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E u r o S c i C o n E v e n t o n
Nursing Diagnosis &
Midwifery
Journal of Nursing and Health Studies
ISSN: 2574-2825
S e p t e m b e r 1 0 - 1 1 , 2 0 1 8
P r a g u e , C z e c h R e p u b l i c
Nursing Diagnosis & Midwifery 2018
Page 22
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, pelvic
pain and pain during pregnanacy. Myofascial pain is identified by palpating skeletal muscle for myofascial trigger points (MTrPs). An
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 band’’ Although the specific pathophysiological basis of MTrPs
development andsymptomatology isunknown, thereareevidencesof histological, neurophysiological, biochemical, andsomatosensory
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 “spinal segmental sensitization” (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-α (TNF-α) and interleukin-1β (IL-1β), 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 themyotomewithin the territory of theSSS.Thedevelopment or amplifiedactivity
of MTrPs is one of the clinical manifestations of SSS. The Segmental Desensitization treatment consists of injection of local anesthetic
agents in the involved dermatome to block the posterior branch of the dorsal spinal nerve along the involved paraspinal muscles. In
addition, local anesthetic injection is applied peripherally near the foci of irritation in local soft tissue, directly into taut bands and trigger
points, using a needling and infiltration technique. Stretching exercises, local heat application and additional transcutaneous electrical
nerve stimulation (TENS) treatment complete the muscular relaxation after the injections. 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 patients’ day-to-day activities to avoid repetitive stress to the injuredmuscles. 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, Therapeutic exercises and proper postures during daily activities are
important for prevention of recurrence.
Biography
Areerat Suputtitada is Professor of Rehabilitation Medicine, full time working faculty at Chulalongkorn University and King Chulalongkorn Memorial Hospital in Bangkok, Thailand.
She received 14 national awards, 7 international awards, and published more than 60 international and 20 national articles in the areas of her experts including neurological
rehabilitation,spasticityanddystonia,gaitandmotion,andPain.Shehasalsobeen invitedto lectureasthekeynotespeakers,parallelandsymposiumspeakersandbechairpersons
for over 100 international conferences.
Myofascial pain syndrome and
sensitization in nursing care
Areerat Suputtitada
Chulalongkorn University and King Chulalongkorn Memorial
Hospital, Thailand
Areerat Suputtitada, J Nurs Health Stud 2018 Volume: 3
DOI: 10.21767/2574-2825-C4-010