Chronic pain lasts more than 3 months. Patients with chronic pain, unlike patients with acute pain, develop specific psychological problems associated with persistent pain. These problems, in turn, can provoke the progression of the pain syndrome and nullify all efforts to restore the patient’s ability to work. Doctors often underestimate the importance of psychological and social factors in the development of chronic pain and do not pay due attention to them when planning chronic pain treatment. Therefore, a patient with chronic pain needs a comprehensive bio psychosocial approach.
One of the most common types of chronic pain is myofascial pain, which is caused by dysfunction of a particular muscle and its fascia, the sheath that connects bones, organs, and blood vessels throughout the body. Such a condition can cause degeneration of certain areas of the fascia and transform into chronic pain and a host of other symptoms.
The main manifestation of such pain is discomfort and discomfort in a particular muscle, which can be triggered by pressure on the so-called trigger point.
Trigger points (TPs) are areas of increased sensitivity and soreness within muscles that, when pressed, because pain in another part of the body – the so-called “reflected” pain.
The presence of myofascial pain drastically reduces the patient’s quality of life and may be one of the reasons for the development of such conditions as:
- Chronic pain in the lower back, neck, pelvic region, etc.
- Sleep disorders
- Tension headache
- Headaches and facial pains after the installation of braces at dentists
- Neuroses and neurosis-like states
- “Office” syndrome
- Pain syndromes with all kinds of posture disorders (scoliosis, flat feet, etc.)
Treatment for myofascial pain:
1. Manual therapy
By influencing the motor stereotype with soft myofascial methods of manual therapy, you can achieve a quick effect and get rid of this type of pain.
2. Therapeutic blockade
A therapeutic blockade is a procedure used to eliminate painful areas in the muscles that contain trigger points. Most often, blockades (injections) into the
Muscles are carried out using local anesthetics (Novocain, lidocaine), but it can also be carried out with a “dry” needle in the presence of allergic reactions.
3. Stretching and use of cooling sprays
The method consists in spraying a cooling spray on the muscle with the presence of TT and its gentle stretching.
4. Medical treatment
The main goal of prescribing medications for patients with myofascial syndrome is to reduce pain and prevent its chronicity, which can lead to sleep disorders and a number of other disorders of the nervous system. Taking medications on your own is not always effective and can even be harmful, so medications should be taken under the supervision of a neurologist.
4. Exercise therapy
The main goal of physical therapy is to restore the balance between the muscles working as a single mechanism. At the initial stage, the rehabilitation doctor needs to reduce pain, which is achieved by using manual therapy methods, therapeutic massage and prescribing appropriate drugs. An integral part of exercise therapy is the formation of the correct motor stereotype and posture by teaching special exercises.
5. Improve posture and ergonomics
Incorrect posture at the desk, special motor patterns in patients with myofascial pain may be a key moment in the development of such disorders. The discovery of additional factors in the ergonomics of the patient’s workplace that influence the formation of chronic myofascial pain can cause a “dramatic” effect in the treatment of such problems. Detailed instructions for changing motor stereotypes can be obtained from a neurologist.
6. Injections of botulinum toxin preparations
In resistant cases, it is possible to introduce these drugs into the zones of muscle hyper tonicity, which causes prolonged muscle relaxation and increases the effectiveness of the treatment of chronic pain syndrome.
Biofeedback is a therapeutic psychological technique in which the patient learns to understand and control the reactions of his body, such as blood pressure, muscle tension, heartbeat and nerve impulses.
A radically different variety is neuropathic pain that occurs when the somatosensory nervous system is damaged or diseased, i.e. is directly related to the involvement of structures related to the conduction, perception and modulation of pain. Neuropathic pain can be caused by damage to both peripheral structures (spinal roots, plexuses, individual nerves, or polyneuropathy) and structures of the central nervous system.