Abstract
Pains from the musculoskeletal system represent a major proportion of complaints among patients seeking health services. Moreover, the efficacy of treatment of many musculoskeletal pain conditions by currently available pharmacologic and nonpharmacologic interventions is often less than optimal (Curatolo and Bogduk, 2001). Thus, it is generally accepted that pain from deep tissues constitutes a special diagnostic and therapeutic challenge, and further insights into the peripheral and central neurobiological mechanisms are necessary to improve diagnosis and management strategies. This chapter will mainly focus on the so-called myofascial pain syndrome (MPS). An unrefined search in PubMed reveals more than 4000 publications with the keyword “myofascial pain syndrome” and several extensive reviews and books are available on this topic (Fricton and Awad, 1990; Vaeroy and Merskey, 1993; Simons et al., 1999; Mense and Simons, 2001; Rivner, 2001; Borg-Stein and Simons, 2002). However, this chapter will attempt to critically review some of the proposed pain mechanisms and most prominent clinical presentations of MPS. In addition, the utility of quantitative sensory testing in assessment of muscle pain conditions will be discussed (Arendt-Nielsen 1997).
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
Similar content being viewed by others
References
Arendt-Nielsen, L., & Svensson, P. (2001). Referred muscle pain: Basic and clinical findings. The Clinical Journal of Pain, 17, 11–19.
Arendt-Nielsen, L., Graven-Nielsen, T., Svarrer, H., & Svensson, P. (1996). The influence of low back pain on muscle activity and coordination during gait: A clinical and experimental study. Pain, 64, 231–240.
Arendt-Nielsen, L., Drewes, A. M., Hansen, J. B., & Tage-Jensen, U. (1997a). Gut pain reactions in man: an experimental investigation using short and long duration transmucosal electrical stimulation. Pain, 69, 255–262.
Arendt-Nielsen, L., Graven-Nielsen, T., Svensson, P., & Jensen, T. S. (1997). Temporal summation in muscles and referred pain areas: an experimental human study. Muscle and Nerve, 20, 1311–1313.
Arendt-Nielsen, L., Laursen, R. J., & Drewes, A. M. (2000). Referred pain as an indicator for neural plasticity. Progress in Brain Research, 129, 343–356.
Bajaj, P., Graven-Nielsen, T., & Arendt-Nielsen, L. (2001a). Osteoarthritis and its association with muscle hyperalgesia: an experimental controlled study. Pain, 93, 107–114.
Bajaj, P., Graven-Nielsen, T., & Arendt-Nielsen, L. (2001b). Trigger points in patients with lower limb osteoarthritis. Journal of Musculoskeletal Pain, 9, 17–33.
Bendtsen, L., Jensen, R., Jensen, N. K., & Olesen, J. (1994). Muscle palpation with controlled finger pressure: new equipment for the study of tender myofascial tissues. Pain, 59, 235–239.
Bendtsen, L., Jensen, R., Jensen, N. K., & Olesen, J. (1995). Pressure-controlled palpation: a new technique which increases the reliability of manual palpation. Cephalalgia, 15, 205–210.
Bendtsen, L., Jensen, R., & Olesen, J. (1996a). Qualitatively altered nociception in chronic myofascial pain. Pain, 65, 259–264.
Bendtsen, L., Jensen, R., & Olesen, J. (1996b). Decreased pain detection and tolerance thresholds in chronic tension-type headache. Archives of Neurology, 53, 373–376.
Bendtsen, L., Nørregaard, J., Jensen, R., & Olesen, J. (1997). Evidence of qualitatively altered nociception in patients with fibromyalgia. Arthritis and Rheumatism, 40, 98–102.
Bengtsson, A., Bäckman, E., Lindblom, B., & Skogh, T. (1994). Long term follow-up of fibromyalgia patients: Clinical symptoms, muscular function, laboratory test — an eight year comparison study. Journal of Musculoskeletal Pain, 2, 67–80.
Berberich, P., Hoheisel, U., & Mense, S. (1988) Effects of carrageenan-induced myositis on the discharge properties of group III and IV muscle receptors in the cat. Journal of Neurophysiology, 59, 1395–1409.
