Myofascial pain therapy

Background: The most important strategy in myofascial pain syndrome therapy is to identify the etiological lesion that causes the activation of myofascial trigger points[s] and to treat the underlying pathology. If the underlying etiological lesion is not appropriately treated, the TrP can only be inactivated temporarily, and never completely. Findings: Generally, active TrPs should be treated conservatively with non-invasive techniques such as physical therapy prior to the consideration of aggressive therapy with invasive techniques such as needling and injection. This principle should also be observed when treating the underlying etiological lesions. Conservative therapy, such as manual therapy combined with thermotherapy and electrotherapy, can usually inactivate painful TrPs. Other situations, however, might necessitate dry needling or TrP injection: 1. persistent pain or discomfort after complete elimination of the underlying pathological lesion responsible for TrP activation, 2. poor response to conservative therapy, 3. intolerable pain, 4. deep location of a TrP, rendering it inaccessible by conservative manual therapy, 5. inadequate time to accept the time-consuming conservative therapy, or 6. personal preference. When treating myofascial pain syndrome, it is also important to eliminate any perpetuating factors that may cause persistent chronic pain, and to provide adequate education and home programs to patients, so that recurrent or chronic pain can be avoided. Conclusions: Myofascial pain should be appropriately treated to inactivate TrPs completely and to avoid recurrence permanently.