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Myofascial syndrome: one of the main medical consultations on muscle pain

In another article we have referred to the symptoms and treatments of the various causes that can cause muscle pains. In this note we will focus in particular on one of the pathologies that are manifested accompanied by muscular pains and we will stop in the current therapeutic strategies to alleviate these symptoms.

Myofascial syndrome represents one of these pathologies, which constitutes one of the most frequent medical consultations of muscular pain. It is characterized by the existence of an area of ​​greater sensitivity known as a trigger point capable of receiving and transmitting pain towards other more distant sectors. However, in many studies it has been described that the most affected parts of the body are the head, shoulders, neck and waist. It is not easily identifiable and therefore often is not correctly diagnosed. In some countries it is estimated that approximately more than half of the consultations related to some pain correspond to myofascial syndrome. It is believed that the prevalence rate of this pathology worldwide ranges from 13% to 45% of the population.

There are several factors that contribute to the onset of myofascial syndrome. In the first place, injuries of traumatic origin should be considered: it is suspected that if the pain that normally accompanies a muscle injury, does not give in after a reasonable amount of time, we are faced with the presence of myofascial pain. On the other hand, bad body positions, both at work and in other circumstances, increase the chances of developing this pathology. It is also necessary to make reference to certain alterations that can undergo the skeletal apparatus and that carry impact in the muscles.

Finally, we must consider the causes of psychological order. It is proven that certain psychic conditions such as stress, anxiety disorders or some degree of depression, have a direct impact on muscle functioning. Similarly, certain sleep disorders may interfere with loosening of the muscles causing them to be unable to rest and are permanently functioning.

In order to confirm the existence that the pain corresponds to the myofascial syndrome, there are some clinical criteria that must be fulfilled. Fundamentally it is necessary that there is a painful point that always produces the same symptom, that is in a tense band and that you perceive a pain in that area but also spread to other areas. It is also considered that it should respond favorably to the treatment, achieving a strong decrease in pain. The important thing about myofascial syndrome in terms of diagnosis is that it has to be both what one can get from the patient’s anamnesis and the physical examination, which is essential to make the diagnosis by palpation.

The current techniques most used to treat this pathology are multidisciplinary: many recommend working with infiltrations with lidocaine, 1% lidocaine (2% not because it can to bring more fibrosis), to work with transversal massages and of precise muscular elongation, located by kinesiotherapy. Other techniques such as kirotherapy, hydrotherapy and exercise, especially stretching, are also considered very useful. Postulatory changes and, above all, physical activity are fundamental. You can eliminate the sensation of pain at the moment infiltrating the patient, but if you do not do the other, the patient will not be able to get rid of the problem completely.

Therefore, those who suffer from this syndrome should be aware of the importance of physical exercise as a mode of treatment but also and fundamentally as prevention. At the same time, be attentive to the posture with which we sit, walk or sleep, as it is the first step to identify bad positions and try to reeducate them. After this, one can think of the treatment with drugs that has its relevance thanks to the effectiveness of some to counter myofascial pain. Infiltration is one of the most accepted methods for attacking pain. Its major defect is that its action is maintained only for a short period of time and in most cases the pain returns. It is recommended to abstain from infiltrating the person with corticosteroids since it does not provide greater effectiveness to relieve the pain and also constitutes an increased risk of damaging the muscle fiber.

The botulinum toxin has been analyzed in several investigations to corroborate its analgesic capacity. The data confirm that this is an extremely effective treatment for the management of low back pain, another entity that presents muscle pain. In the case of myofascial syndrome, botulinum toxin administration has been shown to be more effective than placebo or corticosteroids.

Regarding the use of drugs, a large number of specialists agree that it is advisable to use drugs with analgesic properties by the oral route. Non-steroidal anti-inflammatory drugs, muscle relaxants, and drugs to treat depression are also recommended. Among the anti-inflammatory drugs that are in the first place are ibuprofen and acetaminophen. As discussed in another article both drugs are often combined with other active ingredients to increase analgesic effectiveness. As for the agents that act as relaxants we can mention the carisoprodol that for 20 years has been marketed in the market and its indication covers those conditions related to the musculoskeletal apparatus. Its efficacy derives from its own mechanism of action to affect the nervous system and to bring about the interruption of the transmission of pain. Additionally, if this drug treatment is combined with physical activity and physiotherapy, the chances of greatly reducing painful symptoms are increased. Regarding the mode of use and the dosage schedule of carisoprodol, the criteria of the clinical guidelines stipulate that 300 mg can be taken in three doses per day. In turn it should preferably be taken before going to sleep.

To conclude the article we can report some relevant considerations on myofascial syndrome. Firstly, it is among the diseases that present the most consulted pain and, in turn, cause of work absenteeism. The problem is aggravated since it is a disease that is reluctant to non-pharmacological treatment and can progress towards chronification. In these cases, the full capacity of the person with this syndrome can be affected. For this reason, the timely consultation itself becomes a fundamental aspect to identify the disease as well as a correct treatment with some of the drugs described here.

 

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