Myofascial Low Back Pain: A Review

Physical Medicine and Rehabilitation Clinics of North America

Volumn 21, Issue 4, 2010, Pages 711-724

  Malanga, Gerard A ^a,b,c   Cruz Colon, Eduardo J ^d  

^a Overlook Pain Center   (United States)

^b Atlantic Health   (United States)

^c RUTGERS NEW JERSEY MEDICAL SCHOOL   (United States)

^d KESSLER INSTITUTE FOR REHABILITATION   (United States)

Author keywords

Fibromyalgia; Low back pain; Myofascial pain; Trigger points

Indexed keywords

AMITRIPTYLINE; ANALGESIC AGENT; BOTULINUM TOXIN; BUPIVACAINE; CLONAZEPAM; CYCLOBENZAPRINE; DEXAMETHASONE; DICLOFENAC; HERBACEOUS AGENT; LEVOBUPIVACAINE; LIDOCAINE; MEPIVACAINE; MUSCLE RELAXANT AGENT; NONSTEROID ANTIINFLAMMATORY AGENT; PLACEBO; PRILOCAINE; PROCAINE; ROPIVACAINE; STEROID; TRICYCLIC ANTIDEPRESSANT AGENT;

ACUPUNCTURE; ANALGESIC ACTIVITY; ANAMNESIS; AUTONOMIC DYSFUNCTION; BIOMECHANICS; CHIROPRACTIC; CLINICAL TRIAL; DIAGNOSTIC VALUE; DIFFERENTIAL DIAGNOSIS; DRUG EFFICACY; DRUG MECHANISM; ELASTOGRAPHY; ELECTROMYOGRAM; FIBROMYALGIA; HERBAL MEDICINE; HUMAN; HYPERTHERMIC THERAPY; LOW BACK PAIN; MANIPULATIVE MEDICINE; MASSAGE; MUSCLE STIFFNESS; MYOFASCIAL PAIN; NONHUMAN; PATHOPHYSIOLOGY; PHYSICAL EXAMINATION; PHYSIOTHERAPY; PRIORITY JOURNAL; RANGE OF MOTION; REFERRED PAIN; REVIEW; SKIN IRRITATION; SYSTEMIC DISEASE; TRANSCUTANEOUS NERVE STIMULATION; TRIGGER POINT;

COMORBIDITY; FIBROMYALGIA; GLUCOCORTICOIDS; HUMANS; MUSCLE CONTRACTION; MYOFASCIAL PAIN SYNDROMES; PHYSICAL EXAMINATION; RANGE OF MOTION, ARTICULAR; VITAMIN D DEFICIENCY;

EID: 77958506750     PISSN: 10479651     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.pmr.2010.07.003     Document Type: Review

References (64)

