Managing Myofascial Pain: Effective Treatments and Patient Insights

Q: Managing Myofascial Pain: Effective Treatments and Patient Insights

Hello： It seems that you have put a lot of effort into understanding your pain and have done considerable research. <br>Personally, I don't think it resembles HIVD (Herniated Intervertebral Disc) or spinal stenosis. <br>If the symptoms are not related to the load and movement of

Myofascial Pain

Hello, Doctor: I am 68 years old and have been experiencing pain in my hip.
The pain occurs when I sit, but I do not feel pain when walking, running, or bending forward, backward, or sideways.
The pain is located near the ischial tuberosity and I have been diagnosed with Myofascial Pain, which has persisted for 7-8 months.
Initially, I underwent physical therapy (including heat therapy, interferential current therapy, and ultrasound), followed by steroid injections targeting 4-5 pain points each time.
I have received a total of 8 injections, 5 of which were steroids and 3 were Xylocaine, but the results have not been very effective.
I had a bone scan, which showed no abnormalities, and subsequently underwent an MRI.
The report indicated that I have Herniated Intervertebral Discs (HIVD) at L3-4, L4-5, and L5-S1, classified as grade 2 protrusions, with L5 being compressed and spinal stenosis present.
Therefore, in addition to the aforementioned physical therapy, I have also included lumbar stretching and received two Epidural Injections, which were ineffective.
I do not exhibit symptoms of HIVD or spinal stenosis, as I do not experience pain while walking or running.
The neurosurgeon also believes that I do not have HIVD and thinks my Myofascial Pain may be due to a strain in a specific area.
Currently, I perform heat therapy twice daily at home, followed by stretching exercises, which sometimes alleviate the hip pain.
Additionally, I have been undergoing acupuncture treatment, primarily targeting the Ah Shi points, three times a week for eight weeks (next, I will reduce it to twice a week).
I also visit a pain management clinic once a month for steroid injections into the trigger points, having received two injections so far, and I feel some improvement.

I would like to ask you:
1.
Can acupuncture cure Myofascial Pain? How long might it take?
2.
Will repeated injections in the same area cause any changes in the tissue?
3.
Since steroids cannot be administered frequently and I have already received many injections, causing facial swelling, what other treatments can I consider in addition to acupuncture and the treatments mentioned above?
4.
Is it possible to inject Botox for my symptoms? Would the effects of Botox be better than steroids? What are the potential side effects of Botox injections?

Teng tain bu kan de ren, 60~69 year old female. Ask Date: 2006/06/28

Dr. Pan Yingda reply Rehabilitation

Hello: It seems that you have put a lot of effort into understanding your pain and have done considerable research.
Personally, I don't think it resembles HIVD (Herniated Intervertebral Disc) or spinal stenosis.
If the symptoms are not related to the load and movement of the spine, then the issue may not originate from the spine.
If you experience pain immediately upon sitting (how long do you sit before it hurts?), we should examine which specific area is being compressed or strained—whether it is due to compression or traction.
If you perform a half-squat (similar to sitting in a chair) and do not feel pain, but only feel pain when sitting in a chair, it suggests that a certain point is being compressed (likely near the ischial tuberosity; in my opinion, it could be the bursa in that area).
The symptoms of Myofascial Pain Syndrome are generally more persistent (although they can fluctuate), which does not quite match your situation.
To directly address your questions:
1.
The primary treatment for Myofascial Pain Syndrome is trigger point injection, typically using xylocaine without steroids.
Additionally, we use dry needling (which is essentially acupuncture).
The key is whether there is muscle twitching during the needle insertion; if there isn't, it means the trigger point was not hit, which would reduce the effectiveness of the treatment.
This is based on the theory of Myofascial Pain treatment.
As for acupuncture, if it targets specific points, we won't discuss meridians.
How long will it take to improve? If the trigger point is effectively targeted without underlying issues, it should take about 2-3 sessions.
If it is effective but recurs, there is likely an underlying cause that needs to be addressed.
If it is ineffective, a few sessions should suffice before considering other options.
2.
Yes, generally injections have a more significant impact, as tissue injury and irritation can lead to scar tissue formation.
Acupuncture needles are quite fine, and from the perspective of Myofascial Pain Syndrome, once a week is sufficient.
3.
I recommend trying heat therapy instead of ice therapy; sit directly on an ice pack and then stretch afterward.
Consult a physician or therapist who specializes in structural issues to assess your posture and perform appropriate stretches.
4.
I am not familiar with the use of botulinum toxin therapy, so I cannot provide advice on that.
Since I have not seen you in person, I cannot determine the exact issue, and therefore cannot offer more specific recommendations.
I apologize!

Reply Date: 2006/06/28

More Info

Managing myofascial pain can be a complex process, especially when it has persisted for several months, as in your case. Myofascial pain syndrome (MPS) is characterized by the presence of trigger points—hyperirritable spots in skeletal muscle that can cause pain in the affected muscle and refer pain to other areas. Given your history and the treatments you've undergone, let's address your questions one by one.

1. Can acupuncture cure myofascial pain? How long does it typically take?
Acupuncture has been shown to be effective for many patients with myofascial pain. It works by stimulating the nervous system and promoting the release of endorphins, which can help alleviate pain. The duration of treatment varies from person to person, but many patients report improvements within a few sessions. Generally, a course of treatment may take anywhere from a few weeks to several months, depending on the severity of the pain and the individual’s response to therapy. Consistency is key, and combining acupuncture with other therapies, such as stretching and physical therapy, can enhance its effectiveness.

2. Will repeated needling in the same area cause tissue changes?
Repeated acupuncture or needling in the same area can lead to changes in the tissue, but these changes are generally not harmful. In fact, the goal of needling is to promote healing and reduce pain. However, it is essential to allow the tissue to recover between sessions. Overuse of needling in one area may lead to soreness or irritation, so it’s advisable to monitor your response and discuss any concerns with your acupuncturist or healthcare provider.

3. What other treatments can I consider besides acupuncture and steroid injections?
Since you have already tried various treatments, consider exploring the following options:
- Physical Therapy: A tailored physical therapy program focusing on strengthening and flexibility can be beneficial. Techniques such as myofascial release, dry needling, and therapeutic exercises can help alleviate pain.

- Massage Therapy: Therapeutic massage can help relieve muscle tension and improve circulation, which may reduce pain.

- Cognitive Behavioral Therapy (CBT): If your pain is affecting your mental health, CBT can help you develop coping strategies and reduce the psychological impact of chronic pain.

- Topical Analgesics: Creams or patches containing menthol, capsaicin, or lidocaine can provide localized pain relief.

- Transcutaneous Electrical Nerve Stimulation (TENS): This method uses low-voltage electrical currents to relieve pain and may be worth trying if you haven't already.

4. Can botulinum toxin injections be used? Are they more effective than steroids? What are the side effects?
Botulinum toxin (commonly known as Botox) has been used off-label for myofascial pain and can be effective in reducing muscle tension and pain. Some studies suggest that it may provide longer-lasting relief compared to steroid injections, especially in cases where muscle spasms are a significant contributor to pain. However, the effects can vary, and not all patients respond positively. Potential side effects include localized muscle weakness, bruising at the injection site, and, in rare cases, systemic effects if the toxin spreads beyond the injection site. It is crucial to have these injections performed by a qualified healthcare provider experienced in this treatment.

In conclusion, managing myofascial pain often requires a multifaceted approach. Continue with your current treatments, and consider integrating additional therapies as discussed. Always consult with your healthcare provider before making changes to your treatment plan, especially regarding new injections or therapies. With patience and persistence, many patients find significant relief from their symptoms.

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