Many people with chronic upper back pain eventually undergo unnecessary surgeries and un-indicated disability. This is because many patients’ chronic upper back pain is misdiagnosed as having a skeletal cause, when instead the patient is suffering from unrecognized myofascial trigger point syndrome (MPS). Although MPS is a leading cause of chronic pain and disability in this country, most providers who deal with pain are not taught about MPS. In part, this is because muscles generally receive little attention in modern medical schools as a source of pain.
A patient with MPS will present with non-specific, poorly localized, aching, regional pain in tissue that includes muscles and joints.
Myofascial pain is also associated with spot tenderness, pain that is referred in a characteristic pattern for that tender point (also called a “trigger point”), a local twitch response and a painful limitation of range of motion of the associated joint.
Muscular imbalances and postural deficiencies often cause these painful nodules; the nodules in turn, cause further pain and dysfunction. Overload can do this, as can poor posture. Trigger points may also be brought about by stress and emotional illnesses or constitutional problems. Trigger points may be identified by the electrical signals they produce, but ultrasound may also be used to see these.
Trigger points are characterized as either latent or active. Latent trigger points cause muscular dysfunction but do not actually hurt. Active trigger points hurt, and are painful for nearly everyone at some point in life. In the chronic pain population, trigger points are present 85-95% of the time.
Pain from active trigger points most often presents in those aged 31-50. At this point, most people are in the mature years of maximum activity. Later in life, latent trigger points and stiffness are more common.
Treating MPS is much more conservative, safe and effective than the treatment of the mistakenly diagnosed syndromes and conditions it mimics.
Treatment includes injections at the trigger points, massage, stretching, management of stress and tension and often a home self-treatment program. Patient education along with a home-treatment program is an excellent form of treatment also.
It‘s important to recognize a trigger point early on when a patient presents with upper back pain. If acute MPS is neglected or ignored, it may become chronic and then is complicated, more painful and time-consuming and expensive to treat reliably.
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