Melanie Cole, MS (Host): Welcome to Back to Health, your source for the latest in health, wellness and medical care, keeping you informed so you can make informed healthcare choices for yourself and your whole family. Back to Health features conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine.

I'm Melanie Cole. And joining me today to talk about myofascial pain syndrome is Dr. Tiffany Lin. She's an Assistant Professor of Clinical Anesthesiology at Weill Cornell Medical College, Cornell University. Dr. Lin, thank you so much for joining us today and for joining us again. So, tell us a little bit about myofascial pain syndrome. What is that?

Tiffany Lin, MD: Sure. Thanks for having me. Myofascial pain syndrome is a pain condition that originates from muscles and their surrounding fascia. It is actually very prevalent. It can occur to up to 85 percent of our population. It could be, you know, acute coming from a muscle injury or overuse activity or it could happen without any identifiable precipitating factor. Patients can have localized muscle pain or they can have referred pain in specific patterns. People can develop muscle weakness or decreased range of motion that are associated with tight bands or tight knots. And on exam, we can sometimes identify tight bands that are contracted muscle belly that can be palpated, or we can also identify trigger points that are marked tender spots that can aggravate local or refer pain by compression itself.

Melanie Cole, MS : So Dr. Lin, how do we know? You've mentioned the types of pain that we would feel. But symptoms, because we all feel a lot of different pain and pain is certainly somewhat subjective. So, how do we know what would send us to a physician to get this checked out?

Tiffany Lin, MD: Sure. So, like I said, most people present with just like muscle pain that can be localized or it can spread from like a focal point in like a specific pattern, but I would say what would trigger someone to go to see a physician would be that if that pain becomes more chronic or if, you know, you're doing your usual exercises, stretching and that doesn't help or if it's impacting your normal activities of daily living, impacting your functionality, I would say that's a time to seek, you know, medical attention. You can go to your primary care doctor or a pain doctor that can, one, help rule out any other causes of your pain and, two, refer you to the right therapist that can help with your pain.

Melanie Cole, MS : So then, how do you diagnose that it is myofascial pain syndrome and not something else like fibromyalgia?

Tiffany Lin, MD: Definitely. So, diagnosis is based on clinical signs and symptoms. Currently, there's no unifying diagnostic criteria for myofascial pain. But in general, we look for trigger points that are tender to palpation. When you palpate these trigger points, it can refer in a specific pattern, and sometimes you can also elicit a local twitch response in the muscle by either palpation or needling itself. There are some times we can use devices to help us localize these trigger points such as electromyography, that can pick up spontaneous electrical activities in these trigger points or sometimes ultrasound can also be used to help identify the muscles that can appear more hypoechoic on ultrasound. And that also helps us identify the muscles to treat sometimes during trigger point injections. At the same time, you also want to do your due diligence to rule out other causes of pain that can present very similarly. So, they could be arthritis, bursitis, any nerve entrapment, any trauma itself or any other forms of neuropathic pain and, like you elucidated, fibromyalgia.

Melanie Cole, MS : So, you've mentioned a few times trigger points. Tell the listeners what those are and how they're related to myofascial pain syndrome. What do they mean and how can they help even with treatment?

Tiffany Lin, MD: Yeah. So, trigger points are tender spots within a tight band that can, you know, aggravate local or referred pain. So basically, these are the points where there's sustained muscle contraction. And basically, the way myofascial pain syndrome it starts, is that essentially from various reasons, you can have a sustained contraction of muscle, and that can cut off circulation to the area, decrease oxygen delivery to the area. And essentially, that muscle becomes energy-deficient. And when you have that energy deficiency or energy crisis, the muscle is not able to relax, that can form a trigger point. At the same time, you also have inflammatory mediators that are secreted because of the local, ischemia or loss of circulation, and that can also cause pain and tenderness in the area.

Melanie Cole, MS : So then, if people are suffering from this type of pain, tell us about some of the treatment options that are available. Explain the role of physical therapy, lifestyle changes, stress reduction. There are many causes of pain as you've said, but some of these lifestyle changes and therapies can really help, can't they?