Bonica, J. J. (1990). General considerations of acute pain. In J. J. Bonica (Ed.), The Management of Pain. Second Edition (pp. 159–179). Philadelphia, London: Lea & Febiger.
Borg-Stein, J., & Simons, D. G. (2002). Focused review: myofascial pain. Archives of Physical Medicine and Rehabilitation, 83, 40–47.
Cairns, B. E., Hu, J. W., Arendt-Nielsen, L., Sessle, B. J., & Svensson, P. (2001). Sex-related differences in human pain and rat afferent discharge evoked by injection of glutamate into the masseter muscle. Journal of Neurophysiology, 86, 782–791.
Carlson, C. R., Reid, K. L., Curran, S. L., Studts, J., Okeson, J. P., Falace, D., Nitz, A., & Bertrand, P. M. (1998). Psychological and physiological parameters of masticatory muscle pain. Pain, 76, 297–307.
Clark, G. T., Beemsterboer, P. L., & Jacobson, R. (1984). The effect of sustained submaximal clenching on maximum bite force in myofascial pain dysfunction patients. Journal of Oral Rehabilitation, 11, 387–391.
Coderre, T. J., Katz, J., Vaccarino, A.L., & Melzack, R. (1993). Contribution of central neuroplastirity to pathological pain: review of clinical and experimental evidence. Pain, 52, 259–285.
Curatolo, M., & Bogduk, N. (2001). Pharmacologic pain treatment of musculoskeletal disorders: current perspectives and future prospects. The Clinical Journal of Pain, 17, 25–32.
Curatolo, M., Petersen-Felix, S., Arendt-Nielsen, L., Giani, C., Zbinden, A. M., & Radanov, B. P. (2001). Central hypersensitivity in chronic pain after whiplash injury. The Clinical Journal of Pain, 17, 306–315.
Dubner, R. (1995). Hyperalgesia in response to injury to cutaneous and deep tissues. In J. R. Fricton & R. Dubner (Eds.), Orofacial pain and temporomandibular disorders. Advances in pain research and therapy, vol 21 (pp. 61–71). New York: Raven Press.
Dworkin, S. F., & LeResche, L. (Eds.) (1992). Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique, Journal of craniomandibular disorders: facial & oral pain, 6, 301–355.
Elert, J. E., Dahlqvist, S. R., Almay, B., & Eisemann, M. (1993). Muscle endurance, muscle tension and personality traits in patients with muscle or joint pain-a pilot study. The Journal of Rheumatology, 20, 1550–1556.
Ernberg, M., Hedenberg-Magnusson, B., Alstergren, P., & Kopp, S. (1998). Effect of local glucocorticoid injection on masseter muscle level of serotonin in patients with chronic myalgia. Acta Odontologwa Scandmavua, 56, 129–134.
Fischer, A. A. (Ed.) (1998). Muscle pain syndromes and fibromyalgia. Pressure algometry for quantification of diagnosis and treatment outcome (pp. 1–158). New York: Haworth Medical Press.
Fishbain, D. A., Goldberg, M., Meagher, B. R., Steele, R., & Rosomoff, H. (1986). Male and female chronic pain patients categorized by DSM-III psychiatric diagnostic criteria. Pain, 26, 181–197.
Fricton,J. R., & Awad, E. A. (Eds.) (1990). Myofascial Pain ad Fibromyalgia. Advances in Pain Research and Therapy, Vol 17, New York: Raven Press.
Gay, T., Maton, B., Rendell, J., & Majourau, A. (1994). Characteristics of muscle fatigue in patients with myofascial pain-dysfunction syndrome. Archives of Oral Biology, 39, 847–852.
Goulet, J.-P., Clark, G. T., Flack, V. F., & Liu, C. (1998). The reproducibility of muscle and joint tenderness detection methods and maximum mandibular movement measurement for the tcmporomandibular system. Journal of Orofacial Pain, 12, 17–26.
Gracely, R. H., & Reid, K. I. (1995). Orofacial pain measurement. In J. R. Fricton & R. Dubner (Eds.), Orofacial pain and tetnporomandibular disorders. Advances in pain research and therapy, vol 21 (pp. 117–143). New York; Raven Press.
