Treatment of myofascial pain

Objective: To review new, effective techniques and concepts in treatment [Tx] that have proven long-term results. Findings: The first goal is to instantaneously relieve pain, but recurrence can be prevented only by removal of the etiological factors. Treatment is ineffective unless it concentrates on the immediate cause of pain, which most frequently consists of tender spots [TSs], causing symptoms locally, Less frequent are trigger points [TrPs] that shoot pain into a distant area. Most effective Tx consists of "Needling and Infiltration of the Taut Band" [N&I of TB] with local anesthetic, Needling and infiltration is not limited to the TrP or TS itself, but extends over the entire TB including its attachment to bone. Such N&I mechanically disrupts the TB. Preinjection Block [PIB] is a new technique which prevents pain and sensitization caused by the penetration of the injecting needle into a sensitive area [TS or TrP], There is no reason not to administer PIE routinely before each TrP injection. Paraspinous Blocks consist of spreading the anesthetic along the sprained supra/interspinous ligaments of the sensitized segment. Conclusions: Several studies documented that "N&I of TB" achieved long term relief of pain and normalization of tenderness, quantified by pressure algometry. Paraspinous block instantaneously alleviates pain by reducing activity of TrP/TSs, which often are a component of radicular sensitization. Paraspinous block may also relieve root compression often caused by paraspinal muscle spasm and TrPs.