A critical evaluation of the trigger point phenomenon
Muscle pain and tenderness in the absence of obvious disease are clinical phenomena that are well recognized but poorly understood. The theory of Myofascial Pain Syndrome (MPS) caused by Trigger Points (TrPs) seeks to explain these phenomena. Many clinicians have accepted this diagnosis and its system of treatment with perhaps limited strength of evidence to support the proposed theories.
This article critically evaluates the evidence for the existence of these theories. It raises issues like, poor inter-examiner reliability and poor methodological quality for making the diagnosis of MPS, the involvement of central mechanism as supposed to the theory which mainly relies on local pathophysiology and issues with the effectiveness of TrPs above other interventions. It argues that clinicians cannot ignore the importance of contextual factors when evaluating the outcomes of their treatment for MPS.
Without denying the clinical phenomena themselves, the authors reject the current hypotheses of MPS and TrPs. Instead, it suggests neuroscientific hypotheses to explain the clinical phenomena for the theories outlined, neither of which relies on local pathophysiology. The authors demand a robust and plausible explanation for the pain perceived by patients as coming from their muscles, based on neurobiology of nociception and pain.
> From: Quintner et al., Rheumatology (Oxford) (2014) (Epub ahead of print). All rights reserved to The British Society for Rheumatology. Click here for the Pubmed summary.