Myofascial Pain Syndrome – Some Aspects of Diagnosis and Treatment

Introduction. Back pain occurs in 40.0-80.0% of the population. One of the most common causes of back pain is myofascial pain syndrome. About 84.0% of the adult population has at least one episode of back pain, and 40.0-70.0% in the neck in the life. Myofascial pain syndrome can exist both independently and in the structure of vertebrogenic reflex muscular-tonic syndrome. Aim. To provide the major updated diagnostic and therapeutic aspects of myofascial pain syndrome. Materials and methods. The content analysis, method of system and comparative analysis, the bibliosemantic method of research of actual scientific researches concerning the main updated diagnostic and therapeutic aspects of myofascial pain syndrome have been used. Results. Women have myofascial pain syndrome more often than men. With constant pathological emphasis, the inhibitory processes are weakened, which leads to an increase in the tonus of the entire muscle. In the pathogenesis of hypertonia, local, spinal, segmental mechanisms, and supra-regional structures, including efferent downward paths, are involved: reticulospinal, rubrospinal and pyramidal. Muscle spasm may also arise from the mechanism of the so-called viscerosomatic reflex, with the sympathetic link of the sensory nervous system. In spastic muscles, perfusion deteriorates and hypoxia develops, accompanied by the release of inflammatory mediators and the activation of pain receptors. In addition, insufficient relaxation of the muscular framework leads to the formation of local hypertonicity. Over time, in the sites of local hypertonoses, special trigger points are formed that contain multiple sensitization locuses, which consist of one or more sensitized nerve endings. Clinically trigger point is an area of ​​increased sensitivity within the limits of local muscular thickening, which is a sharp pain during palpation. So, the term “myofascial pain syndrome” quite accurately reflects the localization of the pathological center (muscle or fascia) and indicates the presence of her trigger points – pathogenic sign of the myofascial pain syndrome. Myofascial pain syndrome has clear clinical features – muscle spasm, painful muscle thickening in tense muscles (trigger points), decreased muscle movement and pain zones. The myofascial pain syndrome's diaqgnosis is difficult. Laboratory and instrumental diagnostic procedures are carried out in order to exclude the diseases that have similar clinical signs (tumors, inflammatory lesions of the spinal cord, roots, spinal trauma, diseases of the internal organs, etc.) or if there are signs of a compression (radicular, myelopathic) syndrome. For the same purpose, neuroimaging (computer and magnetoresonance tomography), X-ray diffraction, and electromyography are used to clarify the diagnosis. Muscular pain requires, above all, the exclusion of inflammatory etiology, as well as vertebral compression of root and spinal lesions. The myofascial pain syndrome's diagnostic requires the right palpation technique to identify the three-point points. It is recommended to stretch the muscles along the length at the extremity of the stimulation of pain, during which among the weakened muscles the strain in the form of a tight cord, along which the point of greatest pain is revealed (pressing on it causes reflected pain) can be palpated. Treatment with myofascial pain syndrome should be comprehensive, affecting the underlying etiologic factors, pathogenetic mechanisms, and, of course, used as symptomatic. Treatment for patients with back pain syndrome involves such an algorithm: fixing bandage, physical exercises, nonsteroidal anti-inflammatory drugs, muscle relaxants, vitamin treatment. Conclusions. When treating pain in the back, one must take into account the pathogenetic mechanisms of their occurrence, in particular, the rather frequent variant of these syndromes – myofascial pain syndrome.