Myofascial Pain: Seeking Answers for Chronic Discomfort

Thank you, doctor, for your patience?

Thank you, Doctor, for your response to my previous inquiry.
The doctor mentioned that it might be myofascial pain syndrome, and I would like to ask you again.
I have intermittent pain from my lower back to my ribs, along with a feeling of pressure, tightness, and an indescribable discomfort.
However, I can only identify that the discomfort is on either the left or right side, but I cannot pinpoint the exact location.

From my research on myofascial pain syndrome, I understand the following points:
1.
Sedentary tender points: areas that are painful when pressed.
2.
Latent tender points: areas that do not feel painful but are very painful when pressed.
3.
Trigger points: specific areas that, when pressed, cause pain in other areas (referred pain) or radiate pain like an electric shock.
The symptoms I mentioned previously have already affected my daily life.
I have been seeking medical attention for over a year without any results.
I experience intermittent abdominal pain, which, once it starts, leads to almost 24-hour pain in my lower back to my ribs, both front and back, along with pressure, tightness, and an indescribable discomfort.
The abdominal pain does not occur every day, but the discomfort from my lower back to my ribs is constant.
The discomfort is not fixed; it can last for several days in one area before shifting to another.
Sometimes it is in the front right lower back, sometimes in the front left lower back, and at times in both lower backs.
It can also occur in the back right lower back, back left lower back, or both.
Additionally, it can be felt in the front or back of the left or right ribs.
In summary, the discomfort is not localized and has persisted for over a year.

The abdominal pain has also lasted for over a year, but it does not occur every day.
The discomfort in my lower back to my ribs began after the abdominal pain started.
I have consulted specialists in gastroenterology, gynecology, urology, and allergy and immunology, all of whom found no issues.
The gastroenterologist diagnosed me with irritable bowel syndrome, but after taking medication for over a year, there has been no improvement in either the abdominal pain or the discomfort in my lower back to ribs.
The pediatric gastroenterologist stated that he could not determine if the discomfort in my lower back to ribs was related to gastroenterology.
I have undergone various tests, including an upper endoscopy, barium enema, abdominal ultrasound, and stool tests, all of which returned normal results.

I would like to seek professional advice on which specialty I should consult regarding the discomfort in my lower back to ribs.

Tianqi, 10~19 year old female. Ask Date: 2012/09/07

Dr. Niu Zhenyuan reply Surgery

The issue of musculoskeletal pain among adolescents is increasingly prevalent, primarily due to poor posture from prolonged sitting in front of computers without adequate breaks.
For abdominal pain, it is important to first consider the possibility of constipation.
It is recommended to undergo an X-ray examination by an orthopedic specialist to check for conditions such as scoliosis or fecal impaction.
Of course, engaging in moderate exercise and reducing prolonged sitting is essential for prevention.

Reply Date: 2012/09/07

More Info

Myofascial pain syndrome (MPS) is a complex condition characterized by chronic pain in specific muscle areas, often accompanied by trigger points that can refer pain to other areas of the body. Your description of discomfort from the lower back to the ribs, along with the variability in pain location, aligns with the symptoms commonly associated with myofascial pain.
Given that you have already consulted various specialists, including gastroenterologists and rheumatologists, and have undergone numerous tests without definitive results, it may be beneficial to consider a multidisciplinary approach to your condition. Here are some insights and recommendations that may help you navigate your situation:
1. Understanding Myofascial Pain: Myofascial pain can manifest as localized pain in the muscles and fascia, which are connective tissues surrounding muscles. The pain can be triggered by physical stress, poor posture, or emotional stress. The presence of tender points, as you described, is a hallmark of this syndrome. These points can be sensitive to touch and may cause referred pain in other areas when pressed.

2. Pain Assessment: Since you experience pain that shifts locations, it is important to keep a detailed pain diary. Document when the pain occurs, its intensity, duration, and any activities that may exacerbate or alleviate it. This information can be invaluable for healthcare providers in diagnosing and managing your condition.

3. Physical Therapy: Engaging in physical therapy can be a crucial step in managing myofascial pain. A physical therapist can help you with targeted exercises, stretching, and techniques such as myofascial release, which may alleviate pain and improve function. They can also educate you on proper posture and ergonomics to prevent further strain.

4. Pain Management Techniques: In addition to physical therapy, consider exploring other pain management strategies. These may include:
- Trigger Point Injections: A healthcare provider may inject a local anesthetic or corticosteroid into the trigger points to relieve pain.

- Acupuncture: Some patients find relief from myofascial pain through acupuncture, which may help release tension in the muscles.

- Medication: Nonsteroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants may be prescribed to help manage pain and discomfort.

5. Psychological Support: Chronic pain can take a toll on mental health. If you find yourself feeling overwhelmed or anxious due to your condition, consider speaking with a mental health professional. Cognitive-behavioral therapy (CBT) can be particularly effective in helping individuals cope with chronic pain.

6. Consulting a Pain Specialist: If your symptoms persist despite treatment, it may be beneficial to consult a pain management specialist. These professionals are trained to address complex pain syndromes and can offer advanced treatment options tailored to your specific needs.

7. Holistic Approaches: Incorporating holistic approaches such as mindfulness, meditation, or yoga may also provide relief. These practices can help reduce stress and improve your overall well-being, which may positively impact your pain levels.

In summary, myofascial pain syndrome can be challenging to diagnose and treat, especially when symptoms are widespread and variable. A comprehensive approach involving physical therapy, pain management strategies, and psychological support may offer the best chance for improvement. It’s essential to continue advocating for your health and seeking out specialists who understand the complexities of chronic pain.

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