Among 283 consecutive admissions to a comprehensive pain center, 85 percent were assigned a primary organic diagnosis of myofascial syndromes (Fishbain et al., 1986). Recent reports indicate that myofascial pain syndromes are likely to be the major cause of pain that brings patients to chronic pain treatment centers.
Myofascial Pain Syndromes: How Common Are They? This appendix concentrates on myofascial pain syndromes because they now appear to be the most common and the least well understood of the three conditions.
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The examiner must know precisely what to look for, how to look for it, and then must actually be looking for it. In each case, the diagnosis would probably be missed on routine conventional examination. All three conditions presently require diagnosis by history and physical examination alone. None has a diagnostic laboratory or imaging test at this time. The other two are fibromyalgia or fibrositis, and articular dysfunction. Myofascial trigger points are one of three musculoskeletal dysfunctions that are commonly overlooked and deserve particular attention.
As indicated in Chapter 10, the concept of myofascial trigger points is controversial and was the subject of debate by the committee. The author, who was a member of the Institute of Medicine study committee, is one of the foremost proponents of the concept of trigger points in myofascial pain syndromes and a pioneer in developing treatment methods based on this viewpoint. A description is offered here of the pathogenesis, diagnostic criteria, and treatment approaches to myofascial pain.