Graff-Radford, S. B., Reeves, J. L., Baker, R. L., & Chiu, D. (1989). Effects of trans cutaneous electrical nerve stimulation on myofascial pain and trigger point sensitivity.Pain, 37, 1–5.
Graven-Nielsen, T., & Mense, S. (2001). The peripheral apparatus of muscle pain: Evidence from animal and human studies. The Clinical Journal of Pain, 17, 2–10.
Graven-Nielsen, T., Arendt-Nielsen, L., Svensson, P., & Jensen, T. S. (1997a). Effects of experimental muscle pain on muscle activity and co-ordination during static and dynamic motor function. Electroencephalqgraphy and Clinical Neurophysiology, 105, 156–164.
Graven-Nielsen, T., Kendall, S. A., Henriksson, K. G., Bengtsson, M., Sörensen, J., Johnson, A., Gerdle, B., & Arendt-Nielsen, L. (2000). Ketamine reduces muscle pain, temporal summation, and referred pain in fibromyalgia patients. Pain, 85, 483–491.
Göbel, H., Weigle, L., Kropp, P., & Soyka, D. (1992). Pain sensitivity and pain reactivity of pericranial muscles in migraine and tension-type headache. Cephalalgia, 12, 142–151.
Howell, J. N., Chilla, A. G., Ford, G., David, D., & Gates, T. (1985). An electromyographic study of elbow motion during postexercise muscle soreness. Journal of Applied Physiology, 58, 1713–1718.
Hu, J. W., Sessle, B. J., Raboisson, P., Dallel, R., & Woda, A. (1992). Stimulation of craniofacial muscle afferents induces prolonged facilitatory effects in trigeminal nociceptive brain-stem neurones. Pain, 48, 53–60.
Tsselee, H., De Laat, A., Bogaerts, K., & Lysens, R. (1998). Short-term reproducibility of pressure pain thresholds in masticatory muscles measured with a new algometer. Journal of Orofacial Pain, 12, 203–209.
Jaeger, B., & Reeves, J. L. (1986). Quantification of changes in myofascial trigger point sensitivity with the pressure algometer following passive stretch. Pain, 27, 203–210.
Jensen, K., Andersen, H. Ø., Olesen, J., & Lindblom, U. (1986). Pressure-pain threshold in human temporal region: evaluation of a new pressure algometer. Pain, 25, 313–323.
Jensen, K., Tuxen, C., Pedersen-Bjergaard, U., Jansen, I., & Olesen, J. (1990). Pain and tenderness in human temporal muscle induced by bradykinin and 5-hydroxytryptamine. Peptides, 11, 1127–1132.
Jensen, R., Rasmussen, B. K., Pedersen, B., & Olesen, J. (1993a). Muscle tenderness and pressure pain thresholds in headache. A population study. Pain, 52, 193–199.
Jensen, R., Fuglsang-Frederiksen, A., & Olesen, J. (1994). Quantitative surface EMG of pericranial muscles in headache. A population study. Eledroencephalography and Clinical Neurophysiology, 93, 335–344.
Jensen, R., Bendtsen, L., & Olesen, J. (1998). Muscular factors are of importance in tension-type headache. Headache, 38, 10–17.
Kosek, E., & Hansson, P. (1997). Modulatory influence on somatosensory perception from vibration and heterotopic noxious conditioning stimulation (HNCS) in fibromyalgia patients and healthy subjects. Pain, 70, 41–51.
Kosek, E., & Ordeberg, G. (2000). Lack of pressure pain modulation by heterotopic noxious conditioning stimulation in patients with painful osteoarthritis before, but not following, surgical pain relief. Pain, 88, 69–78.
Langemark, M., Jensen, K., Jensen, T. S., & Olesen J. (1989). Pressure pain thresholds and thermal nociceptive thresholds in chronic tension-type headache. Pain, 38, 203–210.
Lavigne, G. J., Thon, M. T., Rompre, P., Duncan, G. H., & Goulet, J.-P. (1994). Sensory descriptors from touch to pressure-pain and experimental variables: a psychophysiological study in human on pressure-pain threshold. In G. F. Gebhart, D. L. Hammond & T. S. Jensen (Eds.), Proceedings of the 7th world congress on pain. Progress in pain research and management, vol2 (pp. 831–842). Seattle: IASP Press.
