More than five years after I felt my first symptoms, two years after I received my diagnosis of myofascial pain syndrome, and a year after I finally resolved my remaining pelvic pain, The Washington Post published my article on myofascial pain in the Health and Science section on June 18, 2013. Myofascial pain and the strange bladder symptoms it triggered had dominated my life for years, limiting my diet, my exercise, my work, my travel and my social life as I searched for answers about what was happening to my body. I wrote the article so that others don’t have to experience the confusion and frustration that I did. At only 1,500 words, it can’t describe every symptom that someone with myofascial pain – and in particular pelvic pain – experiences, or outline all the treatment options available. But I hope my article prompts perplexed patients and their practitioners to seek out more information and find answers quickly. As a starting point, I include some references below.
In particular, patients experiencing symptoms such as bladder pain and urinary frequency and urgency might be interested in Dr. David Wise’s book A Headache in the Pelvis, and his protocol for treatment described at http://www.pelvicpainhelp.com/. I attended Dr. Wise’s clinic in February 2012. By then, Dr. Timothy Taylor of Richmond VA had successfully treated the trigger points in my hips, thighs and backside with dry needling, taught me how to compress trigger points and stretch my muscles between treatments, and prescribed thyroid medication and vitamin D. With this treatment, most of my symptoms had disappeared or diminished, but the bladder irritation persisted. Dr. Wise’s protocol filled in the remaining gap. It focuses specifically on resolving trigger points in the pelvic floor that cause referred symptoms to the bladder, and includes a relaxation technique to help eliminate the clenching tendency that leads to chronic trigger points.
In the course of researching this article, I reviewed dozens of scientific papers on myofascial pain syndrome and pelvic pain and spoke with many experts. I’ve listed some of the scientific papers here for those interested in current understanding of the pathophysiology, diagnosis and treatment of myofascial pain. I hope to publish a longer magazine piece in coming months that tells more of the myofascial story, and why it’s so challenging to diagnose and treat this condition. In the meantime, my best wishes for successful healing to everyone who may be struggling with myofascial and pelvic pain.
American Physical Therapy Association. Description of Dry Needling.in Clinical Practice: An Educational Resource Paper. Produced by the APTA Public Policy, Practice and Professional Affairs Unit. February 2013.
Physical Therapists and the Performance of Dry Needling: An Educational Resource Paper. Produced by APTA Department of Practice and APTA State Government Affairs. January 2012.
Doggweiler, Ragi. Urologic myofascial pain syndromes. Current Pain and Headache Reports. Vol. 8:445-451. 2004.
Dommerholdt, Jan and Peter Huijbregts (eds). Myofascial Trigger Points: Pathophysiology and Evidence Informed Diagnosis and Management. Jones and Bartlett Publishers LLC, Sudbury Massachusetts. 2011.
Dommerholdt, Jan, Carel Bron, and Jo Frannsen. “Myofascial trigger points: an evidence informed review” in Myofascial Trigger Points: Pathophysiology and Evidence Informed Diagnosis and Management. Dommerholdt, Jan and Peter Huijbregts (eds). Jones and Bartlett Publishers LLC, Sudbury Massachusetts. 2011.
Fernandez-de-las-Peῇas, César, Lars Arendt-Nielson and David G. Simons. “Contributions of myofascial trigger points to chronic tension-type headache” in Myofascial Trigger Points: Pathophysiology and Evidence Informed Diagnosis and Management. Dommerholdt, Jan and Peter Huijbregts (eds). Jones and Bartlett Publishers LLC, Sudbury Massachusetts. 2011.
Gerwin, Robert D. “A review of myofascial pain and fibromyalgia – factors that promote their persistence.” Acupuncture in Medicine Vol. 23(3):121-134.2005.
Gerwin, Robert D. “Classification, epidemiology, and natural history of myofascial pain syndrome.” Current Pain and Headache Reports. Vol. 5:412-420.2001.
Gerwin, Robert D. “Myofascial pain syndrome: unresolved issues and future directions” in Myofascial Trigger Points: Pathophysiology and Evidence Informed Diagnosis and Management. Dommerholdt, Jan and Peter Huijbregts (eds). Jones and Bartlett Publishers LLC, Sudbury Massachusetts. 2011.
Gerwin, Robert D. “Myofascial and visceral pain syndromes: visceral-somatic pain representations.” Journal of Musculoskeletal Pain [The Haworth Medical Press, an imprint of The Haworth Press, Inc.] Vol. 10 (1/2):165-175. 2002.
Gerwin, Robert D., Jan Dommerholt, and Jay P. Shah. “An expansion of Simons’ integrated hypothesis of trigger point formation.” Current Pain and Headache Reports. 8:468–475. 2004.
Gerwin, Robert D., Steven Shannon, Chang-Zern Hong, David Hubbard, Richard Gevirtz. “Interrater reliability in myofascial trigger point examination.” Pain. Vol. 69:65–73. 1997.
Harden, R. Norman, Stephen P. Bruehl, Suzanne Gass, Claudia Miemiec, Brian Barbick. “Signs and symptoms of the myofascial pain syndrome: a national survey of pain management providers.” Clinical Journal of Pain. Vol. 16: 64-72. 2000.
Lucas, Nicholas, Petra Macaskil, Les Irwig, Robert Moran, Nikolai Bogduk. “Reliability of physical examination for diagnosis of myofascial trigger points: a systematic review of the literature. Clinical Journal of Pain. 2009. 25(1):80-89.
McEvoy, Johnson and Peter Huijbregts. “Reliability of myofascial trigger point palpation: a systematic review” in Myofascial Trigger Points: Pathophysiology and Evidence Informed Diagnosis and Management. Dommerholdt, Jan and Peter Huijbregts (eds). Jones and Bartlett Publishers LLC, Sudbury Massachusetts. 2011.
McPartland, John M. and David G. Simons. “Myofascial trigger points: translating molecular theory into manual rherapy” in Myofascial Trigger Points: Pathophysiology and Evidence Informed Diagnosis and Management. Dommerholdt, Jan and Peter Huijbregts (eds). Jones and Bartlett Publishers LLC. Sudbury Massachusetts. 2011.
Shah, Jay P. and Elizabeth A. Gilliams. Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: An application of muscle pain concepts to myofascial pain syndrome. Journal of Body Work and Movement Therapies. Vol. 12: 371-384. 2008.
Shah, Jay P., Terry M. Phillips, Jerome V. Danoff and Lynn H. Gerber. An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. J Appl Physiol 99: 1977–1984. 2005.
Sikdar, Siddartha, Jay. P. Shah, Tadesse Gebreah, Ru-Huey Yen, Elizabeth Gilliams, Jerome Danoff, Lynn H. Gerber. Novel Applications of Ultrasound to Visualize and Characterize Myofascial Trigger Points and Surrounding Soft Tissue. Arch Phys Med Rehabil Vol 90: 1829 -1838. 2009.
Skootsky SA, Jaeger B, Oye RK. “Prevalence of myofascial pain in general internal medicine practice.” Western Journal of Medicine. Vol. 151:157–160. 1989.
Tough, E.A, A.R. White, T.M. Cummings, S.H. Richards, J.L. Campbell.Acupuncture and dry needling in the management of myofascial trigger point pain: a systematic review and meta-analysis of randomised controlled trials. European Journal of Pain. Jan;13(1):3-10. 2009.
Wise, David and Rodney Anderson. A Headache in the Pelvis: A new understanding and treatment for chronic pelvic pain syndromes. Sixth Edition. National Center for Pelvic Pain Research. Occidental CA. 2011.