Dr Mark Miller FRCA
Consultant Anaesthetics and Pain Management
Royal Shrewsbury Hospital and Shropshire Nuffield Hospital.
Born 1965, Edinburgh. Qualified 1990 MBChB Manchester University. Acquired membership of the Royal College of Anaesthetists in 1997.

MYOFASCIAL PAIN

This is pain affecting muscles and connective tissue which is more localised than fibromyalgia.

It is associated with trigger points. These are string-like areas of muscle which one can literally role ones finger over. They are rather painful.

Myofascial trigger points are most frequently palpated in the shoulder, neck and back muscles. They often indicate underlying problems such as ligament damage in the neck and may be present for many years after severe injuries such as whiplash. The trigger points are more than likely a combination of chronic inflammation, neuropathic pain (pain related to spontaneous nerve activity) and muscle spasm.

Treatments include trigger point injections with local anaesthetic and steroid which are most successful where the trigger points are related to inflammation and neuropathic pain.

If muscle spasm is the main cause then steroid injections are of little help and the trigger points can then be injected with a very, very dilute muscle paralysing agent called pancuronium. If pain relief occurs then occasionally it is long term.

More often than not, however, pain relief is transient, and one can then proceed to trigger point injections with Botox. Botox is of course more commonly known to be used for treatment of wrinkles and excessive sweating. It is a muscle relaxant which will last for some 3 months. Treatment can be repeated as necessary. It is very expensive so groups of patients who responded transiently to Pancuronium are treated together. It may take up to 2 weeks to work.

There are many other treatments for this including topical creams with e.g. ibuprofen, acupuncture, TENS, osteopathy, physiotherapy.