Leffler, A. S., Kosek, E., & Hansson, P. (2000b). The influence of pain intensity on somatosensory perception in patients suffering from subacute/chronic lateral epicondylalgia. European Journal of Pain, 4, 57–71.
Leffler, A. S., Kosek, E., Lerndal, T., Nordmark, B., & Hansson, P. (2002). Somatosensory perception and function of diffuse noxious inhibitory controls (DNIC) in patients suffering from rheumatoid arthritis. European Journal of Pain, 5, 161–176.
Lewis, T. (1938). Suggestions relating to the study of somatic pain. British Medical Journal, 1, 321–325.
List, T., Helldmo, M., & Falk, G. (1989). Reliability and validity of a pressure threshold meter in recording tenderness in the masseter muscle and the anterior temporalis muscle. The Journal of Craniomandibular Practice, 7, 223–229.
List, T., Helkimo, M., & Karlsson, R. (1991). Influence of pressure rates on the reliability of a pressure threshold meter. Journal of craniomandibular disorders: facial & oral pain, 5, 173–178.
Maixner, W., Fillingim, R., Booker, D., & Sigurdsson, A. (1995). Sensitivity of patients with painful temporomandibular disorders to experimentally evoked pain. Pain, 63, 341–351.
Maixner, W., Fillingim, R., Sigurdsson, A., Kincaid, S., & Silva, S. (1998). Sensitivity of patients with painful temporomandibular disorders to experimentally evoked pain; evidence for altered temporal summation of pain. Pain, 76, 71–81.
Malow, R. M., Grimm, L., & Olson, R. E. (1980). Differences in pain perception between myofascial pain dysfunction patients and normal subjects: a signal detection analysis. Journal of Psychosomatic Research, 24, 303–309.
McCain, G. A., & Scudds, R. A. (1988). The concept of primary fibromyalgia (fibrositis): clinical value, relation and significance to other chronic musculoskeletal pain syndromes. Pain, 33, 273–287.
McMillan, A. S., & Blasberg, B. (1994). Pain-pressure threshold in painful jaw muscles following trigger point injection. Journal of Orofacial Pain, 8, 384–390.
McMillan, A. S., & Lawson, E. T. (1994). Effect of tooth clenching and jaw opening on pain-pressure thresholds in the human jaw muscles. Journal of Orofacial Pain, 8, 250–257.
Melzack, R., Katz, J., & Jeans, M. E. (1985). The role of compensation in chronic pain: analysis using a new method of scoring the McGill Pain Questionnaire. Pain, 23, 101–112.
Mense, S. (1991). Considerations concerning the neurobiological basis of muscle pain. Canadian Journal of Physiology and Pharmacology, 69, 610–616.
Mense, S. (1993). Nociception from skeletal muscle in relation to clinical muscle pain. Pain, 54, 241–289
Mense, S., & Meyer, H. (1988). Bradykinin-induced modulation of the response behaviour of different types of feline group III and IV muscle receptors. The Journal of Physiology, 398, 49–63.
Mense, S., & Simons, D. G. (2001). Muscle pain. Understanding its nature, diagnosis, and treatment. Philadelphia: Lippincott Williams & Wilkins.
Ohrbach, R., & Gale, E. N. (1989a). Pressure pain thresholds in normal muscles: reliability, measurement effects and topographic differences. Pain, 37, 257–263.
Ohrbach, R., & Gale, E. N. (1989b). Pressure pain thresholds, clinical assessment, and differential diagnosis: reliability and validity in patients with myogenic pain. Pain, 39, 157–169.
Ohrbach, R., Crow, H., & Kamer, A. (1998). Examiner expectancy effects in the measurement of pressure pain thresholds. Pain, 74, 163–170.
Reeves, J. L., Jaeger, B., & Graff-Radford, S. B. (1986). Reliability of the pressure algometer as a measure of myofascial trigger point sensitivity. Pain, 24, 313–321.
