Pain specialists approach myofascial pain treatment using a multi-disciplinary approach.
Myofascial release includes massages at home, medical massages, and specific myofascial release therapy performed by physical therapists. I ask my patients to start with simple home devices called “Remedy Cane” or “Theracane“. These are inexpensive S- or J-shaped sticks that patients can use to give themselves neck and back massages without hurting their shoulders. Because the patient is in full control of the location and force of the massages, it has less risk of worsening the pain.
In terms of medications, muscle relaxants can help with myofascial pain. Some are too sedating and cause excessive drowsiness, for example, carisoprodol and cyclobenzaprine. For this reason, I prescribe instead muscle relaxants like baclofen, tizanidine, and dantrolene to supplement the other treatments.
In terms of medical interventions, pain physicians can provide a trigger point injections into the muscles. This involves local anesthetics. These medications temporarily numb the area and profoundly relax the muscles. Despite the temporary effect, the profound relaxation provides some patients with prolonged relief. During this time, I ask my patients to pursue additional treatments discussed here, in particular, massages, stretches, and exercises to magnify and prolong the benefit. I recommend always using ultrasound guidance for trigger point objections.
Some patients can benefit from the injection of Botox. This is particularly true for those patients with a form of myofascial pain called “dystonia”. Dystonia is characterized by persistent spasm–sometimes with a palpable ball of muscle tissue–that causes pain, reduced range of motion, and involuntary spasms that impact activities such as work, spending time with family, driving, and housework. Botox is an enzyme that chemically disconnects muscles from the nerves that control them. After this disconnection, muscles are profoundly relaxed for up to 12 weeks at a time. During this time, patients with dystonia report reduce the spasms and pain. Again, coupled with physical therapy, stretches and exercises, the benefits of Botox can be prolonged and magnified.
Muscle tone is under the control of our brain and spinal cord. While most of those control is subconscious, there is a component that is under our active control, specifically stress and posture. This is why I often refer patients with myofascial pain to our physical therapists to work on their posture, and to psychologists or biofeedback practitioners to help manage contribution of stress to their myofascial pain.
For some patients, myofascial pain has an underlying identifiable source. For example, some patients with neurologic conditions, such as Parkinson’s disease, may develop dystonia. In that situation, specific treatment of the neurologic condition, in combination with the other treatments mentioned to here, is the right strategy.
In a similar way, frequently we see patients with significant joint pain involving their shoulder, knee, or the back, who also have significant myofascial pain. In this situation, the myofascial pain is often due to the so-called “reflex guarding“. This is a form of reflex where, because movement of the joint causes pain, the brain reflexively tenses muscles around the area in order to reduce motion. The best treatment strategy here is two pronged, and involves pursuing specific treatment of the underlying joint pain–for example shoulder steroid injection or medial branch procedures for the spine–coupled with treatments of myofascial pain as discussed above.