PAIN MANAGEMENT IN PHYSICAL AND REHABILITATION MEDICINE

Marta Imamura, MD PhD

Stecco Antonio, MD

University of Sao Paulo

“Pain is one of the most common reasons for a patient’s visit to the outpatient clinic, and myofascial pain syndrome (MPS) is diagnosed in nearly a third of patients who have musculoskeletal pain disorders.”

Rickards L. The effectiveness of non-invasive treatments for active myofascial trigger point pain: A systematic review of the literature. Int J Osteopath Med 2009;12:42-43.

“Myofascial pain syndromes are among the most frequent pain conditions encountered in the general population. However, at the same time, they are most often under-diagnosed or misdiagnosed conditions.”

Cummings M. Regional myofascial pain: diagnosis and management. Best Practice & Research

Clinical Rheumatology 2007;21(2):367–87.

EPIDEMIOLOGY

“myofascial pain is estimated to be the most common musculoskeletal pain.”Srbely JZ. New trends in the treatment and management of myofascial pain syndrome. Current Pain and Headache

Reports 2010;14:346–52.

“MPS (previously named fibrositis and myofibrositis) is one of the most common disorders encountered by physicians in clinical practice”.

Rachlin ES. Myofascial Pain and Fibromyalgia. In Rachlin ES (ed.). History and Physical examination for regional myofascial pain syndromes. St. Louis: Mosby, 1994, pp. 159–172.

“…30% of patients with regional pain complaints seen in primary care clinics have myofascial pain.”

Skootsky SA, Jaeger B & Oye RK. Prevalence of myofascial pain in general internal medicine practice. The Western Journal of Medicine 1989; 151: 157–160.

“…85% of patients presenting to specialized pain management centers have myofascial pain.”

Gerwin RD. Classification, epidemiology, and natural history of myofascial pain syndrome. Current Pain and Headache Reports 2001; 5: 412–420.

EPIDEMIOLOGY

“The MPS represents the major cause of musculoskeletal pain and the mean prevalence of this condition among middle-aged adults (30–60 years) is reported to be 37% in men and 65% in women, respectively.”

Drewes AM, Jennum P. Epidemiology of myofascial pain, low back pain, morning stiffness and sleep-related complaints in the general population. Journal of Musculoskeletal Pain 1995;3(1):121.

“…In the elderly (>65 years), the prevalence reaches 85% “

Podichetty VK, Mazanec DJ, Biscup RS. Chronic non-malignant musculoskeletal pain in older adults: clinical issues and opioid intervention. Postgraduate Medical Journal 2003;79:627–33.

“…on the basis of demographics of ageing, MPS can potentially become an increasingly important problem in the general population in the years to come.”

Giamberardino MA, Affaitati G, Fabrizio A, Costantini R; Myofascial pain syndromes and their evaluation.; Best Pract Res Clin Rheumatol. 2011 Apr;25(2):185-98.

EPIDEMIOLOGY

“No standard, universally accepted biochemical, electro- diagnostic, diagnostic-imaging, or physical examination criteria exist for a diagnosis of MPS.”

Annaswamy TM et al; Emerging concepts in the treatment of myofascial pain: a review of medications, modalities, and needle-based interventions. ; PM R. 2011 Oct;3(10):940-61.

“Postural stresses, inefficient biomechanics, and repetitive overuse are the most frequently described etiologies of MPS”

Rickards L. The effectiveness of non-invasive treatments for active myofascial trigger point pain: A systematic review of the literature. Int J Osteopath Med 2009;12:42-43.

DIAGNOSIS

“Traditional approaches to treating MPS have included medications such as muscle relaxants, thermal modalities, and massage.”

Rickards L. The effectiveness of non-invasive treatments for active myofascial trigger point pain: A systematic review of the literature. Int J Osteopath Med 2009;12:42-43.

Travell J, Simons D. Myofascial Pain and Dysfunction. The Trigger Point Manual. Vol 1. Baltimore, MD: Williams and Wilkins; 1983.

Esenyel M, Caglar N, Aldemir T. Treatment of myofascial pain. Am J Phys Med Rehabil 2000;79:48-52.

“However, wide variations in practice patterns continue, and no clear consensus exists on the use of these interventions; in addition, awareness of their evidence bases is limited.”

Annaswamy TM et al; Emerging concepts in the treatment of myofascial pain: a review of medications, modalities, and needle-based interventions. ; PM R. 2011 Oct;3(10):940-61

TREATMENT

“There is evidence of central nervous system sensitization and of hyperalgesia and temporal summation of pain in a specific area. Another hypothesis would suggest a facilitated processing of pain messages in the central nervous system, perhaps manifested by neural reorganization in the brain, brainstem, and spinal cord.”

Younger JW, Shen YF, Goddard G, Mackey SC.; Chronic myofascial temporomandibular pain is associated with neural abnormalities in the trigeminal and limbic systems. ; Pain. 2010 May;149(2):222-8.

CENTRAL ORIGIN OF MPS

“The peripheral theory suggests, in contrast, that myofascial pain is due to an alteration of innervations or of nerve stimulation of muscles or of fascia. This theory is based to the hypothesis that the fascia could be considered as a proprioceptive organ, and that it could be altered by trauma, overuse and surgery.”

Stecco C, Stern R, Porzionato A, Macchi V, Masiero S, Stecco A, De Caro R; Hyaluronan within fascia in the etiology of myofascial pain.; Surg Radiol Anat. 2011 Dec;33(10):891-6.

PERIFERAL ORIGIN OF MPS