1. Fishbain D.A., Goldberg M., Megher B.R., et al. Male and female chronic pain patients categorized by DSM-III psychiatric diagnostic criteria. Pain 1986, 26:181-197.
2. Tough E.A., White A.R., Richards S., et al. Variability of criteria used to diagnose myofascial trigger point pain syndrome-evidence from a review of the literature. Clin J Pain 2007, 23:278-286.
3. Alvarez D.J., Rockwell P.G. Trigger points: diagnosis and management. Am Fam Physician 2002, 6:653-660.
4. Partanen J.V., Ojala T.A., Arokoski J.P. Myofascial syndrome and pain: a neurophysiological approach. Pathophysiology 2010, 17:19-28.
5. Travell J.G., Simons D.G. Travell & Simons' myofascial pain and dysfunction: the trigger point manual 1999, Williams & Wilkins, Pennsylvania.
6. Shah J.P., Gilliams E.A. Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: an application of muscle pain concepts to myofascial pain syndrome. J Bodyw Mov Ther 2008, 12:371-384.
7. McPartland J.M. Travell trigger points-molecular and osteopathic perspectives. J Am Osteopath Assoc 2004, 104:244-249.
8. Simons D.G. New views of myofascial trigger points: etiology and diagnosis. Arch Phys Med Rehabil 2008, 89:157-159.
9. Shah J.P., Danoff J.V., Desai M.J., et al. Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points. Arch Phys Med Rehabil 2008, 89:16-23.
10. Hsieh R.L., Lee W.C. Are the effects of botulinum toxin injection on myofascial trigger points placebo effects or needling effects?. Arch Phys Med Rehabil 2008, 89:792-793.
11. Gerwin R.D. The taut band and other mysteries of the trigger point: an examination of the mechanisms relevant to the development and maintenance of the trigger point. Journal of Musculoskeletal Pain 2008, 16:115-121.
12. Hong C.Z., Simons D.G. Pathophysiologic and electrophysiologic mechanisms of myofascial trigger points. Arch Phys Med Rehabil 1998, 79:863-872.
13. Kuan T.S., Hong C.Z., Chen J.T., et al. The spinal cord connections of the myofascial trigger spots. Eur J Pain 2007, 11:624-634.
14. Vedolin G.M., Lobato V.V., Conti P.C., et al. The impact of stress and anxiety on the pressure pain threshold of myofascial pain patients. J Oral Rehabil 2009, 36:313-321.
15. Chien J.J., Bajwa Z.H. What is mechanical back pain and how best to treat it?. Curr Pain Headache Rep 2008, 12:406-411.
16. Gerwin R.D. A review of myofascial pain and fibromyalgia-factors that promote their persistence. Acupunct Med 2005, 23:121-134.
17. Edwards J. The importance of postural habits in perpetuating myofascial trigger point pain. Acupunct Med 2005, 23:77-82.
18. Plotnikoff G.A., Quigley J.M. Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc 2003, 78:1463-1470.
19. Mense S., Simons D.G., Russell I.J. Muscle pain. Understanding its nature, diagnosis and treatment 2001, Lippincott Williams and Wilkins, Baltimore (MD).
20. Lucas N., Macaskill P., Irwig L., et al. Reliability of physical examination for diagnosis of myofascial trigger points: a systematic review of the literature. Clin J Pain 2009, 25:80-89.
21. Myburgh C., Larsen A.H., Hartvigsen J. A systematic, critical review of manual palpation for identifying myofascial trigger points: evidence and clinical significance. Arch Phys Med Rehabil 2008, 89:1169-1176.
22. Njoo K.H., Van der Does E. The occurrence and inter-rater reliability of myofascial trigger points in the quadratus lumborum and gluteus medius: a prospective study in non-specific low back pain patients and controls in general practice. Pain 1994, 58:317-323.
23. Friedrich M., Hahne J., Wepner F. A controlled examination of medical and psychosocial factors associated with low back pain in combination with widespread musculoskeletal pain. Phys Ther 2009, 89:786-803.
24. Bengtsson A., Henriksson K.G., Jorfeldt L., et al. Primary fibromyalgia. A clinical and laboratory study of 55 patients. Scand J Rheumatol 1986, 15:340-347.
25. Wolfe F., Simons D.G., Fricton J., et al. 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. J Rheumatol 1992, 19:944-951.
26. Ge H.Y., Wang Y., Danneskiold-Samsøe B., et al. The predetermined sites of examination for tender points in fibromyalgia syndrome are frequently associated with myofascial trigger points. J Pain 2010, 11(7):644-651.
27. Wilke W.S. New developments in the diagnosis of fibromyalgia syndrome: say goodbye to tender points?. Cleve Clin J Med 2009, 76:345-352.
28. Gerwin R.D., Shannon S., Hong C.Z., et al. Interrater reliability in myofascial trigger point examination. Pain 1997, 69:65-73.
29. Simons D. Myofascial pain management: update of myofascial pain from trigger points 2010. Available at:, Accessed April, 2010. http://www.pain-education.com/myofascial-pain-from-trigger-points.html.
30. Bonci D.C. Algometry validates chiropractic. Dynamic Chiropractic 1994, 15:12.
31. Kinser A.M., Sands W.A., Stone M.H. Reliability and validity of a pressure algometer. J Strength Cond Res 2009, 23:312-314.
32. Delaney G.A., McKee A.C. Inter- and intra-rater reliability of the pressure threshold meter in measurement of myofascial trigger point sensitivity. Am J Phys Med Rehabil 1993, 72:136-139.
33. Sciotti V.M., Mittak V.L., DiMarco L., et al. Clinical precision of myofascial trigger point location in the trapezius muscle. Pain 2001, 93:259-266.
