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Critical Reviews™ in Physical and Rehabilitation Medicine
Research on Myofascial Pain Syndrome
Department of Physical Therapy, Hungkuang University, Taichung, Taiwan
Myofascial trigger point (MTrP) is the major cause of myofascial pain syndrome. On the basis of recent studies on both human and animal subjects, the pathophysiology of MTrP has been better understood. There are multiple sensitive loci in an MTrP region that are sensitized nociceptors in the vicinity of dysfunctional endplates. The irritability of an MTrP depends on the amount of sensitized nociceptors in the MTrP region. Stimulation of the sensitive locus can cause pain, referred pain, and local twitch response. As a result of excessive leakage of acetylcholine in the dysfunctional endplate, sarcomeres in this endplate region become shortened, which can cause taut band formation and elicit an energy crisis that perpetuates the vicious cycle train of "excessive acetylcholine leakage"-"increase of tension in taut band"-"release of sensitizing painful substance." Interruption of this cycle can inactivate the MTrP. However, the most important strategy to treat myofascial pain is to identify and treat the underlying etiological lesion that activates the MTrP. Effective methods that can inactivate an MTrP include stretching, deep-pressure massage, laser therapy, and needling.
KEY WORDS: energy crisis, myofascial trigger points, needling, nociceptors, referred pain, sensitization
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