International Journal of Physical Medicine & Rehabilitation
Open Access
ISSN: 2329-9096
+44 1300 500008
ISSN: 2329-9096
+44 1300 500008
Areerat Suputtitada
Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thailand
Scientific Tracks Abstracts: Int J Phys Med Rehabil
Myofascial pain syndrome (MPS) is a major musculoskeletal pain that occur in every age group, and has been associated
with numerous pain conditions including radiculopathies, osteoarthritis, disc syndrome, tendonitis, migraines, tension
type headaches, computer- related disorders, spinal dysfunction, and pelvic pain. Myofascial pain is identified by palpating
skeletal muscle for myofascial trigger points (MTrPs). A MTrP is classically defined by Professor Janet G Travell and Professor
David G Simons as "a hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut
bandâ??â??. Although the specific pathophysiological basis of MTrPs development and symptomatology is unknown, there are
evidences of histological, neurophysiological, biochemical, and somatosensory abnormalities. These emerging findings suggest
that myofascial pain is a complex form of neuromuscular dysfunction consisting of motor and sensory abnormalities involving
both the peripheral and central nervous systems.
Sensitization in corresponding spinal segments plays a major role in the formation of continuous pain in a given part of the
body. The term called by Professor Andrew A. Fischer for this phenomenon is â??spinal segmental sensitizationâ? (SSS). SSS
is a hyperactive state of the spinal cord caused by irritative foci sending nociceptive impulses from a sensitized damaged
tissue to dorsal horn neurons. The clinical manifestation of dorsal horn sensitization includes hyperalgesia of the dermatome,
pressure pain sensitivity of the sclerotome and myofascial trigger points within the myotomes, which are supplied by the
sensitized spinal segment. There are significant elevated levels of substance P, calcitonin gene-related peptide (CGRP),
bradykinin, tumor necrosis factor-?± (TNF-?±) and interleukin-1?² (IL-1?²), serotonin, and norepinephrine in the vicinity of the
active myofascial trigger point. Overall, pH was significant lower in the active trigger point. The mechanism consists of the
nociceptive stimuli generated in the sensitized areas bombarding the dorsal horn of the spinal cord. This causes central nervous
system sensitization with resultant hyperalgesia of the dermatome and sclerotome and spreads from the sensory component
of the spinal segment to the anterior horn cells, which control the myotome within the territory of the SSS. The development
or amplified activity of MTrPs is one of the clinical manifestations of SSS. The Segmental Desensitization treatment consists
of injection of local anaesthetic agents in the involved dermatome to block the posterior branch of the dorsal spinal nerve
along the involved paraspinal muscles. Extracorporeal shockwave therapy (ESWT) and High Intensity Laser (HTL) also play
a role as desensitization. Prevention of recurrence should focus on appropriate ergonomic changes common in patientsâ?? dayto-
day activities to avoid repetitive stress to the injured muscles. In conclusion, MPS, a common pain syndrome consists of
local pathology and SSS. Hence therapeutic approaches require varieties of techniques for eradiation of trigger point and
desensitization of the whole related spinal segment.
Areerat Suputtitada, M.D. is Professor of Rehabilitation Medicine from Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand. She is the Director of Excellent Center for Gait and Motion at King Chualongkorn Memorial Hospital and Chairperson of Neurorehabilitation Research Unit of Chulalongkorn University. She has been involved in education, residency training, research, and clinical treatment related to rehabilitation medicine for more than 20 years. She was invited as international speaker more than 80 times around the world. She received 18 national and international awards, and published more than 60 national and international articles in several areas of Rehabilitation Medicine including Neurological Rehabilitation, Spasticity and Dystonia, Pain, Gait and Motion, and Sport and Exercise Medicine. She has been elected and appointed to important positions in the ISPRM such as the Chairperson of ISPRM Women and Health Task Force and ISPRM International Exchange Committee.
Email: prof.areerat@gmail.com