Expertconsensusonthediagnosisandtreatmentofmyofascialpainsyndrome

Myofascial pain syndrome (MPS) is a chronic pain condition that affects muscles, fascia, and related soft tissues, characterized by myofascial trigger points (MTrPs) and fascial constrictions. Despite being first described by Dr. Travell in 1952, MPS remains poorly understood and frequently misdiagnosed. A major challenge is that no universally accepted diagnostic criteria exist, partly because there are no specific laboratory markers or definitive imaging findings.

This lack of standardization means MPS is often confused with conditions like fibromyalgia, polymyalgia rheumatica, chronic fatigue syndrome, and polymyositis. In response, the Chinese Association for the Study of Pain convened a panel of domestic experts to develop a consensus document aimed at normalizing how MPS is diagnosed and treated across clinical settings, particularly for frontline physicians including pain specialists.

The expert panel conducted a comprehensive review of domestic and international literature on MPS covering its definition, epidemiology, pathogenesis, clinical manifestations, diagnostic criteria, and treatments. The consensus was developed through expert collaboration rather than a formal systematic review or meta-analysis. The resulting document provides detailed recommendations organized into several domains: etiology and risk factors, epidemiological context, proposed pathophysiological mechanisms, clinical signs and symptoms, diagnostic criteria with required versus auxiliary components, differential diagnosis from related conditions, and a broad overview of therapeutic options. The treatment section covers physical rehabilitation therapies (extracorporeal shock wave, electrotherapy, phototherapy, magnetic therapy, manipulation, stretching, kinesiology tape), pharmacological approaches (NSAIDs, antidepressants, ion channel regulators, muscle relaxants, opioids), needle-based interventions (acupuncture, silver needle puncture, acupotomy, internal heated needle, dry needling), injection techniques (local anesthetic, corticosteroids, botulinum toxin, oxygen-ozone), radiofrequency treatments (thermal coagulation and pulsed RF), and psychological interventions with patient education.

The consensus reports that MPS affects approximately 30.0% to 93.0% of patients with musculoskeletal pain, with about 46.1% of patients showing active MTrPs on physical examination. At least 40.0% of skeletal muscle pain syndromes are attributed to activated trigger points. The condition is most common in the neck, shoulders, and back. The expert panel identified predisposing factors (acute muscle injury, mental stress, overfatigue, insufficient sleep, intense cooling of muscles) and risk factors (hormonal changes, nutrient deficiencies, chronic infection, biomechanical instability, immune diseases).

For diagnosis, the consensus establishes that pathogenic factors or history plus clinical manifestations (pain, stiffness, movement limitation, MTrPs, tenderness) are compulsory, while imaging and specialized examinations are auxiliary. The document differentiates MPS from fibromyalgia syndrome based on several features: MPS has a 2:1 female-to-male ratio versus 10:1 for FMS, localized rather than generalized pain, presence of referred pain and induration, complete relief with local anesthetic injection to MTrPs, and generally good prognosis versus difficult-to-cure FMS. For treatment, the consensus notes that acupuncture and dry needling show good total effective rates and satisfactory short-term pain relief, though long-term cure rates remain uncertain. Silver needle acupuncture is highlighted for high safety, simple operation, wide indications, and excellent long-term effectiveness.

Ultrasound-guided injections are emphasized for improving therapeutic success and reducing complications. Radiofrequency treatment parameters are specified: thermal coagulation at 75 °C for 15-30 seconds for areas without important nerves, and pulsed RF at 42 °C for 120 seconds for areas near important nerves.

This consensus provides a practical framework for clinicians, particularly in China but with broader applicability, to approach MPS more systematically. For patients, the key message is that MPS is common, treatable, and requires addressing underlying causes and triggers rather than just symptoms. The emphasis on removing etiological factors first is important—without this, treatments may fail. The document supports a stepped-care approach: patients with short disease duration and mild symptoms can start with rehabilitation and physical therapy, while those with long-standing, widespread, or refractory symptoms may need more invasive interventions like silver needle acupuncture or radiofrequency ablation combined with psychological support.

The detailed technical specifications for interventions like RF treatment and botulinum toxin dosing (5 U per trigger point, 15-35 U total at 2-week intervals) provide practical guidance. The strong recommendation for ultrasound guidance in injections reflects growing evidence that precision improves outcomes and safety. For patients with chronic MPS, the inclusion of psychotherapy, cognitive-behavioral therapy, and health education acknowledges the biopsychosocial nature of persistent pain. The consensus also serves an important educational function by helping patients and clinicians distinguish MPS from fibromyalgia, which have different prognoses and management approaches.