A 45-Year-Old Man with Chronic Neck Pain of Insidious Onset

Abstract

Musculoskeletal (MSK) pain complaints are one of the most common reasons people present to healthcare providers. Among the myriad of etiologies surrounding MSK pain, myofascial pain syndrome proves to be one of the most difficult for physicians to diagnose and treat. Pain originates from either the muscle or the facial covering of the muscle. Travell and Simon originally defined it as a localized pain originating from a muscle accompanied by a trigger point and/or a characteristic non-dermatomal referral pattern. It often leads to reduce levels of activity, range of motion, and perceived strength. Chronic myofascial pain has been associated with depression and anxiety. Myofascial pain is a common complaint which has been reported to have a lifetime prevalence affecting up to 85% of the general population. The exact pathology of myofascial pain is still unknown, but it is often a multifaceted syndrome. A thorough history with special attention to occupational and postural risk factors, time progression of symptoms, alleviating and aggravating factors, and quality and characteristics of the pain is important for proper management. Physical exam is a crucial part of the diagnosis to identify the correct muscles and to guide management and interventions. Myofascial pain is most commonly associated with myofascial trigger points which are target of many interventions. Management starts with conservative measures such as oral analgesics and physical therapy, and progresses toward more invasive measures like dry needling and ultrasound guided trigger point injections. These interventions must be accompanied by addressing the underlying cause of the myofascial pain syndrome, which may be structural, environmental, or psychological.