Myofascial Pain — a Neuromuscular Disease

News in the World of Myofascial Pain

Life has been tough for those of us with myofascial pain syndrome.  We have too often been met with doctors who “don’t believe in” CMP.  We have been hampered by the lack of a scientifically credible and understandable cause for this condition and an officially recognized set of diagnostic criteria.  This resulted in a lack of training of physicians and therapists.  The insurance companies and the Social Security Administration made our lives even more difficult.  This is about to change.

We now have facts that cannot be disputed.  At last we have proof that myofascial pain caused by trigger points is a true disease.  We know what creates a trigger point, what it is, and many of the ways it can cause us pain and other symptoms.  We know what causes those taut bands that constrict our muscles, and we know why our muscles become so tight that they hurt.

A myofascial trigger point is a localized area starving for oxygen.  It creates an increased local energy demand.  This local energy crisis releases neuroreactive biochemicals  which sensitize nearby nerves.  The sensitized nerves initiate the motor, sensory, and autonomic effects of myofascial trigger points by acting on the central nervous system.  Muscles with trigger points are muscles in a constant state of energy crisis.

Myofascial trigger points can be identified and documented electrophysiologically by characteristic spontaneous electrical activity (SEA).  They may also be identified histologically (which means that the structure of the cells have changed) by contraction knots — the lumps and bumps we know only too well.  Both of these phenomenon seem to result from excessive release of the neurotransmitter acetylcholine (ACh) from the nerve terminal of the motor endplate (the complex end formation of the nerve).

We now have objective confirmation of electromyographic imaging of a myofascial trigger point.  There is also ultrasound imaging of local twitch responses of trigger points, and biopsies of myofascial trigger points that show contraction knots and giant rounded muscle fibers.  To quote from this article, "The endplate dysfunction characteristic of MTrPs involves both the nerve terminal and the postjunctional muscle fiber.  This relationship identifies MTrPs as a neuromuscular disease."  Simons DG. 1999. Diagnostic criteria of myofascial pain caused by trigger points.  J Musculoskeletal Pain 7(1-2):111-120.

A MTrP is always found in a taut band which is histologically related to contraction knots caused by excessive release of ACh in an abnormal endplate.  The pathogenesis of myofascial trigger points appears to involve serious disturbance of the nerve ending and contractile mechanism at multiple dysfunctional endplates.  Doctor Hong has even formed a theory concerning fibromyalgia tender points.   Hong, C-Z. 1999.  Current research on myofascial trigger points-pathophysiological studies.  J Musculoskeletal Pain 7(1-2):121-129.

Please ask your librarian to obtain these articles through Interlibrary loan, and give them to your doctor.  Don’t forget to keep copies for yourselves.

For more information on this issue of the Journal of Musculoskeletal Pain go to Journal of Musculoskeletal Pain from Haworth Medical Press.

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