Myofascial Pain Dysfunction Syndrome- Causes, Symptoms, Diagnosis and Management

Introduction

The myofascial system consists of contractile muscle tissue and connective tissue. The myofascial system can provide symptomatic presentations that are not necessarily distinct and simple to frame, which can lead to discomfort and functional restrictions. Myofascial pain is a regional musculoskeletal pain characterized by strong, hypersensitive muscle trigger points. It is frequently accompanied by referred pain, which resembles a tension headache. Trigger points are firm knots within muscles that are more tender to the touch than the surrounding tissues. It is characterized by the existence of a tight band that can be felt inside the muscle tissue and is typically present in all types of muscles, whether superficial or deep. This tight band may be easily felt with practice and expertise.

What Is Myofascial Pain Dysfunction Syndrome?

It is a disorder characterized by masticatory and associated muscle pain and dysfunction. Although myofascial pain dysfunction syndrome is not life-threatening, treatment significantly improves the patient's quality of life. Unfortunately, constant pain disrupts patients' day-to-day activities, leading them to seek the best treatments only to relieve pain. It primarily affects women aged 15 to 40 and manifests unilaterally in the head and neck region. Pain can range from mild to unbearable and is strongly linked to emotional stress.

What Are the Causes of Myofascial Pain Dysfunction Syndrome?

• Heightened emotional and mental stress (there are neurotic and muscular contractions leading to pain).

• Sleep disturbances (It can cause increased and sustained muscular contractions).

• Poor posture.

• Bruxism (jaw clenching while sleeping) biting foreign objects, such as pens, and continuous chewing of gum.

• Jaw thrusting.

• Malocclusion (irregular teeth).

• Repetitive muscle trauma or injuries to the tissues.

• Sleeping on the stomach with the forearm supporting the jaw.

• Chronic fatigue and viral infections.

• Nutritional deficiencies.

• Other causes include degenerative joint disorders, rheumatoid arthritis (inflammatory joint condition), ankylosis (fusion of jaw bone), dislocations, neoplasia (a type of cancer), and congenital anomalies.

What Are the Symptoms of Myofascial Pain Dysfunction Syndrome?

Most patients would complain of pain at the referred sites rather than at the source of pain, i.e., the trigger points. The pain is usually unilateral (one-sided), dull, and throbbing, with tender masticatory muscles on palpation. Pain is usually felt around the ear and radiates to the same side of the head. Other symptoms include limited, deviated, and slow mandibular movements and clicking sounds in the jaw joint. It is sometimes associated with ear pain, shoulder pain, and dizziness. Pain is reported to worsen by nervousness, speaking, chewing, and yawning. According to studies, the pain becomes more severe during times of stress. It can sometimes cause masticatory muscle hypertrophy, which manifests as facial swelling.

How Is Myofascial Pain Dysfunction Syndrome Diagnosed?

For a better understanding, the patient should describe and elaborate on their symptoms. But, again, history and examination are crucial in determining treatment options.

1. Visual examination of the head and neck.

2. Oral examination (a thorough dental examination).

3. Muscular examination (palpation of individual masticatory muscles).

4. Cervical examination (shoulder and neck muscles are palpated).

5. Temporomandibular sounds on assessment and palpation around the joint.

6. Assessment of the mandibular movement evaluating mouth opening, and associated symptoms such as pain while opening.

7. Radiographic examination:

   • To rule out intra-articular pathologies, skeletal pathologies, and soft tissue pathologies.

   • To detect erosions in the bony articular surface and changes in joint spaces, X-ray (panoramic radiography) and CT are used. Soft tissue abnormalities such as discs, capsules, and temporomandibular joint ligaments are assessed using magnetic resonance imaging (MRI).

8. Psychological assessment: Screening the patient for psychological symptoms such as:

   • Anxiety.

   • Depression.

   • Poor sleep.

   • Poor dietary habits.

   • Anger.

   • Fear.

   • Frustration.

   • Medication dependencies.

How Is Myofascial Pain Dysfunction Syndrome Treated?

Because myofascial pain dysfunction syndrome has complex causes, it is important to list the issues that may contribute to it. The most important treatment modality is patient counseling, which includes providing assurance about pain relief and planning symptomatic pain relief. For long-term results, treatment options can be ruled out further.

1. Physiotherapeutic Modalities

   • Heat Application - Heat helps relax muscles by widening blood vessels, which increases blood flow.

   • Use of Vapocoolant Spray - Ethyl chloride spray is sprayed on the affected area, and the muscle in the affected region is gently stretched.

2. Occlusal Adjustments - Dental malocclusion can be orthodontically treated.

3. Stress Management:

   • The biofeedback technique teaches the patient how to relax daily to keep the muscles and TMJ in perfect harmony.

   • Deep breathing relaxation exercises.

   • Meditation.

4. Occlusal Splint Therapy:

   • Soft splints made of polyvinyl are worn at night. It may serve as a habit-breaker and protect the occlusal surfaces of the teeth.

   • Splints are used to create balanced joint-tooth stabilization of the mandible and reduce muscle hyperactivity.

   • Overusing the splint can also worsen the condition by causing open bites, tooth intrusion, loss of occlusal contact, and worsening symptoms. The diagnosis and treatment plan should be reviewed if the patient does not feel better after three months.

5. Muscle Therapies:

   • Muscle stretching exercises.

   • Non-invasive muscle treatments include ice packs, hot and cold compression, etc.

   • Trigger point injections with a local anesthetic, saline, and steroids.

6. Drugs:

   • Non-steroidal anti-inflammatory drugs (NSAIDs).

   • Opioids and narcotic analgesics.

   • Antidepressants.

   • Muscle relaxants.

7. Botulinum Toxin Injections - By weakening muscles and affecting nerves, the botulinum toxin relaxes muscles.

8. Self-Care Practices - Relaxation techniques, cognitive behavioral treatment, psychological counseling.

9. Surgical Treatments:

   • Intra-Articular Injections - If the primary cause of pain is inflammation in and around the joints, hydrocortisone injection can be given monthly and according to the symptoms.

   • Arthroscopy - The jaw joint cavity is visualized using the fiberoptic endoscope, decisions are made, and treatments are done if there are any abnormalities in the joint cavity.

   • Arthrocentesis - The jaw joint cavity is irrigated using a Ringer Lactate solution to improve mobility and eliminate infection and pain.

   • Other Open Joint Surgeries:

     • Condylectomy - Excision of condyle if the patient has multiple and mixed complications.

     • Arthroplasty - Removing and recontouring of articular surfaces of the bone.

     • Disc Surgery - Disc replacement using grafts.

Conclusion

Treatments and symptom resolution are dependent on an accurate diagnosis and treatment options. As a result, the emphasis should be on history and examination for an accurate diagnosis and treatment. In addition, treatment modalities must be combined with psychological treatments because most studies show a strong link between myofascial pain dysfunction syndrome and psychological stress.