Myofascial Pain Syndrome

“Myofascial pain” is a synonym for muscle pain but it can also include pain in the tendons, ligaments, and other soft tissues. It is a chronic condition, may involve either a single muscle or a group of muscles.

Myofascial pain can result from a sprain or strain. Other causes include:

  • disc injuries

  • fatigue

  • repetitive use

  • excessive use

  • lack of activity

  • some medical problems like a heart attack

Those with myofascial pain usually have "trigger points.” These are tender areas of muscle spasm that do not go away. These can be treated with local trigger point injections. Other common treatments include physical therapy, massage, chiropractic, acupuncture, and especially muscle stretching.

Complex Regional Pain Syndrome

Complex regional pain syndrome (CRPS) is also called reflex sympathetic dystrophy or Sudek’s atrophy. It is a chronic problem due to abnormal nerve impulses. CRPS is most common in people aged twenty to thirty-five. The syndrome is more common in women.

The symptoms of CRPS vary. Continuous, intense pain, out of proportion to the injury, which spreads to other areas of the body, is common. Other symptoms include:

  • pain when an area is touched

  • swelling and stiffness

  • weakness

  • changes in the hair and nails

  • changes in the skin texture or temperature

There is no test for CRPS, but it is necessary to exclude other possible problems. The tests depend on the exact symptoms. There is no single cure for CRPS. A variety of treatments can help. Doctors can help to control the symptoms. Medications, physical therapy, psychological therapy and other complementary treatments like acupuncture and chiropractic can help. If these do not work, sympathetic nerve blocks, the surgical removal of the sympathetic plexus, an intrathecal drug pump, or a spinal cord stimulator may be of benefit.

Neuropathic Pain

Neuropathic pain is a type of chronic pain state that is caused by tissue injury. The nerve fibers are damaged and send inappropriate pain signals. One example is phantom limb pain, which occurs after an amputation. Other causes include: when an arm or a leg has been removed because of illness or injury, but the brain still gets

  • alcoholism

  • back problems

  • chemotherapy

  • diabetes

  • HIV infection

  • multiple sclerosis

  • Shingles

Anti-inflammatory drugs may ease pain. Stronger painkillers, anticonvulsant, and antidepressant drugs may also help. Treating underlying medical problems, such as diabetes, is important. Implantable pain pumps and spinal cord stimulators may work when all else fails.

Arachnoiditis

The arachnoid is the membrane that surrounds the spinal cord and nerve roots. When inflamed, there can be pain that extends from the neck or back into the arms or legs. The pain is most commonly described as a burning or tingling type of discomfort. Symptoms vary greatly and can also include:

  • numbness or weakness

  • a feeling like insects crawling on the skin

  • a sensation like water trickling down the leg

  • shooting pain like electric shocks

  • cramps or spasms

  • bowel or bladder problems

  • sexual dysfunction

Arachnoidis can be caused by myelograms (a diagnostic test), spinal injections, surgery, infections such as meningitis, or chronically pinched nerves. Arachnoiditis can be seen on MRI (magnetic resonance imaging) and electromyograms (EMG) can be used to assess the severity of the problem.

There is no cure for arachnoiditis but there are treatments. The pain can be treated with a variety of medications. Physical therapy, exercise, acupuncture, and psychotherapy are most commonly recommended. Steroids may be of help. Electrical stimulation is sometimes beneficial. Surgery most often causes more scarring and inflammation. Some have advocated endoscopic scar lysis, but this is controversial.

 


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