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Did you just say MTrP's ?

Musculoskeletal pain is the most common manifestation of chronic pain.

The term Neuromusculoskeletal pain is preferable for the forms of chronic pain to convey accurately the notion that the perpetuation of pain depends upon fundamental changes in the nervous system.

Neuroplasticity is a normal adaptive change in the function and/or structure of the nervous system in response to a nociceptive signal. However, in chronic pain, these neuroplastic changes become maladaptive and can fundamentally alter one’s pain threshold, pain intensity, and affective interpretation of pain.

The most common type of Musculo Skeletal pain is believed to be myofascial pain, or pain that arises from discrete hyperirritable palpable nodules in taut bands of muscle called myofascial trigger points (MTrP). MTrP are a commonly overlooked cause of chronic neuromusculoskeletal pain and dysfunction.

Examination for trigger points requires good palpation skills and understanding of the common referral patterns of myofascial pain.

The presence of this type of muscle tissue pain generator is still somewhat controversial given the lack of an objective test to verify its presence and, at this point, diagnosis depends upon the systematic palpation of the soft tissue by an experienced examiner following a thorough medical history.

Gerwin et al. concisely summarized the diagnostic criteria for myofascial pain :

1. Localized pain in a taut band of muscle

2. Local twitch response to cross fiber stimulation of the taut band

3. Pain to deep palpation that is recognized pain

4. Referred pain to a characteristic distant region based on myofascial referral maps

5. Restricted movement in joints related to muscle

6. Weakness that is not caused by neurological compromise

7. Autonomic dysfunction

Conclusions :

· Myofascial trigger points are a common cause of neuromusculoskeletal pain and dysfunction.

· Active myofascial trigger points function as dynamic foci of peripheral nociception that can initiate, accentuate, and maintain central sensitization and chronic pain states.

· Continuous nociceptive input from myofascial trigger points can increase excitability of dorsal horn neurons (causing allodynia and hyperalgesia which is hypersensitivity to pain) and open ineffective synapses—resulting in new receptive fields and referral of pain.

· Physical body work therapy and dry needling act mechanically at a local level to reduce the concentration of unwanted substance in the area (calcitonin related gene peptide, norepinephrine and more…)

Reference : Jay P. Shah Integrating Dry Needling with New Concepts of Myofascial Pain, Muscle Physiology, and Sensitization


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