Myofascial Pain Syndrome: A Nociceptive Condition Comorbid with Neuropathic or Nociplastic Pain
Myofascial pain syndrome is featured by the presence of myofascial trigger points (TrPs). Whether TrPs are primary or secondary phenomena or if they relate to central or peripheral nervous system disorders is controversial. Referred pain, a cardinal sign of TrPs, is a central phenomenon driven by pe...
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MDPI AG
2023-03-01
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| Online Access: | https://www.mdpi.com/2075-1729/13/3/694 |
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| author | César Fernández-de-las-Peñas Jo Nijs Barbara Cagnie Robert D. Gerwin Gustavo Plaza-Manzano Juan A. Valera-Calero Lars Arendt-Nielsen |
| author_facet | César Fernández-de-las-Peñas Jo Nijs Barbara Cagnie Robert D. Gerwin Gustavo Plaza-Manzano Juan A. Valera-Calero Lars Arendt-Nielsen |
| author_sort | César Fernández-de-las-Peñas |
| collection | DOAJ |
| description | Myofascial pain syndrome is featured by the presence of myofascial trigger points (TrPs). Whether TrPs are primary or secondary phenomena or if they relate to central or peripheral nervous system disorders is controversial. Referred pain, a cardinal sign of TrPs, is a central phenomenon driven by peripheral input. In 2021, the International Association for the Study of Pain (IASP) proposed a clinical criteria and grading system for classifying patients with pain on nociceptive, neuropathic, or nociplastic phenotypes. Myofascial TrP pain has been traditionally categorized as a nociceptive phenotype; however, increasing evidence supports that this condition could be present in patients with predominantly nociplastic pain, particularly when it is associated with an underlying medical condition. The clinical response of some therapeutic approaches for managing TrPs remains unclear. Accordingly, the ability to classify myofascial TrP pain into one of these phenotypes would likely be critical for producing more successful clinical treatment outcomes by a precision medicine approach. This consensus paper presents evidence supporting the possibility of subgrouping individuals with myofascial TrP pain into nociceptive, nociplastic, or mixed-type phenotype. It is concluded that myofascial pain caused by TrPs is primarily a nociceptive pain condition, is unlikely to be classified as neuropathic or nociplastic, but can be present in patients with predominantly neuropathic or nociplastic pain. In the latter cases, management of the predominant central pain problem should be a major treatment goal, but the peripheral drive from TrPs should not be ignored, since TrP treatment has been shown to reduce sensitization-associated symptomatology in nociplastic pain conditions, e.g., fibromyalgia. |
| first_indexed | 2024-03-11T06:17:17Z |
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| issn | 2075-1729 |
| language | English |
| last_indexed | 2024-03-11T06:17:17Z |
| publishDate | 2023-03-01 |
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| record_format | Article |
| series | Life |
| spelling | doaj.art-7428c1ace3124241a98f8efec07ed5d52023-11-17T12:11:05ZengMDPI AGLife2075-17292023-03-0113369410.3390/life13030694Myofascial Pain Syndrome: A Nociceptive Condition Comorbid with Neuropathic or Nociplastic PainCésar Fernández-de-las-Peñas0Jo Nijs1Barbara Cagnie2Robert D. Gerwin3Gustavo Plaza-Manzano4Juan A. Valera-Calero5Lars Arendt-Nielsen6Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), 28922 Madrid, SpainPain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1050 Brussel, BelgiumDepartment of Rehabilitation Sciences, Ghent University, 9000 Ghent, BelgiumDepartment of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USADepartment of Radiology, Rehabilitation and Physiotherapy, Complutense University of Madrid, 28040 Madrid, SpainDepartment of Radiology, Rehabilitation and Physiotherapy, Complutense University of Madrid, 28040 Madrid, SpainCenter for Neuroplasticity and Pain (CNAP), Sensory Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, DenmarkMyofascial pain syndrome is featured by the presence of myofascial trigger points (TrPs). Whether TrPs are primary or secondary phenomena or if they relate to central or peripheral nervous system disorders is controversial. Referred pain, a cardinal sign of TrPs, is a central phenomenon driven by peripheral input. In 2021, the International Association for the Study of Pain (IASP) proposed a clinical criteria and grading system for classifying patients with pain on nociceptive, neuropathic, or nociplastic phenotypes. Myofascial TrP pain has been traditionally categorized as a nociceptive phenotype; however, increasing evidence supports that this condition could be present in patients with predominantly nociplastic pain, particularly when it is associated with an underlying medical condition. The clinical response of some therapeutic approaches for managing TrPs remains unclear. Accordingly, the ability to classify myofascial TrP pain into one of these phenotypes would likely be critical for producing more successful clinical treatment outcomes by a precision medicine approach. This consensus paper presents evidence supporting the possibility of subgrouping individuals with myofascial TrP pain into nociceptive, nociplastic, or mixed-type phenotype. It is concluded that myofascial pain caused by TrPs is primarily a nociceptive pain condition, is unlikely to be classified as neuropathic or nociplastic, but can be present in patients with predominantly neuropathic or nociplastic pain. In the latter cases, management of the predominant central pain problem should be a major treatment goal, but the peripheral drive from TrPs should not be ignored, since TrP treatment has been shown to reduce sensitization-associated symptomatology in nociplastic pain conditions, e.g., fibromyalgia.https://www.mdpi.com/2075-1729/13/3/694myofascial paintrigger pointsnociceptive painnociplastic painmusculoskeletal painprecision medicine |
| spellingShingle | César Fernández-de-las-Peñas Jo Nijs Barbara Cagnie Robert D. Gerwin Gustavo Plaza-Manzano Juan A. Valera-Calero Lars Arendt-Nielsen Myofascial Pain Syndrome: A Nociceptive Condition Comorbid with Neuropathic or Nociplastic Pain Life myofascial pain trigger points nociceptive pain nociplastic pain musculoskeletal pain precision medicine |
| title | Myofascial Pain Syndrome: A Nociceptive Condition Comorbid with Neuropathic or Nociplastic Pain |
| title_full | Myofascial Pain Syndrome: A Nociceptive Condition Comorbid with Neuropathic or Nociplastic Pain |
| title_fullStr | Myofascial Pain Syndrome: A Nociceptive Condition Comorbid with Neuropathic or Nociplastic Pain |
| title_full_unstemmed | Myofascial Pain Syndrome: A Nociceptive Condition Comorbid with Neuropathic or Nociplastic Pain |
| title_short | Myofascial Pain Syndrome: A Nociceptive Condition Comorbid with Neuropathic or Nociplastic Pain |
| title_sort | myofascial pain syndrome a nociceptive condition comorbid with neuropathic or nociplastic pain |
| topic | myofascial pain trigger points nociceptive pain nociplastic pain musculoskeletal pain precision medicine |
| url | https://www.mdpi.com/2075-1729/13/3/694 |
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