New Frontiers in the Pathophysiology of Myofascial Pain
Myofascial trigger points (MTrPs) are a ubiquitous and highly underdiagnosed component of many acute and chronic pain complaints. However, they are also a common physical finding in asymptomatic individuals. This dichotomy challenges pain management practitioners to learn how to palpate the soft tissue and distinguish active from latent MTrPs. Making this distinction is critical in order to adequately identify and treat a myofascial component of pain. Despite the high prevalence, there are currently no imaging criteria for the diagnosis of MTrPs or for assessing the clinical outcome of treatments. Therefore, it remains a clinical diagnosis based exclusively on history and physical examination. Accordingly, there is a need to develop objective, repeatable and reliable diagnostic tests for evaluating MTrPs and determining treatment outcome measures. Such measures can be used to properly diagnose and understand the natural history of MTrPs. Future clinical research studies should focus on identifying the mechanisms responsible for the pathophysiology of myofascial pain. Successful treatment depends upon identifying and targeting these mechanisms and addressing the perpetuating factors that sustain this pain syndrome.
Faculty: Jay P. Shah, MD and Juliana Heimur, BA
This 30 minute CME activity is designed for all clinicians who treat chronic pain.
Upon completion of this activity, participants should be better able to:
- Examine the unique neurobiology of muscle pain and the dynamic interplay of muscle nociceptors and endogenous biochemicals in the initiation, amplification, and perpetuation of peripheral and central sensitization.
- Identify the referred pain patterns associated with painful MTrPs that are commonly encountered in clinical practice.
- Determine that the application of standard physical measures together with self-reports successfully distinguishes subjects with no pain from those with myofascial pain syndrome.
- Recognize how muscle pain preferentially actives limbic system structures, and how treatments such as “dry needling” can not only reduce pain, but may also improve mood, function and level of disability.
Jay P. Shah, MD, is a senior staff physiatrist in the Rehabilitation Medicine Department at the NIH Clinical Center in Bethesda, Maryland, and a Diplomate of the American Board of PM&R. Dr. Shah’s clinical research interests include investigating the biochemical milieu, viscoelastic properties, and blood flow characteristics of myofascial trigger points, as well as applying integrative approaches to the evaluation and management of neuromusculoskeletal pain and dysfunction. He lectures internationally on the mechanisms of chronic pain and myofascial pain and teaches workshops on examination and treatment techniques including acupuncture and dry needling. Jay was selected by the American Academy of Pain Management as the 2010 recipient of the Janet Travell Clinical Pain Management Award.
Contributions to the article also made by Juliana Heimur. Juliana Heimur is currently a medical student at Rowan University School of Osteopathic Medicine. She previously served as a research assistant within the Rehabilitation Medicine Department at the National Institutes of Health in Bethesda, MD. Juliana received a B.A. from The George Washington University.
Staff and Content Validation Reviewer Disclosures
The staff involved with this activity and any content validation reviewers of this activity have reported no relevant financial relationships with commercial interests.
Planning Committee/Faculty Disclosure
Dr. Shah reports that he has nothing to disclose.
Juliana Heimur reports that she has nothing to disclose.
Debra Nelson-Hogan, Director of Education for the Academy of Integrative Pain Management, reports that she has nothing to disclose.
Cathleen Coneghen, Assistant Director of Education for the Academy of Integrative Pain Management, reports that she has nothing to disclose.
The information provided at this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a health care provider relative to diagnostic and treatment options of a specific patient’s medical condition.
For questions regarding CME for this activity, you may reach the department of education at the Academy of Integrative Pain Management at firstname.lastname@example.org.
For successful completion of this activity, please complete a pre-test; review the article information, and complete a post-test and evaluation following the activity. You will then be prompted to print your certificate. This activity should take approximately 30 minutes to complete.
This program is accredited for physicians, nurses, and psychologists. All other clinicians can submit the certificate of attendance upon completion of the program to their licensing boards for consideration of credit.
The American Academy of Pain Management is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The American Academy of Pain Management designates this educational activity for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
The American Academy of Pain Management is approved by the California Board of Registered Nursing, Provider Number CEP 15881 for 0.5 contact hour.
The American Academy of Pain Management is approved by the American Psychological Association to sponsor continuing education for psychologists. The American Academy of Pain Management maintains responsibility for this program and its content.
The Academy designates this activity for a maximum of 0.5 CE credit.
- 0.50 AMA PRA Category 1 Credit(s)™
- 0.50 APA
- 0.50 Document of Attendance
- 0.50 Nursing Credit