34. Sikdar S., Shah J.P., Gilliams E., et al. Assessment of myofascial trigger points: a new application of ultrasound and vibration sonoelastography. Conf Proc IEEE Eng Med Biol Soc 2008, 2008:5585-5588.
35. Magnetic resonance elastography: an overview Available at:, Accessed April, 2010. http://www.mayoclinic.org/magnetic-resonance-elastography/.
36. Chen Q., Bensamoun S., Basford J.R., et al. Identification and quantification of myofascial taut bands with magnetic resonance elastography. Arch Phys Med Rehabil 2007, 88:1658-1661.
37. Chen Q., Basford J., An K.N. Ability of magnetic resonance imaging to asses taut bands. Clin Biomech 2008, 23:623-629.
38. Sikdar S., Shah J.P., Gebreab T., et al. Novel applications of ultrasound technology to visualize and characterize myofascial trigger points and surrounding soft tissue. Arch Phys Med Rehabil 2009, 90(11):1829-1838.
39. Hunter C., Dubois M., Zou S., et al. A new muscle pain detection device to diagnose muscles as a source of back and/or neck pain. Pain Med 2010, 11:35-43.
40. Hong C.Z. Treatment of myofascial pain syndrome. Curr Pain Headache Rep 2006, 10:345-349.
41. Han S.C., Harrison P. Myofascial pain syndrome and trigger-point management. Reg Anesth 1997, 22:89-101.
42. Vázquez-Delgado E., Cascos-Romero J., Gay-Escoda C. Myofascial pain associated to trigger points: a literature review. Part 2: differential diagnosis and treatment. Med Oral Patol Oral Cir Bucal 2010, 15(4):e639-e643.
43. Leite F.M., Atallah A.N., El Dib R., et al. Cyclobenzaprine for the treatment of myofascial pain in adults. Cochrane Database Syst Rev 2009, 8. CD006830.
44. Hsieh L.F., Hong C.Z., Chern S.H., et al. Efficacy and side effects of diclofenac patch in treatment of patients with myofascial pain syndrome of the upper trapezius. J Pain Symptom Manage 2010, 39:116-125.
45. Ay S., Evcik D., Tur B.S. Comparison of injection methods in myofascial pain syndrome: a randomized controlled trial. Clin Rheumatol 2010, 29:19-23.
46. American Medical Association Article for trigger point injections-coding guidelines for LCD L19485. Centers for Medicare Services Available at:, Accessed March 16, 2007. http://www.empiremedicare.com/newjpolicy/policy/119485%20_final.htm.
47. Fischer A.A. New approaches in treatment of myofascial pain. Phys Med Rehabil Clin N Am 1997, 8:153-169.
48. Wheeler A.H., Goolkasian P., Gretz S.S. Botulin toxin A for the treatment of chronic neck pain. Pain 2001, 94:255-260.
49. Wheeler A.H., Goolkasian P., Gretz S.S. A randomized, double-blind, prospective pilot study of botulinum toxin injection for refractory, unilateral, cervicothoracic, paraspinal, myofascial pain syndrome. Spine 1998, 23:1662-1666.
50. Shafer N. Pneumothorax following "trigger point" injection. JAMA 1970, 213:1193.
51. Hong C.Z. Lidocaine injection versus Dry needling to myofascial trigger points. The importance of the local twitch response. Am J Phys Med Rehabil 1994, 73:256-263.
52. Hameroff S.R., Crago B.R., Blitt C.D., et al. Comparison of bupivacaine, etidocaine, and saline for trigger-point therapy. Anesth Analg 1981, 60:752-755.
53. Malanga G., Wolff E. Evidence-informed management of chronic low back pain with trigger point injections. Spine J 2008, 8:243-252.
54. Garvey T.A., Marks M.R., Wiesel S.W. A prospective, randomized, double-blind evaluation of trigger-point injection therapy for low-back pain. Spine 1989, 14:962-964.
55. Hong C.Z., Simons D.G. Response to treatment for pectoralis minor myofascial pain syndrome after whiplash. Journal of Musculoskeletal Pain 1992, 1:89-132.
56. Reilich P., Fheodoroff K., Kern U., et al. Consensus statement: botulinum toxin in myofascial [corrected] pain. J Neurol 2004, 251:136-138.
57. Borodic G.E., Acquadro M., Johnson E.A. Botulin toxin therapy for pain and inflammatory disorders: mechanisms and therapeutic effects. Expert Opin Investig Drugs 2001, 10:1531-1544.
58. Göbel H., Heinze A., Reichel G., et al. Efficacy and safety of a single botulinum type A toxin complex treatment (Dysport) for the relief of upper back myofascial pain syndrome: results from a randomized double-blind placebo-controlled multicentre study. Pain 2006, 125:82-88.
59. Cui M., Khanijou S., Rubino J., et al. Subcutaneous administration of botulinum toxin A reduces formalin-induced pain. Pain 2004, 107:25-33.
60. Ferrante F.M., Bearn L., Rothrock R., et al. Evidence against trigger point injection technique for the treatment of cervicothoracic myofascial pain with botulinum toxin type A. Anesthesiology 2005, 103:377-383.
61. Vernon H., Schneider M. Chiropractic management of myofascial trigger points and myofascial pain syndrome: a systematic review of the literature. J Manipulative Physiol Ther 2009, 32:14-24.
62. Furlan A.D., van Tulder M., Cherkin D., et al. Acupuncture and dry-needling for low back pain: an updated systematic review within the framework of the Cochrane Collaboration. Spine 2005, 30:944-963.
63. Itoh K., Katsumi Y., Hirota S., et al. Effects of trigger point acupuncture on chronic low back pain in elderly patients-a sham-controlled randomised trial. Acupunct Med 2006, 24:5-12.
64. Re L., Barocci S., Sonnino S., et al. Linalool modifies the nicotinic receptor-ion channel kinetics at the mouse neuromuscular junction. Pharmacol Res 2000, 42:177-182.