Tiffany Lin, MD: Yeah, definitely. The goal of the treatment is to help with pain relief and correct any precipitating factors that can cause myofascial pain. So, a few things that can cause Myofascial pain, one, it could be an injury itself; two, it could be an ergonomic issue where you're maybe overusing your muscle by lifting heavy objects repeatedly or any ongoing repetitive activities. People can also have abnormal posture or deconditioned muscle. Muscle fatigue can also contribute to development of trigger points. Some patients have scoliosis and spine disease that are structural factors that cause myofascial pain syndrome. Other things such as hypothyroidism, vitamin D deficiency, iron deficiency can also contribute. And like you mentioned, psychological stress, sleep deprivation, any kind of other chronic pain symptoms can kind of ramp up someone's central nervous system for them to be more sensitized to myofascial pain syndrome. So, the first thing, the most important thing is education, identifying factors that are causing your myofascial pain syndrome, and addressing those things specifically.

The next step, you know, physical therapy is very important and ergonomic modification, stretching and strengthening exercises. They can help with myofascial release to break up those pathologic fascial adhesions to reduce muscle tightness and stiffness. They can also employ TENS unit, which is an electrical stimulation, that helps relax the muscle itself. Laser therapy has also been helpful in increasing circulation to the muscle and help relaxing the muscle by delivering that energy that it needs. Biofeedback is also very important, especially for someone who has psychological stress or like have coping issues with pain. With biofeedback, patients can receive real-time feedback on heart rate or muscle tone, and that can help them adjust their behavior and remind them how to relax.

Other than that, medication-wise, we can prescribe anti-inflammatories or muscle relaxants to help pharmacologically. Local anesthetics like a lidocaine patch is also helpful. Nowadays, cannabis can also help with muscle relaxation, whether it's in oral form, inhalational or topical form. For our clinic, we are an interventional clinic. So, we also provide trigger point injections and even Botox injections to help with patients who have persistent myofascial pain despite doing physical therapy and using medications.

Melanie Cole, MS : So, there are so many tools in your toolbox, Dr. Lin, to help people with these types of pain syndromes. How long does that usually take? Tell us a little bit about if we are somebody who suffers from this pain and we start these therapies and we try all these things you've mentioned, how long until we see some results. And also, while you're telling us that, give us your best advice for whether or not we can prevent it. You've mentioned stress reduction and lifestyle modifications, but are there things that we can do so that we maybe don't come up with it in the first place?

Tiffany Lin, MD: I think it's important to not let this become a chronic issue, just because the longer someone's in pain, the more sensitized your body becomes. Being proactive in terms of addressing your lifestyle, you know, managing your stress, participating in physical therapy, that all can prevent an acute episode from developing into a chronic one.

 in terms of duration of treatment that we need, it really depends on how long you've been in pain. So, we always say it's easier to address something when it's in acute phase. When the pain becomes more chronic, it can take a long time. And I do think it's a lifestyle adjustment, a lifetime kind of learning how to deal with your body, how to live with it. We cannot guarantee that your pain is going to go back down to zero, but our goal is to get you to the point where you're going to be functionally able to do what you need to do for a daily living.

For certain treatments such as, you know, trigger point injections and Botox injections, they can have pretty, you know, immediate relief. But everything that we do in terms of injection is just kind of like symptom management. What's really going to help you over the long term is still continuing to do your exercise or stretching, you know, reducing stress and lifestyle modification.

I do think two most important things that you can do to prevent the pain from coming back or prevent the pain from becoming chronic in the first place, exercise is very important, exercise can increase your endorphins in your body that help overcome stress and chronic pain. It can help maintain muscle mass, achieve a healthy weight and, same thing, stress management is very important. Stress can also cause muscle ache and fatigue, so meditation, relaxation techniques, all these things can really help keep your nervous system at bay and also your chronic pain at bay.

Melanie Cole, MS : Great information and advice. Dr. Lin, thank you so much for being such a great guest and really so informative on these types of pain syndrome that so many people suffer from, and there are treatment options out there. Thank you again. And Weill Cornell Medicine continues to see our patients in person as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine.

That concludes today's episode of Back to Health. We'd like to invite our audience to download, subscribe, rate and review Back to Health on Apple Podcasts, Spotify, and Google Podcasts. And for more health tips, go to weillcornell.org and search podcasts. And parents, definitely don't forget to check out our Kids Health Casts. There is so much great information there. I'm Melanie Cole. Thanks so much for joining us today.

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