Myofascial and Referred Pain

Myofascial Pain Syndrome (MPS) is a musculoskeletal pain condition characterized by local and referred pain perceived as deep and aching, and by the presence of myofascial trigger points in any part of the body.

Few epidemiological studies have investigated the prevalence or incidence of myofascial trigger points. One study found that trigger points were the source of pain in 30% of patients consulting a primary care clinician for pain, and a second study reported that trigger points were the principal cause of pain in 85% of patients visiting a tertiary pain clinic. Different studies have demonstrated that myofascial trigger points are associated with several pain conditions, including migraine, tension-type headache, temporomandibular disorder, neck pain, shoulder pain, epicondylalgia, carpal tunnel syndrome, low back pain, pelvic pain, and whiplash syndrome.

Trigger points characteristically elicit referred pain when stimulated. The duration of the referred pain is variable (second, hours, or days). The referred pain is perceived as a deep, aching, and burning pain, although sometimes it may be perceived as superficial pain. The referred pain may spread caudally or cranially, with the intensity and expanded area of referred pain being positively correlated with the degree of trigger point activity (irritability).

The diagnosis and treatment myofascial trigger points is multimodal. The most commonly used interventions are as follows:

    • Trigger point dry Needling has shown clinical benefits
    • Exercise has shown moderate benefit and can include stretching and range of motion, strengthening, endurance, or coordination exercises.
    • Massage, ischemic compression, pressure release, and other soft tissue interventions (such as muscle energy) have shown moderately strong evidence for immediate pain relief.


1. Fernández de las Peñas C, Cuadrado ML, Arendt-Nielsen L, Simons DG, Pareja JA. Myofascial trigger points and sensitisation: an updated pain model for tension type headache. Cephalalgia 2007;27:383–93.

2. Simons D, Travell J, Simons P. Travell & Simons’ myofascial pain & dysfunction: the trigger point manual. Baltimore: Williams & Wilkins; 1999.

3. Tough EA, White AR, Cummings TM, Richards SH, Campbell JL. Acupuncture and dry needling in the management of myofascial trigger point pain: a systematic review and meta-analysis of randomised controlled trials. Eur J Pain

4. Vernon H, Schneider M. Chiropractic management of myofascial trigger points and myofascial pain syndrome: a systematic review of the literature. J Manipulative Physiol Ther 2009;32:14–24.