

Seek Specialty Treatment for Chronic Pain

When there is no relief from long-term pain, some people may turn to “alternative treatments”. However, it is important to verify whether these therapies have been backed by a scientific and clinical evidence. Otherwise, you risk spending your time and money on something that may not work.

If the pain persists for three months or more, and the medication treatment has not been ideal and is affecting mental health, and the pain index is at a moderate to high level, it is advisable to seek diagnosis from a pain specialist. Pain specialists use an interdisciplinary approach to provide a comprehensive assessment of the patient’s pain, identify the root causes of pain, and assess suitable medication and dosage, or perform interventional therapy, with a high chance of resolving the pain problems.

I have dedicated almost two decades to the field of pain medicine, and it has truly been a rewarding journey. One of my most memorable experiences was with a patient suffering from post-herpetic neuralgia, who had tried various treatments without success. After a few adjustments to her medication by a pain specialist, her pain significantly improved. Another patient, who was battling cancer and struggling to sleep comfortably due to pain, found relief after being treated by a pain specialist. It’s moments like these that remind me the difference we can make in people’s lives.