Reid, K. I., Gracely, R. H., & Dubner, R. A. (1994). The influence of time, facial side, and location on pain-pressure thresholds in chronic myogenous temporomandibular disorder. Journal of Orofacial Pain, 8, 258–265.
Reinert, A., Kaske, A., & Mense, S. (1998). Inflammation-induced increase in the density of neuropeptide-immunoreactive nerve endings in rat skeletal muscle. Experimental Brain Research, 121, 174–180.
Rivner, M. H. (2001). The neurophysiology of myofascial pain syndrome. Current Pain and Headache Reports, 5, 432–440.
Sand, T., Zwart, J. A., Helde, G., & Bovim, G. (1997). The reproducibility of cephalic pain pressure thresholds in control subjects and headache patients. Cephalalgia, 17, 748–755.
Schiffman, E., Fricton, J. R., Haley, D., & Tylka, D. (1988). A pressure algometer for myofascial pain syndrome: reliability and validity testing In R. Dubner, G. F. Gebhart & M. R Bond (Eds.), Proceedings of the 5th world congress on pain. Pain research and clinical management, vol 3 (pp. 407–413). Amsterdam: Elsevier.
Schoenen, J., Bottin, D., Hardy, F., & Gerard, P. (1991a). Cephalic and extracephalic pressure pain thresholds in chronic tension-type headache. Pain, 47, 145–149.
Scudds, R. A., Trachsel, L. C., Luckhurst, B. J., & Percy, J. S. (1989). A comparative study of pain, sleep quality and pain responsiveness in fibrositis and myofascial pain syndrome. Journal of Rheumatology Supplement, 19, 120–126.
Sessle, B. J. (1995). Masticatory muscle disorders: basic science perspectives In B. J. Scssle, P. S. Bryant & R. A. Dionne (Eds.), Temporomandibular disorders and related pain conditions. Progress in pain research and management, vol4 (pp. 47–61). Seattle: IASP Press.
Sihvonen, T., Partanen, J., Hänninen, O., & Soimakallio, S. (1991). Electric behavior of low back muscles during lumbar pelvic rhythm in low back pain patients and healthy controls. Archives of Physical and Medicine Rehabilitation, 72, 1080–1087.
Simons, D. G., Travell, J. G., & Simons, L. (1999). Myofascial pain and dysfunction, The trigger point manual. Baltimore: Williams & Williams.
Smythe, H. (1992). Links between fibromyalgia and myofascial pain syndromes. The Journal of Rheumatology, 19, 842–843.
Sola, A. E. & Bonica, J. J. (1990). Myofascial pain syndromes. In J. J. Bonica, J. D. Loeser, C. R. Chapman & W E. Fordyce (Eds.), The Management of Pain (ed. 2) (pp. 352–367). Philadelphia: Lea & Fibiger.
Staud, R., Vierck, C. J., Cannon, R. L., Mauderli, A. P., & Price, D. D. (2001). Abnormal senskization and temporal summation of second pain (wind-up) in patients with fibromyalgia syndrome. Pain, 91, 165–175.
Stohler, C. S., Yamada, Y., & Ash, M. M.Jr. (1985). Antagonistic muscle stiffness and associated reflex behaviour in the pain-dysfunctional state. Helvetica Odontologica Acta, 29, 13–20.
Svensson, P., Arendt-Nielsen, L., Nielsen, H., & Larsen, J. K. (1995). Effect of chronic and experimental jaw muscle pain on pain-pressure thresholds and stimulus-response curves. Journal of Orofacial Pain, 9, 347–356.
Svensson, P., Arendt-Nielsen, L., & Houe, L. (1996). Sensory-motor interactions of human experimental unilateral jaw muscle pain: A quantitative analysis. Pain, 64, 241–249.
Svensson, P., Houe, L., & Arendt-Nielsen, L. (1997). Bilateral experimental muscle pain changes electromyographic activity of human jaw-closing muscles during mastication. Experimental Brain Research, 116, 182–185.
Svensson, P., Graven-Nielsen, T., Matre, D. A., & Arendt-Nielsen, L. (1998). Experimental muscle pain does not cause long-lasting increases in resting EMG activity. Muscle and Nerve, 21, 1382–1389.
