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Musculoskeletal pain

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Loop Alumni Library, to provide data-driven analysis of journals when seeking publication. Calculators UpToDate. EBMcalc Anesthesia Stat! Preoperative Algorithms Anesthesiology Institute. Pain from a myofascial TrP is a distinct, discrete and constant pattern or map of pain with no gender or racial differences able to reproduce symptoms - referred pain map [5].

Trigger points develop in the myofascia, mainly in the center of a muscle belly where the motor endplate enters primary or central TrPs [5]. Those are palpable nodules within the tight muscle at the size of mm and can demonstrate at different places in any skeletal muscles of the body. We all have TrPs in the body.

TrPts can be divided in several groups [5] :. Little is known about the formation of TrPs. There are some theories written in literature who try to explain the formation, sensitization, and manifestation of TrPs, but few of them have strong evidence [3] [10] [11].


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Under normal conditions, pain from TrPs is mediated by thin myelinated Ad fibers and unmyelinated C fibers. Various noxious and innocuous events, such as mechanical stimuli or chemical mediators, may excite and sensitize Ad fibers and C fibers and thereby play a role in the development of TrPs. Electrophysiological investigations of TrPs reveals phenomena which indicate that the electrical activity arises from dysfunctional extrafusal motor endplates rather than from muscle spindles [12].

Polymodal theory explains the existence of polymodal receptors PMRs throughout the body which under certain constant, pathological stimuli turn into trigger points [13]. Radiculopathic theory explains direct relationship between problems on nerve roots which lead to local and distant neurovascular signals and trigger points creation [14]. Peripheral and Central Sensitization - Central sensitization is a phenomenon, together with peripheral sensitization, which helps in understanding chronic or amplified pain. There is central sensitization after an intense or repetitive stimulus of the nociceptor present in the periphery, leading to a reversible increase of excitability and of the synaptic efficacy of central nociceptive pathway neurons.

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Manifested as hypersensitivity to pain called tactile allodynia and hyperalgesia secondary to puncture or pressure. These CNS changes may be detected by electrophysiological or imaging techniques [15] [16]. No laboratory test or imaging technique has been established for diagnosing TrPs [2].

Anamnesis a patient's account of their own clinical history should be specific. The patient must be asked about fibromyalgia, as well as the presence of it in the family history of diseases. Also, the patient should be asked about his physical and daily activities in the presence and in the past as a lack of exercise and sedentary life may be a pathogenic factor.

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Firstly, the exact location and right TrP should be palpated. Other signs to check up to be sure we are at the proper spot are:. Examination through palpation can be performed standing, sitting or lying down. There also have to be performed the ROM examination as well as postural examination. Fischer has proposed the use of a pressure threshold meter algometer , as a means of quantitative documentation of TrPs, and for quantifying the effects of the physical therapy treatment.

Pressure pain threshold and visual analogue scale VAS scores were the outcome measures more used in the analyzed trials. ROM also may be an outcome measurement for evaluating therapy [18]. With the injection, the TrP is made inactive and the pain is alleviated. Often, a brief course of treatment will result in sustained relief. Injections are performed by a physician and usually take a few minutes.

Several sites may be injected in one visit.

These are other possible therapies written in literature. Note: not all of theme have strong scientifical evidence. A lot of the researches are not placebo-controlled and immediate effects after treatment may occur due to placebo-effects [18] :. The content on or accessible through Physiopedia is for informational purposes only. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider.

Read more. Search Search. Toggle navigation p Physiopedia. Contents Editors Categories Share Cite. Contents loading Trigger Points. Jump to: navigation , search. Primary or Central TrPs are those that cause severe pain locally at the pressure with irradiation according to referred pain map. Usually are based around the center of a muscle belly. Secondary or Satellite TrPs arise in response to existing central trigger points in surrounding muscles. They usually spontaneously withdraw when the central TrP is healed.

Can be present in the form of a cluster.