Svensson, P., List, T., & Hector, G. (2001). Analysis of stimulus-evoked pain in patients with myofascial temporomandibular pain disorders. Pain, 92, 399–409.
Swarbrick, E. T., Hegarty, J. E., Bat, L., Williams, C. B., & Dawson, A. M. (1980). Site of pain from the irritable bowel. The Lancet, 2, 443–446.
Taiwo, Y O., & Levine, J. D. (1992). Serotonin is a directly-acting hyperalgesic agent in the rat. Neuroscience, 48, 485–490.
Travell, J. G., & Simons, D. G. (1992). Myofascial pain and Dysfunction. The trigger point manual. Baltimore: Williams & Wilkins.
Triano, J. J., & Schultz, A. B. (1987). Correlation of objective measure of trunk motion and muscle function with low-back disability ratings. Spine, 12, 561–565.
Tunks, E., McCain, G. A., Hart, L. E., Teasell, R. W., Goldsmith, C. H., Rollman, G. B., McDermid, A. J., & DeShane, P. J. (1995). The reliability of examination for tenderness in patients with myofascial pain, chronic fibromyalgia and controls. The Journal of Rheumatology, 22, 944–952.
Vaeroy, H., & Merskey, H. (Eds.) (1993). Progress in Fibromyalgia and Myofascial pain. Pain Research and Clinical Management, Vol 6. Amsterdam: Elsevier.
Vecchiet, L., Giamberardino, M. A., & Saggini, R. (1991). Myofascial pain syndromes: clinical and pathophysiological aspects. The Clinical Journal of Pain, 7 (Suppl. 1), 16–22.
Vecchiet, L., Giamberardino, M. A., de Bigontina, P., & Dragani, L. (1994). Comparative sensory evaluation of parietal tissues in painful and nonpainful areas in fibromyalgia and myofascial pain syndrome. In G. F. Gebhart, D. L. Hammond & T. S. Jensen (Eds.), Proceedings of the 7th world congress on pain. Progress in pain research and management, vol 2 (pp. 177–185). Seattle: IASP Press.
Watanabe, M., Tabata, T., Huh, J. I., Inai, T., Tsuboi, A., Sasaki, K., & Endo, Y (1999). Possible involvement of histamine in muscular fatigue in temporomandibular disorders: animal and human studies. Journal of Dental Research, 78, 769–775.
Wolfe, F., Simons, D. G., Fricton, J., Bennett, R. M., Goldenberg, D. L., Gerwin, R., Hathaway, D., McCain, G. A., Russell, I. J., Sanders, H. O., Skootsky, S. A. (1992). The fibromyalgia and myofascial pain syndromes: a preliminary study of tender points and trigger points in persons with fibromyalgia, myofascial pain syndrome and no disease. The Journal of Rheumatology, 19, 944–951.
Woolf, G., Bennett, G. J., Doherty, M., Dubner, R., Kidd, B., Koltzenburg, M., Lipton, R., Loeser, J. D., Payne, R., & Totebjörk, E. (1998). Towards a mechanism-based classification of pain. Pain, 77, 227–229.
Wright, A., Graven-Nielsen, T., Davies, I., & Arendt-Nielsen, L. (2002). Temporal summation of pain from skin, muscle and joint following nociceptive ultrasonic stimulation in humans. Experimental Brain Research, 144, 475–482.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2004 Springer Science+Business Media New York
About this chapter
Cite this chapter
Arendt-Nielsen, L., Graven-Nielsen, T., Svensson, P. (2004). Disturbances of Pain Perception in Myofascial Pain Syndrome and other Musculoskeletal Pains. In: Lautenbacher, S., Fillingim, R.B. (eds) Pathophysiology of Pain Perception. Plenum Series in Rehabilitation and Health. Springer, Boston, MA. https://doi.org/10.1007/978-1-4419-9068-6_6
Download citation
DOI: https://doi.org/10.1007/978-1-4419-9068-6_6
Publisher Name: Springer, Boston, MA
Print ISBN: 978-1-4613-4780-4
Online ISBN: 978-1-4419-9068-6
eBook Packages: Springer Book Archive